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Review
. 2017 Aug 26;21(1):226.
doi: 10.1186/s13054-017-1810-2.

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

Danielle E Bear  1   2   3   4   5 , Liesl Wandrag  6   7 , Judith L Merriweather  8 , Bronwen Connolly  9   10   11   12 , Nicholas Hart  13   9   10 , Michael P W Grocott  14   15   16 ; Enhanced Recovery After Critical Illness Programme Group (ERACIP) investigators
Affiliations
Review

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

Danielle E Bear et al. Crit Care. .

Abstract

The lack of benefit from randomised controlled trials has resulted in significant controversy regarding the role of nutrition during critical illness in terms of long-term recovery and outcome. Although methodological caveats with a 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 specifically on recent clinical trials and evaluates the impact of nutrition during critical illness on long-term physical and functional recovery.Specific focus on the trial design and methodological limitations has been considered in detail. Limitations include delivery of caloric and protein targets, patient heterogeneity, short duration of intervention, inappropriate clinical outcomes and a disregard for baseline nutritional status and nutritional intake in the post-ICU period.With survivorship at the forefront of critical care research, it is imperative that nutrition studies carefully consider biological mechanisms and trial design because these factors can strongly influence outcomes, in particular long-term physical and functional outcome. Failure to do so may lead to inconclusive clinical trials and consequent rejection of the potentially beneficial effects of nutrition interventions during critical illness.

Keywords: Critical illness; Energy; Nutrition; Physical recovery; Protein.

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Conflict of interest statement

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

DEB has received speaker fees and conference attendance support from Nutricia, Baxter, BBraun and Fresenius Kabi, and grant support through her institution from Corpak MedSystems UK. MPWG serves on the medical advisory board of Sphere Medical Ltd (UK) and is a director of Oxygen Control Systems Ltd (UK), and has received honoraria for speaking and/or travel expenses from Edwards Lifescience, Fresenius-Kabi, BOC Medical (Linde Group), Ely-Lilly Critical Care (2008) and Cortex GmBH. The remaining authors declare that they have no competing interests.

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