93 PROTEIN AND ENERGY INTAKE DURING ICU-RECOVERY 6 6.1 INTRODUCTION Advances in intensive care medicine in the past decades have resulted in increased survival rates.1 Still, many survivors of critical illness suffer from long-termhealth deficits and a reduced quality of life.2–4 These health problems are described as the Post-Intensive Care Syndrome (PICS) and can have various consequences, including increased healthcare utilisation and reduced societal participation.5–7 Recovery after critical illness, especially in patients with a prolonged ICU-stay, can be tedious or even fail to occur. The consequences of critical illness include, but are not limited to, severe catabolism, loss of muscle mass and function, overall weakness, and multiple organ dysfunction.8,9 To illustrate, a recent 5-year follow-up of 433 ICU-survivors observed that more than a third of patients experienced abnormal aerobic exercise capacity and reduced physical functioning compared to a healthy sedentary control population.10 A key element that may limit the recovery potential of ICU-patients during and after ICU-admission is nutritional status. Previous research has indicated that a significant proportion of ICU-patients is malnourished (38-78%) or physically frail (30%).11,12 Patients with impaired nutritional status at ICU-admission -as for instance approximated by a low bioimpedance analysis (BIA)-derived phase angle- have a higher risk of one year mortality.13 However, muscle loss associated with ICU-admission may be reduced by providing adequate nutritional support during ICU-stay when combined with early mobilisation.14,15 To achieve this, protein adequacy during and after ICU in particular may be essential in reducing catabolism in critical illness survivors.16 There are several opinion papers and reviews focusing on nutritional strategies post-ICU -with varying protein targets for the recovery phase ranging from 1.2 to 2.5 g/kg/day, but robust data regarding dietary intake post-ICU and recovery outcomes is lacking.17,18 Therefore, we performed a prospective observational 1-year follow-up study in ICU-patients with a length of stay of at least 48-hours from the Medical Centre Leeuwarden, in Fryslân, The Netherlands. The aim of this study was, first, to assess energy and protein intake during ICU-stay and during the first year of recovery. Second, we investigated the role of nutritional support in protein and energy intake during ICU-stay and after discharge. Third, the relation between protein intake, intake barriers, paramedic support, and long-term outcomes was explored.
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