“Nutrition in critical illness survivors: Why gaining a grip matters”

In this viewpoint, we explore the challenges and opportunities in nutritional therapy for patients in the post-ICU recovery phase. The complexity of metabolic alterations and organ dysfunction in critical illness highlights the need for individualized nutritional strategies. Current approaches to protein and energy dosing remain generalized, indicating a lack of phenotyping and endotyping. The transition from critical illness to recovery is a gradual process, with patients often spending extended periods in hospital wards after ICU discharge. We identify this post-ICU period as a crucial anabolic window for muscle regeneration and rehabilitation. However, there is a lack of clear guidance and strong evidence for nutritional therapy in post-ICU patients. Large studies and RCT's that investigate nutritional adequacy and the necessary follow-up are lacking. We call for dedicated research to develop intelligent approaches to post-ICU nutrition, leveraging new technologies including artificial intelligence, wearables and collaborative tools. Multidisciplinary teams are a key component in the post ICU recovery while the importance of interdisciplinary collaboration in addressing these challenges is clear. The incorporation of economic considerations in developing nutritional care strategies is important, as is the need for smart implementation strategies to improve nutritional care for ICU survivors. Enhanced care for ICU survivors could improve nutrition adequacy and with that decrease the incidence of malnutrition with lower readmissions and infections rates resulting in a lower economic burden. The focus in this article is the post ICU period but the rehabilitation period after discharge should not be overlooked. Finally, we conclude that through these efforts, we can significantly enhance the recovery and outcomes of patients transitioning from critical illness to rehabilitation.