The nutritional characteristics and experiences of survivors of critical illness after hospital discharge: A multi-method narrative review

IF 2.6 Q3 NUTRITION & DIETETICS Clinical nutrition ESPEN Pub Date : 2025-04-03 DOI:10.1016/j.clnesp.2025.03.171

Josephine M. Dudzik , Ethan K. Balk , Andrea L. Deierlein

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Abstract

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.

Methods

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.

Results

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.

Conclusions

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.

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危重病人出院后的营养特征与经验：多方法叙事回顾。

背景与目的：许多危重疾病的幸存者经历长期的功能、认知和心理障碍，即重症监护后综合征（PICS）。然而，重症监护病房（ICU）幸存者出院后的营养恢复经验仍未得到充分认识和了解。本综述的目的是描述危重疾病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经验。方法：检索2024年6月至8月PubMed、CINAHL Complete和Scopus电子数据库中符合条件的定量和定性研究。摘要和全文根据预先确定的纳入和排除标准进行筛选。本综述纳入了对出院后危重疾病成年幸存者的人体测量、营养和/或经验数据进行分析的初步研究。结果：共纳入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增加很小或适度。平均卡路里（18-33.5卡路里/公斤/天）和蛋白质（0.96-1.6克/公斤/天）摄入量在很大程度上不能满足促进康复所需的要求，导致营养不良率很高，出院后3个月的营养不良率为16.8-63%。在出院后，由于严重疾病造成的持续身体和功能限制，在营养恢复方面面临着许多障碍。正在进行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果，但仍未得到充分利用。改善此类服务的可得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。结论：出院后，许多危重疾病幸存者面临许多营养恢复障碍，导致长期营养并发症。未来的研究工作应针对营养特征、营养变量与PICS之间的关系，以及确定和发展有效的营养干预措施，以改善重症患者出院后的长期预后。

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来源期刊

Clinical nutrition ESPEN NUTRITION & DIETETICS-

CiteScore

4.90

自引率

3.30%

发文量

512

期刊介绍： Clinical Nutrition ESPEN is an electronic-only journal and is an official publication of the European Society for Clinical Nutrition and Metabolism (ESPEN). Nutrition and nutritional care have gained wide clinical and scientific interest during the past decades. The increasing knowledge of metabolic disturbances and nutritional assessment in chronic and acute diseases has stimulated rapid advances in design, development and clinical application of nutritional support. The aims of ESPEN are to encourage the rapid diffusion of knowledge and its application in the field of clinical nutrition and metabolism. Published bimonthly, Clinical Nutrition ESPEN focuses on publishing articles on the relationship between nutrition and disease in the setting of basic science and clinical practice. Clinical Nutrition ESPEN is available to all members of ESPEN and to all subscribers of Clinical Nutrition.