Nutritional Rehabilitation After Prolonged Critical Illness: The Year After the Intensive Care Unit
DOI:
https://doi.org/10.5281/zenodo.22303817Keywords:
Critical illness, Muscle wasting, Protein delivery, Rehabilitation, Post-intensive careAbstract
Muscle loss during critical illness is rapid, large and well characterised. In 63 patients studied prospectively from admission,
rectus femoris cross-sectional area fell 17.7 per cent by day 10, and in the subset examined by all three methods the ratio of
protein to DNA fell 29.5 per cent by day 7. Loss was concentrated in those with multiorgan failure, 15.7 per cent by day 7 against
3.0 per cent with single organ failure. The inference that more protein should therefore be given has been tested. In 1,301
mechanically ventilated patients randomised to at least 2.2 g/kg per day or no more than 1.2, time to discharge alive gave a
hazard ratio of 0.91 (95% CI 0.77 to 1.07) and 60-day mortality a risk ratio of 1.08 (0.92 to 1.26). Among those with acute kidney
injury the higher dose was associated with slower discharge, hazard ratio 0.50 (0.40 to 0.80), and higher mortality, 1.40 (1.10 to
1.80). A Bayesian re-analysis put the probability of harm on the primary outcome at 92 per cent. The year after the unit, which is
where recovery actually happens, has almost no trial evidence at all.
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