Dudrick and colleagues demonstrated that all nutrients necessary for growth could be provided by intravenous feeding. Infusion of hypertonic glucose through a central venous catheter was first described in 1955 and indwelling catheters, hypertonic glucose, protein hydrolysates, and other nutrients were used successfully on a limited clinical basis over the next 10 years. Protein nutrition, provided by intravenous AA infusion, has been used for more than 70 years and it was believed that insufficient intravenous energy provision prevented the efficient use of these AAs. Additional research is urgently needed to address these issues. The identification of a protein target for individual critically ill patients is crucial for outcomes, particularly for specific subpopulations, such as obese and older patients. We describe the methods for assessment of protein status, and outcomes related to protein nutritional support for critically ill patients. We present protein-related nutrition concepts, including adaptation to starvation and stress, anabolic resistance, and potential adverse effects of amino acid provision. We discuss the challenges physicians face in administering the optimal amount of protein and amino acids. Studies identifying optimal dosing for proteins and amino acids are not currently available. In this review, we present the growing scientific evidence showing the importance of protein and amino acid provision in nutritional support and their impact on preservation of muscle mass and patient outcomes. Although the body adapts in some ways to starvation, metabolic stress in patients causes increased protein turnover and loss of lean body mass. Understanding the optimal amount of protein intake during nutritional support is therefore fundamental to appropriate clinical care. However, proteins and amino acids are fundamental to recovery and survival, not only for their ability to preserve active tissue (protein) mass but also for a variety of other functions. Proteins and amino acids are widely considered to be subcomponents in nutritional support.
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