198 CHAPTER 9 known that providing adequate nutritional support combined with early mobilisation can reduce muscle loss during critical illness.15,16 However, reaching nutritional targets during and after ICU-stay in particular, can be difficult.17 Furthermore, there is very limited evidence on dietary intake in the post-hospital period of ICU-survivors. Chapter 6 therefore elaborates on findings of an extensive follow-up study regarding nutritional intake during ICU-stay and the first year after hospital discharge. In this study, the majority of patients did not achieve protein adequacy (1.2 g/kg/d) throughout ICU-stay and the first year of recovery. Specifically, patients relying solely on oral intake without supplementation were at risk for a very low protein intake. Only a small proportion of patients visited a registered dietician or speech and language therapist during the year, whilst taste and swallowing issues were reported in up to 28% and 16% throughout the year, respectively. However, supplementary feeding was found to increase protein and energy intake in the first year of recovery and both visits to a registered dietician as the use of supplements was positively correlated with increased protein intake. These findings confirm that dietary intake in ICU-survivors is insufficient and support is lacking. More structured and personalised nutritional care involving specialised paramedics throughout the patient journey is urgently needed. Improving recovery after critical illness One of the main goals of improving nutritional status, combined with (early) mobilisation during and after ICU-stay, is to attenuate muscle wasting and other harmful mechanisms associated with prolonged critical illness and ICUadmission.16,18 Despite a growing amount of research on protein provision and exercise therapy, clear evidence is lacking. The heterogeneity of the patient group, barriers limiting adherence to dietary and/or exercise protocols, and metabolic alterations, among others, may limit the potential benefits of these interventions.17,19,20 Nevertheless, it is likely that these aspects play an important role in why some patients recover and others don’t. To assess the effect of protein provision alone, or combined with exercise therapy, Chapter 7 provides an extensive systematic review of the literature on this subject. Out of almost 5000 potentially relevant records, 15 articles were found suitable for data extraction. Some evidence was found for the beneficial effect of protein and/or exercise interventions on patient-reported outcomes, like muscle health and independency in activities of daily living. However, sound evidence remains lacking due to heterogeneity and lack of high-quality studies. One remarkable finding in this review is that protein targets (according to predefined standard
RkJQdWJsaXNoZXIy MjY0ODMw