197 DISCUSSION AND FUTURE PERSPECTIVES 9 criteria for full physical recovery. Moreover, impaired recovery was associated with higher dependency on medical professionals, as patients required homecare more often and had more healthcare visits throughout the year. Finally, although a third of all patients worked less hours than before ICU-admission after 12-months, only 14% of patients with limited recovery were participating in any work-related activities at this timepoint, indicating that the majority of these patients are unable to retake their place in society and strengthening the call for more adequate aftercare support during rehabilitation. MALNUTRITION AND FRAILTY IN ICU-PATIENTS It is commonly known that (p)rehabilitation of patients starts as soon as someone is admitted to the ICU or, in case of a planned admission, already after the preoperative screening. In an ideal world, all ICU-patients would be assessed for frailty before admission. However, this is often not feasible in the acute setting, making adequate predictions of outcome and recovery problematic. Although the use of common markers of severity of illness, like the APACHE- scoring system, has made it possible to evaluate treatment strategies and their impact on short-term mortality, they may not be sufficient in providing information regarding the long-term recovery potential of the patient.12 Adequate assessment of the patient’s premorbid status can provide valuable insights in their ability to achieve a meaningful recovery. To illustrate, malnutrition and frailty pre-ICU have been linked to the chance of survival and may provide professionals with valuable information regarding the ability of the patient to recover after discharge.13,14 One promising method to assess baseline physical health and nutritional status in the acute setting is the use of bioelectrical impedance analysis (BIA). In Chapter 5 the predictive value of the BIA-derived phase angle on long-term survival is discussed. In this large cohort, a phase angle below 4.6 was associated with a 1.85x risk for mortality in the first year of recovery, independent of severity of illness during ICU-stay. Investigating the predictive value of phase angle for patient-reported outcomes, like HRQoL, may provide additional information on rehabilitation potential. Although phase angle does not provide a full picture of the patient’s pre- admission frailty and nutritional status, it is easy to use and may be a valuable addition to the baseline frailty assessment of ICU-patients. While screening for pre-admission frailty is valuable in identifying patients at risk of non-recovery at baseline, malnutrition during and after ICU-stay may play an equally important role in how patients recover over time. It is commonly
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