Personalized protein delivery in critical care: from phenotyping and endotyping to post-ICU recovery

PURPOSE OF REVIEW: This review examines the importance of optimizing protein delivery during and in the convalescence of critical illness, with a focus on the challenges associated with individual protein dosing strategies. RECENT FINDINGS: Muscle mass depletion often begins within the first days of intensive care unit (ICU) admission, emphasizing the need for adequate protein intake. However, many ICU patients fail to meet recommended targets. Large-scale studies have shown mixed results on high-protein intake, with some suggesting no added benefit or even harm in certain groups. This review highlights the need for individualized protein dosing guided by phenotyping and endotyping and discusses the challenges in assessing body composition, illustrated by a case study. The potential role of biomarkers in optimizing protein dosing is also explored, alongside factors that hinder adequate protein intake. SUMMARY: Further research is needed to determine the optimal protein strategy for critically ill patients, with a focus on enhancing functional outcomes and quality of life, particularly for survivors who face long-term physical and cognitive challenges. Future guidelines should incorporate individualized approaches, leveraging emerging technologies and patient-centred data to tailor protein delivery and enhance recovery outcomes.