Nutrition therapy and critical illness: practical guidance for the ICU, post-ICU, and long-term convalescence phases

Abstract Background Although mortality due to critical illness has fallen over decades, the number of patients with long-term functional disabilities has increased, leading to impaired quality of life and significant healthcare costs. As an essential part of the multimodal interventions available to improve outcome of critical illness, optimal nutrition therapy should be provided during critical illness, after ICU discharge, and following hospital discharge. Methods This narrative review summarizes the latest scientific insights and guidelines on ICU nutrition delivery. Practical guidance is given to provide optimal nutrition therapy during the three phases of the patient journey. Results Based on recent literature and guidelines, gradual progression to caloric and protein targets during the initial phase of ICU stay is recommended. After this phase, full caloric dose can be provided, preferably based on indirect calorimetry. Phosphate should be monitored to detect refeeding hypophosphatemia, and when occurring, caloric restriction should be instituted. For proteins, at least 1.3 g of proteins/kg/day should be targeted after the initial phase. During the chronic ICU phase, and after ICU discharge, higher protein/caloric targets should be provided preferably combined with exercise. After ICU discharge, achieving protein targets is more difficult than reaching caloric goals, in particular after removal of the feeding tube. After hospital discharge, probably very high-dose protein and calorie feeding for prolonged duration is necessary to optimize the outcome. High-protein oral nutrition supplements are likely essential in this period. Several pharmacological options are available to combine with nutrition therapy to enhance the anabolic response and stimulate muscle protein synthesis. Conclusions During and after ICU care, optimal nutrition therapy is essential to improve the long-term outcome to reduce the likelihood of the patient to becoming a “victim” of critical illness. Frequently, nutrition targets are not achieved in any phase of recovery. Personalized nutrition therapy, while respecting different targets during the phases of the patient journey after critical illness, should be prescribed and monitored.

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Anemia in Critically Ill Patients With Acute Respiratory Distress Syndrome and Posthospitalization Physical Outcomes

Journal of Intensive Care Medicine ◽

10.1177/0885066620913262 ◽

2020 ◽

pp. 088506662091326

Author(s):

Matthew A. Warner ◽

Daryl J. Kor ◽

Ryan D. Frank ◽

Victor D. Dinglas ◽

Pedro Mendez-Tellez ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Critical Illness ◽

Muscle Strength ◽

Respiratory Distress Syndrome ◽

Hospital Discharge ◽

Distress Syndrome ◽

Physical Status ◽

Icu Discharge ◽

Multivariable Regression ◽

Physical Outcomes

Objective: Anemia is common during critical illness and often persists after hospital discharge; however, its potential association with physical outcomes after critical illness is unclear. Our objective was to assess the associations between hemoglobin at intensive care unit (ICU) and hospital discharge with physical status at 3-month follow-up in acute respiratory distress syndrome (ARDS) survivors. Methods: This is a secondary analysis of a multisite prospective cohort study of 195 mechanically ventilated ARDS survivors from 13 ICUs at 4 teaching hospitals in Baltimore, Maryland. Multivariable regression was utilized to assess the relationships between ICU and hospital discharge hemoglobin concentrations with measures of physical status at 3 months, including muscle strength (Medical Research Council sumscore), exercise capacity (6-minute walk distance [6MWD]), and self-reported physical functioning (36-Item Short-Form Health Survey [SF-36v2] Physical Function score and Activities of Daily Living [ADL] dependencies). Results: Median (interquartile range) hemoglobin concentrations at ICU and hospital discharge were 9.5 (8.5-10.7) and 10.0 (9.0-11.2) g/dL, respectively. In multivariable regression analyses, higher ICU discharge hemoglobin concentrations (per 1 g/dL) were associated with greater 3-month 6MWD mean percent of predicted (3.7% [95% confidence interval 0.8%-6.5%]; P = .01) and fewer ADL dependencies (−0.2 [−0.4 to −0.1]; P = .02), but not with percentage of maximal muscle strength (0.7% [−0.9 to 2.3]; P = .37) or SF-36v2 normalized Physical Function scores (0.8 [−0.3 to 1.9]; P = .15). The associations of physical outcomes and hospital discharge hemoglobin concentrations were qualitatively similar, but none were statistically significant. Conclusions: In ARDS survivors, higher hemoglobin concentrations at ICU discharge, but not hospital discharge, were significantly associated with improved exercise capacity and fewer ADL dependencies. Future studies are warranted to further assess these relationships.

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Acute skeletal muscle wasting and dysfunction predict physical disability at hospital discharge in patients with critical illness

Critical Care ◽

10.1186/s13054-020-03355-x ◽

2020 ◽

Vol 24 (1) ◽

Author(s):

Kirby P. Mayer ◽

Melissa L. Thompson Bastin ◽

Ashley A. Montgomery-Yates ◽

Amy M. Pastva ◽

Esther E. Dupont-Versteegden ◽

...

Keyword(s):

Skeletal Muscle ◽

Critical Illness ◽

Physical Function ◽

Hospital Discharge ◽

Muscle Power ◽

Muscle Size ◽

Ultrasound Images ◽

Icu Admission ◽

Percent Change ◽

Icu Discharge

Abstract Background Patients surviving critical illness develop muscle weakness and impairments in physical function; however, the relationship between early skeletal muscle alterations and physical function at hospital discharge remains unclear. The primary purpose of this study was to determine whether changes in muscle size, strength and power assessed in the intensive care unit (ICU) predict physical function at hospital discharge. Methods Study design is a single-center, prospective, observational study in patients admitted to the medicine or cardiothoracic ICU with diagnosis of sepsis or acute respiratory failure. Rectus femoris (RF) and tibialis anterior (TA) muscle ultrasound images were obtained day one of ICU admission, repeated serially and assessed for muscle cross-sectional area (CSA), layer thickness (mT) and echointensity (EI). Muscle strength, as measured by Medical Research Council-sum score, and muscle power (lower-extremity leg press) were assessed prior to ICU discharge. Physical function was assessed with performance on 5-times sit-to-stand (5STS) at hospital discharge. Results Forty-one patients with median age of 61 years (IQR 55–68), 56% male and sequential organ failure assessment score of 8.1 ± 4.8 were enrolled. RF muscle CSA decreased significantly a median percent change of 18.5% from day 1 to 7 (F = 26.6, p = 0.0253). RF EI increased at a mean percent change of 10.5 ± 21% in the first 7 days (F = 3.28, p = 0.081). At hospital discharge 25.7% of patients (9/35) met criteria for ICU-acquired weakness. Change in RF EI in first 7 days of ICU admission and muscle power measured prior to ICU were strong predictors of ICU-AW at hospital discharge (AUC = 0.912). Muscle power at ICU discharge, age and ICU length of stay were predictive of performance on 5STS at hospital discharge. Conclusion ICU-assessed muscle alterations, specifically RF EI and muscle power, are predictors of diagnosis of ICU-AW and physical function assessed by 5x-STS at hospital discharge in patients surviving critical illness.

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A Combined Early Cognitive and Physical Rehabilitation Program for People Who Are Critically Ill: The Activity and Cognitive Therapy in the Intensive Care Unit (ACT-ICU) Trial

Physical Therapy ◽

10.2522/ptj.20110414 ◽

2012 ◽

Vol 92 (12) ◽

pp. 1580-1592 ◽

Cited By ~ 57

Author(s):

Nathan E. Brummel ◽

James C. Jackson ◽

Timothy D. Girard ◽

Pratik P. Pandharipande ◽

Elena Schiro ◽

...

Keyword(s):

Intensive Care ◽

Critical Illness ◽

Hospital Discharge ◽

Critically Ill ◽

Functional Outcomes ◽

Cognitive Rehabilitation ◽

Rehabilitation Program ◽

Physical Rehabilitation ◽

Surgical Intensive Care

Background In the coming years, the number of survivors of critical illness is expected to increase. These survivors frequently develop newly acquired physical and cognitive impairments. Long-term cognitive impairment is common following critical illness and has dramatic effects on patients' abilities to function autonomously. Neuromuscular weakness affects similar proportions of patients and leads to equally profound life alterations. As knowledge of these short-term and long-term consequences of critical illness has come to light, interventions to prevent and rehabilitate these devastating consequences have been sought. Physical rehabilitation has been shown to improve functional outcomes in people who are critically ill, but subsequent studies of physical rehabilitation after hospital discharge have not. Post-hospital discharge cognitive rehabilitation is feasible in survivors of critical illness and is commonly used in people with other forms of acquired brain injury. The feasibility of early cognitive therapy in people who are critically ill remains unknown. Objective The purpose of this novel protocol trial will be to determine the feasibility of early and sustained cognitive rehabilitation paired with physical rehabilitation in patients who are critically ill from medical and surgical intensive care units. Design This is a randomized controlled trial. Setting The setting for this trial will be medical and surgical intensive care units of a large tertiary care referral center. Patients The participants will be patients who are critically ill with respiratory failure or shock. Intervention Patients will be randomized to groups receiving usual care, physical rehabilitation, or cognitive rehabilitation plus physical rehabilitation. Twice-daily cognitive rehabilitation sessions will be performed with patients who are noncomatose and will consist of orientation, memory, and attention exercises (eg, forward and reverse digit spans, matrix puzzles, letter-number sequences, pattern recognition). Daily physical rehabilitation sessions will advance patients from passive range of motion exercises through ambulation. Patients with cognitive or physical impairment at discharge will undergo a 12-week, in-home cognitive rehabilitation program. Measurements A battery of neurocognitive and functional outcomes will be measured 3 and 12 months after hospital discharge. Conclusions If feasible, these interventions will lay the groundwork for a larger, multicenter trial to determine their efficacy.

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Acute skeletal muscle wasting and dysfunction predict physical disability at hospital discharge in patients with critical illness

10.21203/rs.3.rs-57908/v3 ◽

2020 ◽

Author(s):

Kirby P. Mayer ◽

Melissa L. Thompson Bastin ◽

Ashley A. Montgomery-Yates ◽

Amy M. Pastva ◽

Esther E. Dupont-Versteegden ◽

...

Keyword(s):

Skeletal Muscle ◽

Critical Illness ◽

Physical Function ◽

Hospital Discharge ◽

Muscle Power ◽

Muscle Size ◽

Ultrasound Images ◽

Icu Admission ◽

Percent Change ◽

Icu Discharge

Abstract Background: Patients surviving critical illness develop muscle weakness and impairments in physical function, however, the relationship between early skeletal muscle dysfunction and physical function at hospital discharge remains unclear. The primary purpose of this study was to determine if changes in muscle size, strength and power assessed in the intensive care unit (ICU) predict physical function at hospital discharge. Methods: Study design is a single-center, prospective, observational study in patients admitted to the medicine or cardiothoracic ICU with diagnosis of sepsis or acute respiratory failure. Rectus femoris (RF) and tibialis anterior (TA) muscle ultrasound images were obtained day one of ICU admission, repeated serially and assessed for muscle cross-sectional area (CSA), layer thickness (mT), and echointensity (EI). Muscle strength, as measured by Medical Research Council-sum score, and muscle power (lower-extremity leg-press) were assessed prior to ICU discharge. Physical function was assessed with performance on 5-times sit-to-stand (5STS) at hospital discharge. Results: Forty-one patients with median age of 61 years (IQR 55-68), 56% male, and sequential organ failure assessment score of 8.1 ± 4.8 were enrolled. RF muscle CSA decreased significantly a median percent change of 18.5% from day 1 to 7 (F = 26.6, p = 0.0253). RF EI increased at a mean percent change of 10.5 ± 21% in the first 7 days (F = 3.28, p = 0.081). At hospital discharge 25.7% of patients (9/35) met criteria for ICU-acquired weakness. Change in RF EI in first 7 days of ICU admission and muscle power measured prior to ICU were strong predictors of ICU-AW at hospital discharge(AUC = 0.912). Muscle power at ICU discharge, age and ICU length of stay were predictive of performance on 5STS at hospital discharge. Conclusion: ICU-assessed muscle alterations, specifically RF EI and muscle power are predictors of diagnosis of ICU-AW and physical function assessed by 5x-STS at hospital discharge in patients surviving critical illness.

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Acute skeletal muscle wasting and dysfunction predict physical disability at hospital discharge in patients with critical illness

10.21203/rs.3.rs-57908/v4 ◽

2020 ◽

Author(s):

Kirby P. Mayer ◽

Melissa L. Thompson Bastin ◽

Ashley A. Montgomery-Yates ◽

Amy M. Pastva ◽

Esther E. Dupont-Versteegden ◽

...

Keyword(s):

Skeletal Muscle ◽

Critical Illness ◽

Physical Function ◽

Hospital Discharge ◽

Muscle Power ◽

Muscle Size ◽

Ultrasound Images ◽

Icu Admission ◽

Percent Change ◽

Icu Discharge

Abstract Background: Patients surviving critical illness develop muscle weakness and impairments in physical function, however, the relationship between early skeletal muscle alterations and physical function at hospital discharge remains unclear. The primary purpose of this study was to determine if changes in muscle size, strength and power assessed in the intensive care unit (ICU) predict physical function at hospital discharge. Methods: Study design is a single-center, prospective, observational study in patients admitted to the medicine or cardiothoracic ICU with diagnosis of sepsis or acute respiratory failure. Rectus femoris (RF) and tibialis anterior (TA) muscle ultrasound images were obtained day one of ICU admission, repeated serially and assessed for muscle cross-sectional area (CSA), layer thickness (mT), and echointensity (EI). Muscle strength, as measured by Medical Research Council-sum score, and muscle power (lower-extremity leg-press) were assessed prior to ICU discharge. Physical function was assessed with performance on 5-times sit-to-stand (5STS) at hospital discharge.Results: Forty-one patients with median age of 61 years (IQR 55-68), 56% male, and sequential organ failure assessment score of 8.1 ± 4.8 were enrolled. RF muscle CSA decreased significantly a median percent change of 18.5% from day 1 to 7 (F = 26.6, p = 0.0253). RF EI increased at a mean percent change of 10.5 ± 21% in the first 7 days (F = 3.28, p = 0.081). At hospital discharge 25.7% of patients (9/35) met criteria for ICU-acquired weakness. Change in RF EI in first 7 days of ICU admission and muscle power measured prior to ICU were strong predictors of ICU-AW at hospital discharge (AUC = 0.912). Muscle power at ICU discharge, age and ICU length of stay were predictive of performance on 5STS at hospital discharge.Conclusion: ICU-assessed muscle alterations, specifically RF EI and muscle power are predictors of diagnosis of ICU-AW and physical function assessed by 5x-STS at hospital discharge in patients surviving critical illness.

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Enhanced Recovery after Intensive Care (ERIC): study protocol for a German stepped wedge cluster randomised controlled trial to evaluate the effectiveness of a critical care telehealth program on process quality and functional outcomes

BMJ Open ◽

10.1136/bmjopen-2019-036096 ◽

2020 ◽

Vol 10 (9) ◽

pp. e036096 ◽

Cited By ~ 3

Author(s):

Christine Adrion ◽

Bjoern Weiss ◽

Nicolas Paul ◽

Elke Berger ◽

Reinhard Busse ◽

...

Keyword(s):

Critical Care ◽

Intensive Care ◽

Critical Illness ◽

Stepped Wedge ◽

Link Type ◽

Cluster Randomised ◽

Icu Discharge ◽

Randomised Controlled ◽

The Impact

IntroductionSurvival after critical illness has noticeably improved over the last decades due to advances in critical care medicine. Besides, there is an increasing number of elderly patients with chronic diseases being treated in the intensive care unit (ICU). More than half of the survivors of critical illness suffer from medium-term or long-term cognitive, psychological and/or physical impairments after ICU discharge, which is recognised as post-intensive care syndrome (PICS). There are evidence-based and consensus-based quality indicators (QIs) in intensive care medicine, which have a positive influence on patients’ long-term outcomes if adhered to.Methods and analysisThe protocol of a multicentre, pragmatic, stepped wedge cluster randomised controlled, quality improvement trial is presented. During 3 predefined steps, 12 academic hospitals in Berlin and Brandenburg, Germany, are randomly selected to move in a one-way crossover from the control to the intervention condition. After a multifactorial training programme on QIs and clinical outcomes for site personnel, ICUs will receive an adapted, interprofessional protocol for a complex telehealth intervention comprising of daily telemedical rounds at ICU. The targeted sample size is 1431 patients. The primary objective of this trial is to evaluate the effectiveness of the intervention on the adherence to eight QIs daily measured during the patient’s ICU stay, compared with standard of care. Furthermore, the impact on long-term recovery such as PICS-related, patient-centred outcomes including health-related quality of life, mental health, clinical assessments of cognition and physical function, all-cause mortality and cost-effectiveness 3 and 6 months after ICU discharge will be evaluated.Ethics and disseminationThis protocol was approved by the ethics committee of the Charité—Universitätsmedizin, Berlin, Germany (EA1/006/18). The results will be published in a peer-reviewed scientific journal and presented at international conferences. Study findings will also be disseminated via the website (www.eric-projekt.net).Trial registration numberClinicalTrials.gov Registry (NCT03671447).

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Long-term kidney function of patients discharged from hospital after an intensive care admission: observational cohort study

Scientific Reports ◽

10.1038/s41598-021-89454-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ryan W. Haines ◽

Jonah Powell-Tuck ◽

Hugh Leonard ◽

Siobhan Crichton ◽

Marlies Ostermann

Keyword(s):

Critical Care ◽

Critical Illness ◽

Hospital Discharge ◽

Kidney Function ◽

Kidney Injury ◽

Function Recovery ◽

Observational Cohort ◽

Initial Drop

AbstractThe long-term trajectory of kidney function recovery or decline for survivors of critical illness is incompletely understood. Characterising changes in kidney function after critical illness and associated episodes of acute kidney injury (AKI), could inform strategies to monitor and treat new or progressive chronic kidney disease. We assessed changes in estimated glomerular filtration rate (eGFR) and impact of AKI for 1301 critical care survivors with 5291 eGFR measurements (median 3 [IQR 2, 5] per patient) between hospital discharge (2004–2008) and end of 7 years of follow-up. Linear mixed effects models showed initial decline in eGFR over the first 6 months was greatest in patients without AKI (− 9.5%, 95% CI − 11.5% to − 7.4%) and with mild AKI (− 12.3%, CI − 15.1% to − 9.4%) and least in patients with moderate-severe AKI (− 4.3%, CI − 7.0% to − 1.4%). However, compared to patients without AKI, hospital discharge eGFR was lowest for the moderate-severe AKI group (median 61 [37, 96] vs 101 [78, 120] ml/min/1.73m2) and two thirds (66.5%, CI 59.8–72.6% vs 9.2%, CI 6.8–12.4%) had an eGFR of < 60 ml/min/1.73m2 through to 7 years after discharge. Kidney function trajectory after critical care discharge follows a distinctive pattern of initial drop then sustained decline. Regardless of AKI severity, this evidence suggests follow-up should incorporate monitoring of eGFR in the early months after hospital discharge.

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Trajectories of depression in sepsis survivors: an observational cohort study

Critical Care ◽

10.1186/s13054-021-03577-7 ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

Monique Boede ◽

Jochen S. Gensichen ◽

James C. Jackson ◽

Fiene Eißler ◽

Thomas Lehmann ◽

...

Keyword(s):

Chronic Pain ◽

Depressive Symptoms ◽

Depressive Symptom ◽

Critical Illness ◽

Posttraumatic Stress ◽

Symptom Trajectories ◽

Sum Score ◽

Icu Discharge ◽

Sepsis Survivors

Abstract Background Advances in critical care medicine have led to a growing number of critical illness survivors. A considerable part of them suffers from long-term sequelae, also known as post-intensive care syndrome. Among these, depressive symptoms are frequently observed. Depressive symptom trajectories and associated factors of critical illness survivors have rarely been investigated. Study objective was to explore and compare different trajectories of depressive symptoms in sepsis survivors over 1 year after discharge from ICU. Methods Data of a randomized controlled trial on long-term post-sepsis care were analyzed post hoc. Depressive symptoms were collected at 1, 6 and 12 months post-ICU discharge using the Major Depression Inventory (MDI), among others. Statistical analyses comprised descriptive analysis, univariate and multivariate, linear and logistic regression models and Growth Mixture Modeling. Results A total of 224 patients were included into this analysis. We identified three latent classes of depressive symptom trajectories: Over the course of 1 year, 152 patients recovered from mild symptoms, 27 patients showed severe persistent symptoms, and 45 patients recovered from severe symptoms. MDI sum scores significantly differed between the three classes of depressive symptom trajectories at 1 and 6 months after ICU discharge (p < 0.024 and p < 0.001, respectively). Compared with other classes, patients with the mild recovered trajectory showed lower levels of chronic pain (median sum score of 43.3 vs. 60.0/53.3 on the Graded Chronic Pain Scale, p < 0.010) and posttraumatic stress (4.6% with a sum score of ≥ 35 on the Posttraumatic Stress Scale 10 vs. 48.1%/33.3%, p < 0.003); and higher levels of health-related quality of life (HRQOL) using the Short Form-36 scale within 1 month after ICU discharge (p < 0.035). Conclusions In the first year after discharge from ICU, sepsis survivors showed three different trajectories of depressive symptoms. Course and severity of depressive symptoms were associated with chronic pain, posttraumatic stress and reduced HRQOL at discharge from ICU. Regular screening of sepsis survivors on symptoms of depression, chronic pain and posttraumatic stress within 1 year after ICU may be considered. Trial registration ISRCTN, ISRCTN 61744782. Registered April 19, 2011—Retrospectively registered, http://www.isrctn.com/ISRCTN61744782.

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Recovery from Covid-19 critical illness: a secondary analysis of the ISARIC4C CCP-UK cohort study and the RECOVER trial

10.1101/2021.06.15.21258879 ◽

2021 ◽

Author(s):

Ellen E Pauley ◽

Thomas M Drake ◽

David Griffith ◽

Nazir I Lone ◽

Ewen M Harrison ◽

...

Keyword(s):

Critical Illness ◽

Hospital Discharge ◽

Invasive Mechanical Ventilation ◽

Secondary Analysis ◽

Total Sample ◽

Health State ◽

Severe Fatigue ◽

Fatigue Severity

Background We aimed to compare the prevalence and severity of fatigue in survivors of Covid-19 versus non-Covid-19 critical illness, and to explore potential associations between baseline characteristics and worse recovery. Methods We conducted a secondary analysis of two prospectively collected datasets. The population included was 92 patients who received invasive mechanical ventilation (IMV) with Covid-19, and 240 patients who received IMV with non-Covid-19 illness before the pandemic. Follow-up data was collected post-hospital discharge using self-reported questionnaires. The main outcome measures were self-reported fatigue severity and the prevalence of severe fatigue (severity >7/10) 3 and 12-months post-hospital discharge. Results Covid-19 IMV-patients were significantly younger with less prior comorbidity, and more males, than pre-pandemic IMV-patients. At 3-months, the prevalence (38.9% [7/18] vs. 27.1% [51/188]) and severity (median 5.5/10 vs. 5.0/10) of fatigue was similar between the Covid-19 and pre-pandemic populations respectively. At 6-months, the prevalence (10.3% [3/29] vs. 32.5% [54/166]) and severity (median 2.0/10 vs. 5.7/10) of fatigue was less in the Covid-19 cohort. In the Covid-19 population, women under 50 experienced more severe fatigue, breathlessness, and worse overall health state compared to other Covid-19 IMV-patients. There were no significant sex differences in long-term outcomes in the pre-pandemic population. In the total sample of IMV-patients included (i.e. all Covid-19 and pre-pandemic patients), having Covid-19 was significantly associated with less severe fatigue (severity <7/10) after adjusting for age, sex, and prior comorbidity (adjusted OR 0.35 (95%CI 0.15-0.76, p=0.01). Conclusion. Fatigue may be less severe after Covid-19 than after other critical illness.

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Acute Skeletal Muscle Wasting and Dysfunction Predict Physical Disability at Hospital Discharge in Patients With Critical Illness

10.21203/rs.3.rs-57908/v1 ◽

2020 ◽

Author(s):

Kirby P. Mayer ◽

Melissa L. Thompson Bastin ◽

Ashley A. Montgomery-Yates ◽

Amy M. Pastva ◽

Esther E. Dupont-Versteegden ◽

...

Keyword(s):

Skeletal Muscle ◽

Critical Illness ◽

Physical Function ◽

Hospital Discharge ◽

Physical Disability ◽

Muscle Power ◽

Muscle Dysfunction ◽

Icu Admission ◽

Percent Change ◽

Icu Discharge

Abstract Background: Patients surviving critical illness develop muscle weakness and impairments in physical function, however, the relationship between early skeletal muscle dysfunction and physical function at hospital discharge remains unclear. The primary purpose of this study was to determine if changes in muscle size, strength and power assessed in the intensive care unit (ICU) predict physical function at hospital discharge. Methods: Study design is a single-center, prospective, observational study in patients admitted to the medicine or cardiothoracic ICU with diagnosis of sepsis or acute respiratory failure. Rectus femoris (RF) and tibialis anterior (TA) muscle ultrasound images were obtained day one of ICU admission, repeated serially and assessed for muscle cross-sectional area (CSA), layer thickness (mT), and echointensity (EI). Muscle strength, as measured by Medical Research Council-sum score, and muscle power (lower-extremity leg-press) were assessed prior to ICU discharge. Physical function was assessed with performance on 5-times sit-to-stand (5STS) at hospital discharge.Results: Forty-one patients with median age of 61 years (IQR 55-68), 56% male, and sequential organ failure assessment score of 8.1 ± 4.8 were enrolled. RF muscle CSA decreased significantly a median percent change of 18.5% from day 1 to 7 (F = 26.6, p = 0.0253). RF EI increased at a mean percent change of 10.5 ± 21% in the first 7 days (F = 3.28, p = 0.081). At hospital discharge 25.7% of patients (9/35) met criteria for ICU-acquired weakness. Change in RF EI in first 7 days of ICU admission and muscle power measured prior to ICU were strong predictors of ICU-AW at hospital discharge (AUC = 0.912). Muscle power at ICU discharge, age and ICU length of stay were predictive of performance on 5STS at hospital discharge.Conclusion: ICU-assessed muscle dysfunction is a predictor of physical disability at hospital discharge in patients surviving critical illness.

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