The role of nutritional support in the physical and functional recovery of critically ill patients: a narrative review

Abstract

There is ongoing debate about the role of nutrition during critical illness in terms of long-term outcomes. Even taking into account the inability to adequately assess all biological mechanisms associated with nutrition, it should be recognized that the available randomized trials, nutritional support during the early phase of critical illness, when considered in isolation from other treatment, may have very limited long-term functional value. This review focuses on recent clinical studies and evaluating the impact of critical nutrition on long-term physical and functional recovery.
 Critical survival is becoming an increasingly important subject of attention. Future research on nutritional support should consider specific factors that can provide measurable benefits in terms of both physical and functional recovery. These factors include the development of strategies to ensure adequate nutritional interventions, the provision of nutrition for a period of time in which biologically it is possible to observe differences in the results assessed, and the selection of appropriate methods of assessing the results recorded at clinically significant time points. One of these results is an assessment of muscle mass and function, as well as quality of life. In addition, selection of patients who are most likely to benefit from nutritional interventions and nutritional research after transfer from ICU deserves special attention.

Relationship Between Nutrition Intake and Outcome After Subarachnoid Hemorrhage: Results From the International Nutritional Survey

“…[42][43][44][45] Early initiation of enteral nutrition is encouraged to support maintenance of gut integrity, modulation of the stress and immune response and attenuation of disease severity, which may, in turn, improve overall outcome, especially related to short term motor weakness and long term physical recovery. 34 An encouraging finding from this survey was the average time to initiation of enteral nutrition was <36 hours from time of ICU admission, consistent with current guidelines, and similar to times previously reported for the entire cohort in this survey. 15 Despite starting enteral nutrition early, the most common initial order was to start at a low rate and slowly increase to goal rate over a period 24 hours.…”

“…33 Focusing on physical recovery is likely the most pertinent endpoint to determine the efficacy of nutritional therapies, especially those targeting protein intake. 34 Physical activity after SAH is underreported, though there is data to indicate that long term impaired physical recovery is common, directly relates to muscle weakness, contributes to persistent fatigue and has a significant impact on overall outcome. [35][36][37][38][39] Inadequate protein intake, resulting in protein energy catabolism, has a direct impact on muscle health and subsequent physical recovery.…”

Nutrition in postacute rehabilitation of COVID-19 survivors

“…This is not unsurprising given that this is a novel disease and little has been known about the disease progression and impact on nutritional status until recently. Additionally, a similar research gap relating to nutritional interventions in general ICU survivors has previously been identified [24].…”

Performance of NUTRIC score to predict 28-day mortality in critically ill patients after replacing APACHE II with SAPS 3

“…Nevertheless, Toledo et al demonstrated similar findings in a younger population (mean age of 63) [21]. Finally, functional and health-related quality of life measures would be one of the most relevant outcomes in nutrition studies, but usually are secondary outcomes in large randomized controlled trials [30]. We do not have this information in our database, but we acknowledge the importance of this outcome for future studies in critical care nutrition, since like our study the other published validation cohorts of NUTRIC Score applied mortality as the primary outcome.…”