Dudzik Josephine M, Balk Ethan K, Deierlein Andrea L
New York University, Steinhardt School of Culture, Education, and Human Development, Department of Nutrition and Food Studies, 411 Lafayette St, 5th Floor, New York, NY 10003, USA.
New York University, School of Global Public Health, 708 Broadway, New York, NY 10003, USA.
Clin Nutr ESPEN. 2025 Jun;67:612-625. doi: 10.1016/j.clnesp.2025.03.171. Epub 2025 Apr 3.
BACKGROUND & AIMS: Many survivors of critical illness experience long-term functional, cognitive, and psychological impairments known as post-intensive care syndrome (PICS). Yet, the nutritional recovery experiences of intensive care unit (ICU) survivors after hospital discharge remain underrecognized and poorly understood. The objective of this review was to characterize nutritional indices and nutrition-related outcomes in survivors of critical illness, and to understand the nutritional recovery experience after hospital discharge.
Searches were conducted for eligible quantitative and qualitative studies between June and August 2024 using PubMed, CINAHL Complete, and Scopus electronic databases. Abstracts and full texts were screened against predetermined inclusion and exclusion criteria. Primary research analyzing anthropometric, nutritional, and/or experiential data of adult survivors of critical illness after hospital discharge were included in this review.
21 quantitative (n = 3054) and 7 qualitative (n = 162) studies were included. After hospital discharge, ICU survivors seldom returned to their baseline weight with many having small to modest weight gains in the first months of recovery. Average calorie (18-33.5 calories/kilogram/day) and protein (0.96-1.6 g/kg/day) intakes largely did not meet requirements needed to facilitate recovery, resulting in high rates of malnutrition, ranging from 16.8 to 63 % 3 months after discharge. A multitude of barriers to nutritional recovery were faced in the post-discharge period resulting from persistent physical and functional limitations due to critical illness. Ongoing individualized nutrition monitoring and follow-up from dietetic professionals knowledgeable in post-ICU care has the potential to improve nutrition-related outcomes for survivors yet remains underutilized. Improving the availability and affordability of such services is a key facilitator to improve the nutritional recovery experience for ICU survivors.
After hospital discharge, many survivors of critical illness face numerous barriers to nutritional recovery resulting in long-term nutritional complications. Future research efforts should target nutritional characterization, associations between nutritional variables and PICS, and the identification and development of effective nutrition interventions to improve long-term outcomes for survivors of critical illness after hospital discharge.
许多危重症幸存者会经历长期的功能、认知和心理障碍，即所谓的重症监护后综合征（PICS）。然而，重症监护病房（ICU）幸存者出院后的营养恢复情况仍未得到充分认识和理解。本综述的目的是描述危重症幸存者的营养指标和营养相关结局，并了解出院后的营养恢复情况。
于2024年6月至8月期间，使用PubMed、CINAHL Complete和Scopus电子数据库检索符合条件的定量和定性研究。根据预先设定的纳入和排除标准筛选摘要和全文。本综述纳入了分析成年危重症幸存者出院后人体测量、营养和/或经验数据的原发性研究。
纳入了21项定量研究（n = 3054）和7项定性研究（n = 162）。出院后，ICU幸存者很少恢复到基线体重，许多人在恢复的头几个月体重有小幅至适度增加。平均热量（18 - 33.5千卡/千克/天）和蛋白质（0.96 - 1.6克/千克/天）摄入量在很大程度上未达到促进恢复所需的要求，导致出院后3个月营养不良发生率较高，范围为16.8%至63%。出院后阶段，由于危重症导致的持续身体和功能限制，营养恢复面临诸多障碍。由了解ICU后护理的饮食专业人员进行持续的个性化营养监测和随访，有可能改善幸存者的营养相关结局，但目前仍未得到充分利用。提高此类服务的可及性和可负担性是改善ICU幸存者营养恢复体验的关键促进因素。
出院后，许多危重症幸存者面临营养恢复的诸多障碍，导致长期营养并发症。未来的研究应针对营养特征、营养变量与PICS之间的关联，以及识别和开发有效的营养干预措施，以改善危重症幸存者出院后的长期结局。
