The journey towards recovery after intensive care

the_journey_towards_recovery

One of the key, new challenges for healthcare professionals within both hospital and community settings is how to manage COVID-19 patients who are being discharged from ICU after stays of up to 2 weeks, sometimes longer (compared with a previous, pre-COVID-19 average of 2-3 days),1,2 this presents new and challenging health issues to manage. 

Muscle wasting is the most common complication of critical illness, occurring in up to 50% of patients, and is associated with functional disability3

Studies have shown that patients can lose up to 1kg of muscle (‘lean body mass’ vs body fat) for every day in ICU.4 This loss of strength can have a negative impact on both their ability to fight other infections, as well as lengthening the recovery process.5,6 This can lead to patients needing more care and support when they return home.



The power of nutrition 

Patients admitted to ICU may have already benefitted from nutitional support to help reduce muscle loss and maintain their nutritional status.7

Medical nutrition that is high in protein and energy is particularly important for maintaining and/or rebuilding muscle and is linked to improved survival rates and a fewer health complications. 5,8-10

“We have to take responsibility for our patients’ outcomes not just in the ICU, but also what happens to them after ICU… because if our patients go home, but can’t walk down the street with the people they love or hold their grandchildren again, then are we creating survivors or are we creating victims?” Professor Paul Wischmeyer, ESPEN 2018

References:

1.Stam HK, Stucki G, Bickenbach J, et al. COVID-19 and post intensive care syndrome: a call for action. J. Rehabil Med. 2020;52(4). 

2.Choon-Huat G, Hoenig H. How should the rehabilitation community prepare for 2019-nCoV?. Archives of Physical Medicine and Rehabilitation 2020, in press. 

3.Puthucheary ZA.  An update on muscle wasting in ICU. SIGNA VITAE. 2017;13(3): 30-31.

4.Puthucheary ZA, Rawal J, McPhail M, et al. Acute skeletal muscle wasting in critical illness. JAMA. 2013; 310:1591-1600.

5.Demling RH. Nutrition, Anabolism, and the Wound Healing Process: An Overview. Journal of Plastic Surgery. 2009;9(e9):65-94.

6.Herridge MS, Cheung AM, Tansey CM, et al. One-Year Outcomes in Survivor of the Acute Respiratory Distress Syndrome. N Engl J Med. 2003;348(8);683-93.

7.McClave SA, Taylor BE, Martindale RG, et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN. 2016;40(2):159–211

8.Weijs PJM, Mogensen KM, Rawd JD, et al. Protein Intake, Nutritional Status and Outcomes in ICU Survivors: A Single Center Cohort Study. J Clin Med. 2019;8(1):E43. 

9.Weijs PJM, Looijaard W, Beishuizen A, et al. Critical Care. 2014;18:701-10.

10.Allingstrup MJ, Esmailzadeh N, Knudsen W, et al. Clinical Nutrition. 2012;31:462-8.

11.Cheung AM, et al. Two-year outcomes, health care use, and costs of survivors of acute respiratory distress syndrome. Am J Respir Crit Care Med. 2006;174(5):538–44.

12.Iwashyna TJ, et al. Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA. 2010;304(16):1787–94.

13.Wischmeyer PE. Are we creating survivors…or victims in critical care? Delivering targeted nutrition to improve outcomes. Curr Opin Crit Care. 2016;22(4):297-84

14.Puthucheary ZA, et al. Acute skeletal muscle wasting in critical illness. JAMA. 2013;310:1591-600.

15.Herridge MS, et al. Functional disability 5 years after acute respiratory distress syndrome. NEJM. 2011; 364(14):1293-304

16.Ridley EJ, et al. What Happens to Nutrition Intake in the Post Intensive Care Unit Hospitalization Period? An Observational Cohort Study in Critically Ill Adults. JPEN. 2019;45(1);88-95

17.Zanten van ARH, et al. Nutrition therapy and critical illness: practical guidance for the ICU, post-ICU, and long-term convalescence phases. Crit Care. 2019; 23:368

18.Merriweather J, et al. Nutritional rehabilitation after ICU - does it happen: a qualitative interview and observational study. J Clin Nurs. 2014;23(5-6)654-62. https://doi.org/10.1111/jocn.12241

19.Peterson SJ, et al. Adequacy of oral intake in critically ill patients 1 week after extubation. J Am Diet Assoc. 2010;110(3):427-33.

20.Desai SV, et al. Long-term complications of critical care. Crit. Care Med. 2011;39(2):371–9

21.Hopkins RO, et al. Instrumental activities of daily living after critical illness: a systematic review. Ann Am Thorac Soc. 2017;14(8):1332-4.