Nutritional Interventions on Physical Functioning for Critically Ill Patients: An Integrative Review

Abstract

Background Poor physical functioning (PF) is a common issue among critically ill patients. It was suggested that reasonable nutrition accelerates PF recovery. However, the details and types of nutritional interventions on the PF of different intensive care unit (ICU) patients at present have not been well analyzed yet. This study aimed to systematically synthesize nutritional interventions on PF in different ICU populations. Methods Whittemore and Knafl’s framework was employed. PubMed, EMBASE, Web of Science, CINAHL Plus with Full Text, and Cochrane Library were searched to obtain studies from January 2010 to September 2020, with a manual search of the included studies’ references. Record screening, data extraction, and quality appraisal were conducted independently by each reviewer before reaching an agreement after discussion. Results Twelve studies were included reporting the effects of early parenteral nutrition, early enteral nutrition, early goal-directed nutrition, early adequate nutrition, higher protein delivery, higher energy delivery, low energy delivery, energy and protein delivery, intermittent enteral feeding on PF like muscle mass, muscle strength, and function. Function was the most common outcome but showed little improvements. Muscle strength outcomes improved the most. The mechanically ventilated were the most popular target ICU population. The commenced time of the interventions is usually within 24 to 48 hours after ICU admission. Conclusion Research on nutritional interventions on critically ill patients’ PF is limited, but most are of a high level of evidence. Few intervention studies specified their evidence basis. Qualitative studies investigating timeframe of initiating feeding, perspectives of the patients’ perspectives and caregivers are warranted to advance research and further discuss this topic.

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“…Слід відмітити, що внутрішньовенне введення вуглеводів, білків та жирів також не викликає підвищення секреторної активності панкреацитів, а у разі введення гідролізату білка виникає ефект їх пригнічення. Однак при внутрішньовенному введенні глюкози у пацієнтів з тяжким перебігом ГП існує ризик виникнення гіперглікемії через резистентність до інсуліну, що спостерігається у хворих з критичними станами [15] . Враховуючи вище зазначене, незважаючи на певні труднощі у забезпеченні доступу для ЕХ, введення харчової суміші в шлунково-кишковий тракт вважається найбільш виправданим.…”

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“…Flaccidity and usually symmetrical weakness are aspects present in CIP, CIM, and CIPNM; a potential differentiation factor may be the null or decreased response to sensitivity to pain, vibration, or temperature in those with CIP, while these functions would be present in CIM [ 35 , 39 ].…”

“…In awake patients, muscle strength can be assessed using the Medical Research Council (MRC) scale, which rates muscle weakness in six muscle groups, giving scores between 0 (no contraction) and 5 (normal force). The CIPNM is defined when the total CRF score is less than 48, having previously ruled out other causes of weakness [ 39 , 40 ].…”

“…The exercise protocols focused on transfers (from the supine to sitting), walking, and cycle ergometry adjacent to the bed [ 37 ]. Zhou et al (2021) mention that malnutrition is the leading cause of "critical illness polyneuropathy", stressing the harmful effects of parenteral nutrition in critically ill patients and supporting early enteral feeding [ 39 ]. McGlory et al report that omega-3 fatty acid supplementation improves skeletal muscle anabolism [ 40 ] and has potent anti-inflammatory properties [ 41 ].…”