Critical Illness, ICU Acquired Weakness, Malnutrition
Conditions
Keywords
Early nutrition therapy, Early mobilisation, Long stay ICU patient, Physiotherapy
Brief summary
Due to medical advances and quality of care, mortality in adult intensive care units (ICUs) has decreased significantly in recent years, leading to a significant increase in the number of patients with high rehabilitation needs on discharge from the ICU. A specific management by a multidisciplinary team has been set up since 2017 at the Geneva-ICU for long-stay patients (hospitalised ≥ 7 days). This study aim to assess whether an optimization of the nutritional therapy coupled with an early mobility during and after the ICU stay allows an improvement in the muscle function at hospital discharge compared to patients receiving the standard care.
Detailed description
Due to medical advances and quality of care, mortality in adult intensive care units (ICUs) has decreased significantly in recent years, leading to a significant increase in the number of patients with high rehabilitation needs on discharge from the ICU. Indeed, these patients are at high risk of complications related to their ICU stay (cognitive impairment, ICU acquired weakness, diaphragm dysfunction, ICU polyneuropathy, post-traumatic stress, malnutrition, etc.). Despite prolonged periods of rehabilitation, there is a significant decrease in functional status and quality of life compared to the previous status of these patient. A specific management by a multidisciplinary team has been set up since 2017 at the Geneva-ICU for long-stay patients (hospitalised ≥ 7 days) including special attention to weaning from ventilation, nutrition, mobilisation, anxiety, pain, skin condition etc. The culture of nutritional therapy and early mobilisation is already well established at the Geneva-ICU. However, a comprehensive approach to nutrition and mobilisation during and after the ICU stay could be optimised. The objective of the study is to determine whether optimization of nutritional therapy combined with early mobilization for patients with long ICU stay will improve muscle function at discharge compared with patients receiving standard care.
Interventions
OTHEROptimisation of nutrition therapy coupled with early mobilisation
Optimisation of nutrition therapy coupled with early mobilisation with: * Optimisation of nutrition therapy during ICU stay * Optimisation of physiotherapy during ICU stay * Better communication and closer collaboration between physiotherapy and nutrition teams. * Optimisation of continuity of the care.
OTHERStandard care
Patients will receive nutritional therapy and mobilisation according to local standard procedures.
Sponsors
HEIDEGGER CP
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Randomized controlled trial
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Any patient admitted to the adult ICU : * ≥18 years old * On mechanical ventilation with an expected length of stay ≥ 7 days * Requiring artificial nutrition (enteral and/or parenteral nutrition)
Exclusion criteria
Therapeutic withdrawal Pregnant or breastfeeding patients Neurological disorders with motor deficits: * New or pre-existing neuromuscular or nervous system disease * Spinal cord injury Severe polytrauma of the lower limbs (amputation etc.) Non-independent ambulation (including walking aids) before ICU admission For organizational reasons not allowing follow-up : * Transfer to another ICU * Patient living abroad from Switzerland * Patient living in nursing homes preceding to ICU admission * Incarcerated patients * Intellectual/cognitive disabilities or language barrier, limiting ability to follow the instructions
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Walking distance | Hospital discharge or end of the intervention (4 weeks after ICU discharge) | 6 MWT |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Body composition | At ICU discharge; at hospital discharge or end of the intervention; at 6 months post-ICU stay | Electrical bio impedance |
| Grip Strength | At ICU discharge; at hospital discharge or end of the intervention; at 6 months post-ICU stay | Handgrip |
| Gradation of muscle function | At ICU discharge; at hospital discharge or end of the intervention; at 6 months post-ICU stay | MRC |
| Physical functionality | At ICU discharge; at hospital discharge or end of the intervention; at 6 months post-ICU stay | PFIT & SPPB |
| Weight difference | At ICU admission, at ICU discharge; at hospital discharge or end of the intervention; at 6 months post-ICU stay | Comparison between weight at ICU admission, at hospital discharge and at 6 months post-ICU stay |
| Walking distance | At ICU discharge (if achievable); 6 months post-ICU stay | 6 MWT |
| Food intake estimation | At 6 months post-ICU stay | 3 days food diary |
| Quality of life (SF-12) | At 6 months post-ICU stay | SF-12 |
| Return to work/activity preceding to the event | At 6 months post-ICU stay | Collected during the 6 month post-ICU stay consultation |
| Length of ICU and hospital stay | At ICU and hospital discharge | Collected in the patient form |
| Duration of mechanical ventilation | At ICU discharge | Collected in the patient form |
| Appetite | At ICU discharge; at hospital discharge or end of the intervention; at 6 months post-ICU stay | 10-point survey scale |
Countries
Switzerland
Contacts
Primary ContactClaudia Heidegger, MD
Backup ContactAude de Watteville, Bsc
Outcome results
None listed