MATERIALS AND METHODS: We carried out this systematic review based on the instructions of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Ethical agreement was not necessary as main data have not been collected. During March 2022, we searched the main English databases, for example, Google Scholar, Web of Sciences, EMBASE, EBSCO, ScienceDirect, Scopus, and PubMed/MEDLINE, with limitation to human clinical trials. For this study, no time limit was applied for the publication of articles.

RESULTS: Out of 1380 papers, 52 papers up to March 2022 were eligible for review in this systematic review. Based on the obtained results, the most widely used medicinal plants for aromatherapy in patients with cardiovascular diseases were Lavandula angustifolia (lavender, 55.7%), Rosa damascena (Damask rose, 11.5%), and Mentha piperita (peppermint, 5.8%), respectively. Most studies have been performed on the effect of aromatherapy on coronary angiography (21 papers, 40.4%), followed by artery bypass graft surgery (14 studies, 26.9%), and cardiac patients (5 studies, 9.6%). Most studies on the effect of aromatherapy in cardiovascular diseases were performed on anxiety (31 papers, 59.6%), sleep quality (8 studies, 15.4%), and hemodynamic parameters (6 studies, 11.5%), respectively.

METHODS: In this multicenter randomized trial, critically ill patients will be randomized to receive supplemental enteral protein (1.2 g/kg/day) added to standard enteral nutrition to achieve a high amount of enteral protein (range of 2-2.4 g/kg/day) or no supplemental enteral protein to achieve a moderate amount of enteral protein (0.8-1.2 g/kg/day). The primary outcome is 90-day all-cause mortality; other outcomes include functional and health-related quality-of-life assessments at 90 days. The study sample size of 2502 patients will have 80% power to detect a 5% absolute risk reduction in 90-day mortality from 30 to 25%. Consistent with international guidelines, this statistical analysis plan specifies the methods for evaluating primary and secondary outcomes and subgroups. Applying this statistical analysis plan to the REPLENISH trial will facilitate unbiased analyses of clinical data.

CONCLUSION: Ethics approval was obtained from the institutional review board, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia (RC19/414/R). Approvals were also obtained from the institutional review boards of each participating institution. Our findings will be disseminated in an international peer-reviewed journal and presented at relevant conferences and meetings.