En route to beautiful Prague for the European Society of Clinical Nutrition and Metabolism Congress. Excited to share the results of our TARGET Protein Trial on Tuesday 8:30am and seeing lots of familiar faces. If we haven’t met, come say hi! 👋🏻

Career highlight! Honoured to present @ProteinTarget with @msummo2 at @CritCareReviews in Belfast. You can read all about the trial in JAMA: jamanetwork.com/journals/jam… Or watch the full recording at: criticalcarereviews.com

Great way to end a busy fortnight of conferences!

We used Nutrison Protein Plus in the usual care arm as this was the most common product used in our region. The impact of an even lower protein dose is unclear without trials that explore this, however I would be concerned about the impact of this on muscle mass/function.

3. Lower protein doses (1.2g protein/kg/day) increased to goal over the first 4 days of ICU should be considered. 4. Future work may target the time to ⬆️ protein doses, given the impact of lower protein dose on muscle mass/malnutrition, potentially guided by urea levels.

My interpretation: 1. Short-term early higher dose protein feeding does not impact outcomes in critically ill patients. 2. Caution should be taken particularly for patients with an AKI at baseline.

For sub-groups, there was heterogeneity of treatment effect in those receiving mechanical ventilation (P = 0.02; very low credibility) and those receiving new kidney replacement therapy at baseline (P < .001; moderate credibility).

Blood urea increased from day 1 to 10 from 7.3 to 13.0 in the augmented group to 7.5 to 10.6 in the usual care group.

For the primary outcome, there was no difference in number of days free of the index hospital and alive at day 90: augmented protein: 62 (0-77) vs usual protein: 64 (0- 77) days; median diff -1.97 (95% CI -7.24, 3.30). There were no differences in any secondary outcome.

3397 patients (64% M, ~61y, ~80% IMV, APACHE 19, BMI 27) were recruited with high trial compliance. Mean protein doses (noted this data is for a subset of patients only) were lower than previous trials and with a mean duration of feeding of ~3.5 days.

We conducted a cluster randomised, double-crossover, clinical trial comparing augmented (Nutrison Protein Intense 100g protein/L) versus usual protein (Nutrison Protein Plus 63g/L) delivery in all patients receiving enteral nutrition in ICU. 8 ICUs participated for 12 months.

@ProteinTarget results presented today at #CCR25 and published in @JAMA_current: jamanetwork.com/journals/jam… My takeaways: 🧵

Such a pleasure to present the @ProteinTarget trial at this incredible venue.