RCT

EFFORT Protein

The effect of higher protein dosing in critically ill patients with high nutritional risk

Lancet, 2023 · International pragmatic randomized trial (n=1301)

Clinical question

Does high-dose protein improve discharge alive in high-nutritional-risk mechanically ventilated ICU patients?

Population: Mechanically ventilated, nutritionally high-risk ICU adults
Intervention: >=2.2 g/kg/day protein
Comparator: <=1.2 g/kg/day usual protein
Primary outcome: Time to discharge alive from hospital up to 60 days
Result: No improvement in discharge alive; possible harm signal in AKI and high organ-failure subgroups.

What the trial found

Aggressive high-dose protein did not improve outcomes and may harm selected high-risk patients.

Current guideline position

Important counterweight to older high-protein targets.

Clinical interpretation

Avoid routine very-high early protein dosing, particularly in AKI/high organ failure.

Clinical Context & Relevant Topics (1)

Disease Reference

Critical Illness Nutrition & Metabolism

Phased energy and protein delivery, early enteral nutrition when safe, indirect calorimetry, refeeding prevention, feeding-intolerance troubleshooting, and individualized parenteral nutrition timing.

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