الفهرس 
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Abstract
Acute critical illness is associated with breakdown of muscle proteins. The body in turn acts through synthesis of external proteins by liver, spleen and the bone marrow to compensate for this rapid loss. By time, this leads to immunosuppression and additional delayed wound healing. this also leads to acquired muscle weakness inside ICU and increased overall mortality.
Parenteral nutrition should start as soon as possible to prevent the rapid deterioration of these cases. It should include a balanced diet with all its components especially protein component to alleviate this rapid loss. Some hypothesized that large dose of protein supplements especially during the early period is beneficial in these cases. So, we started to investigate the impact of high vs standard protein dose parenteral nutrition on the overall mortality and additional icu parameters as ICU length of stay and muscle weakness.
Methods:
Sexity acute critical patients who were recently admitted to ICU and need parenteral nutrition were divided into 2 groups; a standard protein group whose nutrition plan includes a 1 gm/kg/day of proteins and a high protein group whose plan includes 2 gm / kg / day proteins.
Results:
We divided the participating patients into 2 groups that were age and sex matched. We also found that BMI was not significantly different between both groups. We found that protein dose was not significantly associated with overall mortality.
In addition, the length of stay of patients inside ICU unit or inside hospital was not significantly different between both groups. Ventilation duration was not significantly different between both groups.
The APACHEII and SOFA score were not significantly different between both groups. In addition, we found that nitrogen balance was more negative among patients with high protein intake compared to the standard one with in the first 3 days. However, this difference was not statistically significant at the end of the follow up period.
On the other hand, we found that the hand grip strength was nearly similar between both groups. However, at the end of the first week of follow up, we found that this difference was statistically significant. HGS was significantly higher among patients with high protein intake compared to the standard group.
Similarly, we found that the forearm thickness, quadriceps muscle thickness and overall muscles were significantly higher among patients with high protein intake compared to the standard one at the end of the first week of follow up period. By three days, this difference was not significantly obvious between both groups.
Conclusion:
Critical illness is considered a life threatening condition that alters muscle metabolism. This is also associated with muscle protein loss which in turn increases the protein requirements for those patients to improve their prognosis. Starting the parenteral nutrition is crucial for those patients. We found that high protein intake was not associated with a decrease in ventilator days, icu length of stay or overall mortality.
APACHE and SOFA score were not also dependent on the dose of protein supplemented in the form of TPN. On the other hand, patients with high protein intake managed to achieve a better hand grip strength at the end of the first week of follow up. In addition, the quadriceps muscle thickness significantly improved with high protein intake.