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Quantification of lean and fat tissue repletion following critical illness: a case report.

Reid CL, Murgatroyd PR, Wright A, Menon DK - Crit Care (2008)

Bottom Line: She had successfully regained weight and was back to her pre-illness body weight.Body composition measurements showed that an incredible 73% of the weight gained was due to an increase in body fat.The magnitude of body composition changes in the present patient are startling and support the need for longitudinal body composition data in a wider ICU population.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Anaesthesia, University of Cambridge, Box 93, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK. clr42@cam.ac.uk

ABSTRACT

Introduction: Muscle wasting is a recognised feature of critical illness and has obvious implications for patient rehabilitation and recovery. Whilst many clinicians believe lean tissue repletion to be a slow process following critical illness, and a probable explanation for poor functional recovery of patients many months after resolution of the illness, we have found no studies quantifying body composition changes during patient recovery.

Methods: A combination of assessment techniques were used to monitor changes in body composition (that is, fat, water, protein and mineral), following intensive care unit (ICU) discharge, in a 38-year-old female recovering from extrapontine myelinolysis. Assessments were made at discharge from the ICU and then again 1 month, 3 months, 6 months and 12 months later. Functional recovery (respiratory muscle and hand-grip strength) and quality of life (36-item Short-form Health Survey) were assessed at these same timepoints.

Results: Twelve months after discharge from the ICU, and despite an extensive rehabilitation programme and improvements in respiratory muscle and hand-grip muscle strength, our patient was unable to return to full-time employment and continued to complain of fatigue. She had successfully regained weight and was back to her pre-illness body weight. Body composition measurements showed that an incredible 73% of the weight gained was due to an increase in body fat.

Conclusion: It is difficult to extrapolate the results of a single case to the wider ICU population, not least because the present patient sustained a significant neurological injury, but our data are the first to support the long-held belief that patient weight gain following critical illness is largely attributable to a gain in fat mass. The magnitude of body composition changes in the present patient are startling and support the need for longitudinal body composition data in a wider ICU population.

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Changes in skeletal muscle depth. Change as a percentage of the initial measurement over the course of the intensive care unit (ICU) stay.
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Figure 1: Changes in skeletal muscle depth. Change as a percentage of the initial measurement over the course of the intensive care unit (ICU) stay.

Mentions: In keeping with previous studies in critically ill patients, the present patient lost a significant amount of weight and lean tissue. On admission her weight was 69.0 kg (body mass index, 25.3). During her 33-day stay on the ICU the patient lost 11.2 kg total weight (16.2% weight loss) or, perhaps more importantly, 36% of her peripheral skeletal muscle mass (Figure 1). Following discharge to the ward, the patient commenced an intensive rehabilitation programme and an energy-dense (40 kcal/kg), high-protein (1.5 g/kg) nutritional support regimen to meet increased nutritional requirements and to facilitate weight gain.


Quantification of lean and fat tissue repletion following critical illness: a case report.

Reid CL, Murgatroyd PR, Wright A, Menon DK - Crit Care (2008)

Changes in skeletal muscle depth. Change as a percentage of the initial measurement over the course of the intensive care unit (ICU) stay.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2481478&req=5

Figure 1: Changes in skeletal muscle depth. Change as a percentage of the initial measurement over the course of the intensive care unit (ICU) stay.
Mentions: In keeping with previous studies in critically ill patients, the present patient lost a significant amount of weight and lean tissue. On admission her weight was 69.0 kg (body mass index, 25.3). During her 33-day stay on the ICU the patient lost 11.2 kg total weight (16.2% weight loss) or, perhaps more importantly, 36% of her peripheral skeletal muscle mass (Figure 1). Following discharge to the ward, the patient commenced an intensive rehabilitation programme and an energy-dense (40 kcal/kg), high-protein (1.5 g/kg) nutritional support regimen to meet increased nutritional requirements and to facilitate weight gain.

Bottom Line: She had successfully regained weight and was back to her pre-illness body weight.Body composition measurements showed that an incredible 73% of the weight gained was due to an increase in body fat.The magnitude of body composition changes in the present patient are startling and support the need for longitudinal body composition data in a wider ICU population.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Anaesthesia, University of Cambridge, Box 93, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK. clr42@cam.ac.uk

ABSTRACT

Introduction: Muscle wasting is a recognised feature of critical illness and has obvious implications for patient rehabilitation and recovery. Whilst many clinicians believe lean tissue repletion to be a slow process following critical illness, and a probable explanation for poor functional recovery of patients many months after resolution of the illness, we have found no studies quantifying body composition changes during patient recovery.

Methods: A combination of assessment techniques were used to monitor changes in body composition (that is, fat, water, protein and mineral), following intensive care unit (ICU) discharge, in a 38-year-old female recovering from extrapontine myelinolysis. Assessments were made at discharge from the ICU and then again 1 month, 3 months, 6 months and 12 months later. Functional recovery (respiratory muscle and hand-grip strength) and quality of life (36-item Short-form Health Survey) were assessed at these same timepoints.

Results: Twelve months after discharge from the ICU, and despite an extensive rehabilitation programme and improvements in respiratory muscle and hand-grip muscle strength, our patient was unable to return to full-time employment and continued to complain of fatigue. She had successfully regained weight and was back to her pre-illness body weight. Body composition measurements showed that an incredible 73% of the weight gained was due to an increase in body fat.

Conclusion: It is difficult to extrapolate the results of a single case to the wider ICU population, not least because the present patient sustained a significant neurological injury, but our data are the first to support the long-held belief that patient weight gain following critical illness is largely attributable to a gain in fat mass. The magnitude of body composition changes in the present patient are startling and support the need for longitudinal body composition data in a wider ICU population.

Show MeSH
Related in: MedlinePlus