The Role of Nutritional Support in the Physical and Functional Recovery of Critically Ill Patients

A Narrative Review

Danielle E. Bear; Liesl Wandrag; Judith L. Merriweather; Bronwen Connolly; Nicholas Hart; Michael P. W. Grocott

Disclosures

Crit Care. 2017;21(226) 

In This Article

Recovery From Critical Illness

There are few studies investigating nutritional support after the first week of critical illness. However, oral intake has been reported to be inadequate in patients following extubation,[64,65] regardless of the presence of enteral feeding.[65] Failure to meet nutritional targets following the first week of ICU stay and into the post-ICU phase may indeed negatively influence any long-term measurements of skeletal muscle mass and physical or functional ability, and may be a confounder in studies measuring these outcomes in recent clinical trials. In addition, post-ICU studies which have included varying degrees of nutrition intervention have shown conflicting results[73,74] and therefore little is understood about the clinical effectiveness of these interventions in the post-ICU phase However, it is clear that this is a research priority.[75]

Furthermore, the investigation of multi-modal interventions, coupling appropriate nutrition and exercise interventions at specific time points, is warranted given the physiological evidence that increases in muscle mass and improvements in exercise capability are stronger when these interventions are provided in tandem.[15] Indeed, a study investigating the effects of a combined nutrition and exercise intervention in the ICU is due to commence later this year.[76] The outcome of extending the combination of these two interventions in the post-ICU phase should also be investigated.

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