128 CHAPTER 7 7.4 DISCUSSION Overall, this review showed that thus far, protein provision with or without exercise therapy has not proven to be effective among survivors of critical illness. No evidence of a clear difference in QoL, physical functioning, muscle health, and mortality between intervention and comparator groups was seen. In contrast, the effect of enhanced protein provision or combined protein-exercise therapy has shown to improve outcomes in other clinical populations and healthy individuals.63-65 Several reasons could explain why this was not the case in this review. The majority of included RCTs fail to adhere to the minimum protein recommendation for critically ill patients, even when supplemental PN was administered in an attempt to reach protein goals.46,47,50 This was consistent with two previous systematic reviews25,26 and multiple other studies that reported inadequate nutritional support from EN or oral intake during and after ICU-stay.66-70 The amount of recommended protein for critically ill patients is higher than for healthy individuals71: 1.2-2.0g/kg/ day5,39,72 and even 2.0-2.5g/kg/day is proposed after hospital discharge.73 In four included RCTs, the target protein of the comparator group was below the minimum recommendation of 1.2g/kg/day,54,55 or a standard (low protein) EN formula was used.47,57 Additionally, the comparator groups seemed to be less adequately fed compared to the intervention groups. For example, one study showed that the aim of 1.5g/kg/day vs. 1.0g/kg/day, resulted in an 80% (1.2g/kg/ day) and 75% (0.75g/kg/day) adequate protein intake respectively.55 Table 2. Effects of combined protein-exercise therapy on quality of life, physical functioning, and muscle health (mean difference) Study Year Outcome Post-intervention or baseline-difference Timepoint measured Nakamura1 2021 Quality of life (EQ-5D) Post-intervention Hospital discharge Nakamura 2021 Physical functioning: participation Restriction (Barthel Index) Post-intervention Hospital discharge Nakamura 2021 Muscle health (CT FML change, %) Baseline-difference Day 1-10 Abbreviations: CI: confidence interval. EQ-5D: EuroQol 5 Dimension. EQ-5D-5L: 5-level EuroQol 5 Dimension (score range= 1-5). VAS: Visual Analogue Scale (rank of overall health. Score range=0-100). MD: mean difference. n: number of participants. CT: Computed Tomography scan. FML: femoral muscle loss. 1 Unclear how the total EQ-5D score was derived.
RkJQdWJsaXNoZXIy MjY0ODMw