The Effect of Higher Protein Dosing in Critically ill Patients: A Multicentre Registry-based Randomized Trial Purpose To investigate the effects of higher protein dosing (≥2.2 g/kg/d) vs lower protein dosing (≤1.2 g/kg/d) on clinical outcomes in critically ill patients with nutrition ‘risk factors’. Hypothesis A higher delivery of protein/amino acids to nutritionally high-risk critically ill patients will be associated with improved survival and a quicker rate of recovery. Inclusion Criteria Adult patients ≥ 18 years old Nutritionally ‘high-risk’ (have one or more of the following): Low (≤25) or high BMI (≥35) Moderate to severe malnutrition (as defined by local assessments). Frailty (Clinical Frailty Scale ≥5, obtained from proxy) Sarcopenia (SARC-F score ≥4, obtained from proxy) From point of screening, a projected duration of mechanical ventilation >4 days Requiring mechanical ventilation with actual or expected total duration of mechanical ventilation > 48 hours Questions can be directed to the: [ICU Dietitian or Site Investigator], [Name], at [Phone number and/or email] For more information about the EFFORT Trial, visit us on CCN: https://www.criticalcarenutrition.com/ Clinicaltrials.gov NCT03160547