• Danielle E Bear, Liesl Wandrag, Judith L Merriweather, Bronwen Connolly, Nicholas Hart, GrocottMichael P WMPWIntegrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, University of Southampton, Southampton, UK.Respiratory and Critical Care Research Theme, Southampton NIHR Biomedical Research Centre, Southampton, , and Enhanced Recovery After Critical Illness Programme Group (ERACIP) investigators.
• Department of Nutrition and Dietetics, Guy's and St Thomas' NHS Foundation Trust, London, UK. Danielle.Bear@gstt.nhs.uk.
• Crit Care. 2017 Aug 26; 21 (1): 226226.

AbstractThe 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.

15 keywords...

hide…