95 PROTEIN AND ENERGY INTAKE DURING ICU-RECOVERY 6 With approval of the local research ethic committee of the Medical Centre Leeuwarden (METC-number: RTPO 1055), this study was conducted with a deferred consent procedure. If a patient was unable to provide consent during the baseline measurements due to, for example, sedation or delirium, they were asked when clinical evaluation indicated them fit to give an informed response.23 Patients suffering from severe cognitive impairments after awakening, e.g. post-anoxic coma, or those for whom ICU-mortality was inevitable, were therefore not included. 6.2.3 Data collection Datawas collected from the electronic patient data files and frommeasurements during ICU-stay, at study visits and in telephone interviews, both at 3, 6 and 12-months post-ICU (Table 1). Baseline and ICU-characteristics were collected as part of standard care. The clinical frailty scale (CFS, 1-9, higher is worse) was used to assess pre-admission physical frailty.24 Patients with a CFS≥4 were identified as ‘pre-frail’. At the end of the study period, the total number of ICU and hospital-readmissions and one-year mortality rates were retrieved from the electronic patient records. Dietary intake during and post-ICU Dietary intake and feeding routes for the first seven days of ICU-admission were obtained from electronic patient data records. For food consumed out of the patient’s own accord, from now on referred to as oral diet (OD), standard digital food registration lists were used. The registration of enteral (EN), parenteral (PN), or OD was recorded by a specialised ICU-nurse or dietician. Dietary intake in the post-ICU period was obtained by averaging the intake of two 24h recalls of a normal weekday.25 A food processing app of the Dutch nutritional society (de Eetmeter, Voedingscentrum) was used to estimate energy and protein intake.26 Additional information regarding swallowing or taste issues and the use of dietary supplementation was gathered in an unstructured interview. Data about the number of visits to a dietician or a speech & language therapist (SLT) were obtained during the separate research visits. As the follow-up period of this study coincided with the start of the Covid-19 pandemic, which resulted in periods of lockdown and reduced ability to perform research visits in the hospital, some data could not be collected. If possible, a researcher performed a home-visit to secure the data collection when a research visit was not feasible. An overview of the amount of missing
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