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

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Abstract

Randomized controlled trials addressing the role of nutrition during long-term recovery from critical illness, including other outcomes, have not shown clear benefits, leading to significant controversy on the topic. Although methodological caveats with failure to adequately appreciate biological mechanisms may explain these disappointing results, it must be acknowledged that nutritional support during early critical illness, when considered alone, may have limited long-term functional impact.

This narrative review focuses on recent clinical trials, evaluating the impact of nutrition on long-term physical and functional recovery from critical illness, with specific emphasis on the details of trial design and methodological limitations. Such limitations include delivery of caloric and protein targets, patient heterogeneity, short duration of intervention, inappropriate clinical outcomes, and disregard for baseline nutritional status and intake in the post-ICU period. With survival at the forefront of critical care research, it is imperative that nutrition studies carefully consider biological mechanisms and trial design, which strongly influence long-term physical and functional outcomes among others. Failure to do so may lead to inconclusive clinical trials and consequent rejection of the potential benefits of nutrition interventions during critical illness.

This article is the legal Russian-language translation from the original publication of Bear D.E. et al. “The role of nutritional support in the physical and functional recovery of critically ill patients: a narrative review” in Critical Care [2017;21(1):226. doi: 10.1186/s13054-017-1810-2] with the permission of the copyright holders.

About the authors

Danielle E. Bear

Guy’s and St Thomas’ NHS Foundation Trust; King’s College London

Email: cnm@eco-vector.com

Department of Nutrition and Dietetics, Department of Critical Care, Division of Asthma, Allergy, and Lung Biology, National Institute for Health Research (NIHR), Biomedical Research Centre, Lane Fox Clinical Respiratory Physiology Research Centre

United Kingdom, London; London

Liesl Wandrag

Guy’s and St Thomas’ NHS Foundation Trust

Email: cnm@eco-vector.com

Department of Nutrition and Dietetics, Department of Critical Care

United Kingdom, London

Judith L. Merriweather

University of Edinburgh; Royal Infirmary of Edinburgh

Email: cnm@eco-vector.com

Anaesthesia, Critical Care and Pain Medicine

United Kingdom, Edinburgh; Edinburgh

Bronwen Connolly

Guy’s and St Thomas’ NHS Foundation Trust; King’s College London; The University of Melbourne

Author for correspondence.
Email: cnm@eco-vector.com

National Institute for Health Research (NIHR), Biomedical Research Centre, Lane Fox Clinical Respiratory Physiology Research Centre, Centre for Human and Aerospace Physiological Sciences, Department of Physiotherapy

United Kingdom, London; London; Melbourne, VIC, Australia

Nicholas Hart

King’s College London; Guy’s and St Thomas’ NHS Foundation Trust

Email: cnm@eco-vector.com

Division of Asthma, Allergy, and Lung Biology, National Institute for Health Research (NIHR), Biomedical Research Centre, Lane Fox Clinical Respiratory Physiology Research Centre

United Kingdom, London; London

Michael P. W. Grocott

University of Southampton; Southampton NIHR Biomedical Research Centre; University Hospital Southampton NHS Foundation Trust

Email: cnm@eco-vector.com

Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Respiratory and Critical Care Research Theme, Anaesthesia and Critical Care Research Unit

United Kingdom, Southampton; Southampton; Southampton

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