The Effect of Higher Protein Dosing in Critically ill Patients: A Multicentre Registry-based Randomized Trial Timelines: Patients are to be screened and randomized within 96 hours of their admission to your ICU. Inclusion Criteria Patients must meet all inclusion criteria to be included in the trial. Adult patients >18 years old 2) Have >1 of the following high nutrition risk factors: 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, projected duration of mechanical ventilation >4 days 3) Expected to be mechanically ventilated for an additional 48 hours from screening

The Effect of Higher Protein Dosing in Critically ill Patients: A Multicentre Registry-based Randomized Trial Exclusion Criteria >96 continuous hours of mechanical ventilation before screening Expected death or withdrawal of life- sustaining treatments within 7 days from screening Pregnant The responsible clinician feels that the patient either needs low or high protein Patient requires parenteral nutrition only and site does not have products to reach the high protein dose group. Randomizing Patients All screened patients that meet all inclusion criteria are entered into REDCap, regardless if they meet exclusion criteria. All data collected for randomized patients are to be entered in REDCap. Contact the Project Leader, [NAME], at [email] if you have any questions.