Early nutrition combined with early exercise in critical patients: what is the current evidence? – an integrative review
DOI:
https://doi.org/10.5281/zenodo.7383334Keywords:
Early Nutrition. Early Exercise. Intensive Care.Abstract
Critical patients have high catabolism related to increased inflammatory cytokines, predominance of catabolic hormones and greater sympathetic response. To reduce the effects generated by ICU admission, early Nutritional Therapy has been recommended as it is associated with a lower risk of infection and hospital stay. Loss of muscle strength is also an important consequence in this patient profile and some findings contribute to inferring that early physical activity in the ICU may be associated with a better clinical outcome. The objective of this work was to review recent literature related to the effects of the combination of early NT associated with early physical activity in critically ill patients. This is an integrative review in which the search was carried out through the databases: MEDLINE, SciELO, BDENF and LILACS, based on the guiding question: ''Early Nutritional Therapy combined with Early Physical Exercise in critically ill patients: what are the current evidence? 319 articles were identified in the extensive search in the databases. These were screened, leaving 5 articles that make up this review. There are findings on the benefit of combining early NT with early physical exercise, however, there are also studies showing no significant difference in this association. It is important to mention that there are methodological limitations in both statements. Despite the theme being broad and well known in the healthy population, adequate early nutritional supply associated with early physical activity within ICUs is still a topic that raises doubts and has conflicts within the scientific community. The need for further studies on this topic is clearly noticeable.
Downloads
References
Hsu CC, Sun CY, Tsai CY, Chen MY, Wang SY, Hsu J te, et al. Metabolism of proteins and amino acids in critical illness: From physiological alterations to relevant clinical practice. Vol. 14, Journal of Multidisciplinary Healthcare. Dove Medical Press Ltd; 2021. p. 1107–17.
Powers J, Samaan K. Malnutrition in the ICU patient population. Vol. 26, Critical Care Nursing Clinics of North America. W.B. Saunders; 2014. p. 227–42.
Silva AP, Maynard K, Cruz M. Effects of motor physical therapy in critically ill patients - literature review. Revista Brasileira Terapia Intensiva . 2010 Feb 22;22(1):85-91.
Van Zanten ARH, de Waele E, Wischmeyer PE. Nutrition therapy and critical illness: Practical guidance for the icu, post-icu, and long-term convalescence phases. Vol. 23, Critical Care. BioMed Central Ltd.; 2019.
Khalid I, Doshi P, DiGiovine B. Early enteral nutrition and outcomes of critically ill patients treated with vasopressors and mechanical ventilation. American Journal of Critical Care. 2010 May;19(3):261–8.
Sundström-Rehal M, Tardif N, Rooyackers O. Can exercise and nutrition stimulate muscle protein gain in the ICU patient? Vol. 22, Current Opinion in Clinical Nutrition and Metabolic Care. Lippincott Williams and Wilkins; 2019. p. 146–51.
Casaer MP. Muscle weakness and nutrition therapy in ICU. Curr Opin Clin Nutr Metab Care. 2015 Mar 13;18(2):162–8.
Hickmann CE, Castanares-Zapatero D, Deldicque L, van den Bergh P, Caty G, Robert A, et al. Impact of very early physical therapy during septic shock on skeletal muscle: A randomized controlled trial. Crit Care Med. 2018;46(9):1436–43.
Arias-Fernández P, Romero-Martin M, Gómez-Salgado J, Fernández-García D. Rehabilitation and early mobilization in the critical patient: systematic review.
Alaparthi GK, Gatty A, Samuel SR, Amaravadi SK. Effectiveness, safety, and barriers to early mobilization in the intensive care unit. Vol. 2020, Critical Care Research and Practice. Hindawi Limited; 2020.
Zhang L, Hu W, Cai Z, Liu J, Wu J, Deng Y, et al. Early mobilization of critically ill patients in the intensive care unit: A systematic review and meta-analysis. PLoS One. 2019 Oct 1;14(10).
Tavares De Souza M, Dias Da Silva M, de Carvalho R. Revisão integrativa: o que é e como fazer Integrative review: what is it? How to do it? Vol. 8. 2010.
Azevedo JRA, Lima HCM, Frota PHDB, Nogueira IROM, de Souza SC, Fernandes EAA, et al. High-protein intake and early exercise in adult intensive care patients: a prospective, randomized controlled trial to evaluate the impact on functional outcomes. BMC Anesthesiol. 2021 Dec 1;21(1).
Nakano H, Naraba H, Hashimoto H, Mochizuki M, Takahashi Y, Sonoo T, et al. Novel protocol combining physical and nutrition therapies, Intensive Goal-directed REhabilitation with Electrical muscle stimulation and Nutrition (IGREEN) care bundle. Crit Care. 2021 Dec 1;25(1).
Zhou W, Yu L, Fan Y, Shi B, Wang X, Chen T, et al. Effect of early mobilization combined with early nutrition on acquired weakness in critically ill patients (EMAS): A dual-center, randomized controlled trial. Wolf SE, editor. PLoS One [Internet]. 2022 May 26 [cited 2022 Sep 3];17(5):e0268599. Available from: https://dx.plos.org/10.1371/journal.pone.0268599
Shields BA, Carpenter JN, Bustillos BD, Jordan AN, Cunningham KB, Vega SJ, et al. The Interplay of Nutrition, Physical Activity, Severity of Illness, and Mortality in Critically Ill Burn Patients: Is There a Connection? Journal of Burn Care and Research. 2019 Oct 16;40(6):936–42.
Kagan I, Cohen J, Bendavid I, Kramer S, Mesilati-Stahy R, Glass Y, et al. Effect of Combined Protein-Enriched Enteral Nutrition and Early Cycle Ergometry in Mechanically Ventilated Critically Ill Patients—A Pilot Study. Nutrients. 2022 Apr 1;14(8).
