Effect of high versus standard protein provision on functional recovery in people with critical illness (PRECISe): an investigator-initiated, double-blinded, multicentre, parallel-group, randomised controlled trial in Belgium and the Netherlands

The Lancet, Journal Year: 2024, Volume and Issue: 404(10453), P. 659 - 669

Published: Aug. 1, 2024

Language: Английский

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Post-intensive care syndrome follow-up system after hospital discharge: a narrative review

Journal of Intensive Care, Journal Year: 2024, Volume and Issue: 12(1)

Published: Jan. 12, 2024

Abstract Background Post-intensive care syndrome (PICS) is the long-lasting impairment of physical functions, cognitive and mental health after intensive care. Although a long-term follow-up essential for successful management PICS, few reviews have summarized evidence efficacy PICS system. Main text The system includes clinic, home visitations, telephone or mail follow-ups, telemedicine. first clinic was established in U.K. 1993 its use spread thereafter. There are currently no consistent findings on clinics. Under recent recommendations, attendance at needs to start within three months hospital discharge. A multidisciplinary team approach important treatment from various aspects impairments, including nutritional status. We classified face-to-face telephone-based assessments recommendations. Recent medications, rehabilitation, nutrition were summarized. Conclusions This narrative review aimed summarize discharge provide comprehensive prevention PICS.

Language: Английский

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The effects of higher versus lower protein delivery in critically ill patients: an updated systematic review and meta-analysis of randomized controlled trials with trial sequential analysis

Critical Care, Journal Year: 2024, Volume and Issue: 28(1)

Published: Jan. 6, 2024

Abstract Background A recent large multicentre trial found no difference in clinical outcomes but identified a possibility of increased mortality rates patients with acute kidney injury (AKI) receiving higher protein. These alarming findings highlighted the urgent need to conduct an updated systematic review and meta-analysis inform practice. Methods From personal files, citation searching, three databases searched up 29-5-2023, we included randomized controlled trials (RCTs) adult critically ill that compared vs lower protein delivery similar energy between groups reported and/or patient-centred outcomes. We conducted random-effect meta-analyses subsequently sequential analyses (TSA) control for type-1 type-2 errors. The main subgroup analysis investigated studies without combined early physical rehabilitation intervention. AKI no/not known was also conducted. Results Twenty-three RCTs ( n = 3303) 1.49 ± 0.48 0.92 0.30 g/kg/d were included. Higher not associated overall (risk ratio [RR]: 0.99, 95% confidence interval [CI] 0.88–1.11; I 2 0%; 21 studies; low certainty) other In small studies, showed trend towards improved self-reported quality-of-life function measurements at day-90 (standardized mean 0.40, CI − 0.04 0.84; 30%). subgroup, significantly (RR 1.42, 1.11–1.82; 3 confirmed by TSA high certainty, number needed harm is 7). serum urea (mean 2.31 mmol/L, 1.64–2.97; 7 studies). Conclusion Higher, delivery, does appear affect general may increase AKI. Further investigation intervention non-AKI warranted. Prospero ID CRD42023441059.

Language: Английский

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Malnutrition in Adults

New England Journal of Medicine, Journal Year: 2024, Volume and Issue: 391(2), P. 155 - 165

Published: July 10, 2024

Language: Английский

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Nutrition in the intensive care unit: from the acute phase to beyond

Intensive Care Medicine, Journal Year: 2024, Volume and Issue: 50(7), P. 1035 - 1048

Published: May 21, 2024

Recent randomized controlled trials (RCTs) have shown no benefit but dose-dependent harm by early full nutritional support in critically ill patients. Lack of may be explained anabolic resistance, suppression cellular repair processes, and aggravation hyperglycemia insulin needs. Also high amino acid doses did not provide benefit, instead associated with patients organ dysfunctions. However, most studies focused on interventions initiated during the first days after intensive care unit admission. Although intervention window some RCTs extended into post-acute phase critical illness, large studied beyond week. Hence, clear evidence-based guidance when how to initiate advance nutrition is lacking. Prolonged underfeeding will come at a price as there validated metabolic monitor that indicates readiness for medical therapy, an adequate response nutrition, which likely varies between micronutrient status cannot assessed reliably, inflammation can cause redistribution, so plasma concentrations are necessarily reflective total body stores. Moreover, individual micronutrients proven beneficial. Accordingly, current evidence provides strategies avoid, ideal regimen remains unclear. In this narrative review, we summarize findings recent studies, discuss possible mechanisms explaining results, point out pitfalls interpretation their effect clinical practice, formulate suggestions future research.

Language: Английский

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Post‐intensive care syndrome: Recent advances and future directions

Acute Medicine & Surgery, Journal Year: 2024, Volume and Issue: 11(1)

Published: Jan. 1, 2024

Post-intensive care syndrome comprises physical, cognitive, and mental impairments in patients treated an intensive unit (ICU). It occurs either during the ICU stay or following discharge is related to patients' long-term prognosis. The same concept also applies pediatric patients, it can greatly affect status of family members. In 10 years since post-intensive was first proposed, research has expanded. Here, we summarize recent evidence on regarding its pathophysiology, epidemiology, assessment, risk factors, prevention, treatments. We highlight new topics, future directions, strategies overcome among people ICU. Clinical basic are still needed elucidate mechanistic insights discover therapeutic targets interventions for syndrome.

Language: Английский

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Nutritional Support in the ICU

BMJ, Journal Year: 2025, Volume and Issue: unknown, P. e077979 - e077979

Published: Jan. 2, 2025

Abstract Critical illness is a complex condition that can have devastating impact on health and quality of life. Nutritional support crucial component critical care aims to maintain or restore nutritional status muscle function. A one-size-fits-all approach the components has not proven beneficial. Recent randomized controlled trials challenge conventional strategy safety potential benefits below-usual calorie protein intakes at early, acute phase illness. Further research needed define optimal throughout intensive unit stay. Individualized strategies relying risk assessment tools biomarkers deserve further investigation in rigorously designed, large, multicenter, randomized, trials. Importantly, although crucial, it might be sufficient enhance recovery critically ill patients. Thus, achieving greatest efficacy may require individualized combined with prolonged physical rehabilitation within multimodal, holistic program patient's journey.

Language: Английский

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Überwachung von Ernährungstherapie und Kalorienzufuhr

AINS - Anästhesiologie · Intensivmedizin · Notfallmedizin · Schmerztherapie, Journal Year: 2025, Volume and Issue: 60(03), P. 142 - 154

Published: March 1, 2025

The Section Metabolism and Nutrition of the German Interdisciplinary Association for Intensive Care Emergency Medicine (DIVI) recently published two position papers specifying some aspects guideline on clinical nutrition critically ill patients by Society Nutritional in 2018. This article provides a condensed overview practice; key these are presented focussing monitoring energy expenditure macronutrient administration.

Language: Английский

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Combining proteins with n-3 PUFAs (EPA + DHA) and their inflammation pro-resolution mediators for preservation of skeletal muscle mass

Critical Care, Journal Year: 2024, Volume and Issue: 28(1)

Published: Feb. 1, 2024

Abstract The optimal feeding strategy for critically ill patients is still debated, but must be adapted to individual patient needs. Critically are at risk of muscle catabolism, leading loss mass and its consequent clinical impacts. Timing introduction protein targets have been explored in recent trials. These suggest that “moderate” provision (maximum 1.2 g/kg/day) best during the initial stages illness. Unresolved inflammation may a key factor driving catabolism. omega-3 (n-3) fatty acids eicosapentaenoic acid (EPA) docosahexaenoic (DHA) substrates synthesis mediators termed specialized pro-resolving or SPMs actively resolve inflammation. There evidence from other settings high-dose oral EPA + DHA increases synthesis, decreases breakdown, maintains mass. responsible some these effects, especially upon breakdown. Given findings, as part medical nutritional therapy seems prevent persistence related anabolic resistance loss.

Language: Английский

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From bedside to recovery: exercise therapy for prevention of post-intensive care syndrome

Journal of Intensive Care, Journal Year: 2024, Volume and Issue: 12(1)

Published: Feb. 29, 2024

Abstract Background As advancements in critical care medicine continue to improve Intensive Care Unit (ICU) survival rates, clinical and research attention is urgently shifting toward improving the quality of survival. Post-Intensive Syndrome (PICS) a complex constellation physical, cognitive, mental dysfunctions that severely impact patients’ lives after hospital discharge. This review provides comprehensive multi-dimensional summary current evidence practice exercise therapy (ET) during an ICU admission prevent manage various domains PICS. The aims elucidate mechanisms effects ET rehabilitation highlight suboptimal functional outcomes patients growing public health concern needs be addressed. Main body commences with brief overview relationship between PICS ET, describing latest on this topic. It subsequently summarises use ICU, wards, post-hospital discharge, illuminating problematic transition these settings. following chapters focus function, detailing multi-faceted biological pathophysiological benefits all three domains. followed by chapter focusing co-interventions how maximise enhance effect outlining practical strategies for optimise effectiveness ET. next describes several emerging technologies have been introduced/suggested augment support provision admission. Lastly, discusses future directions. Conclusion global healthcare concern. guide clinicians, researchers, policymakers, providers utilising as therapeutic preventive measure address problem. An improved understanding gaps addressed will greatly assist clinicians their efforts rehabilitate survivors, helping them return normal

Language: Английский

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