Overcoming the physical impact of a long stay in intensive care

The journey towards stronger patient recovery following COVID-19

One of our key challenges is to make sure we can help COVID-19 patients, once discharged, recover not only from the effects of disease itself, but also from consequences of a long period in ICU.”

Dr. Riccardo Caccialanza, Head of Dietetics and Clinical Nutrition Unit at the IRCCS
Policlinico San Matteo Foundation, Pavia (Italy)

As a healthcare professional, most of your patients and their families will have been touched by the coronavirus pandemic. For those directly affected by COVID-19 disease, you will probably be concerned for their wellbeing and that of their families, and eager to ensure the best possible outcomes for all. Whatever happens over the coming weeks and months, it’s certain that the pandemic will have changed the way we think about and approach many aspects of healthcare.

One of the key, new challenges within both hospital and community setting is how to manage COVID-19 patients who are being discharged from ICU after stays of up to 2 weeks, sometimes longer (compared with a previous, pre-COVID-19 average of 2-3 days),1,2 a situation presenting new and challenging health issues to manage.

Muscle wasting is the most common complication of critical illness, occurring in up to 50% of patients, and is associated with functional disability3

Studies have shown that patients can lose up to 1kg of muscle (‘lean body mass’ vs body fat) for every day in ICU.4 This loss of strength can have a negative impact on both their ability to fight other infections, as well as lengthening the recovery process.5,6 This can lead to patients needing more care within healthcare systems that are already under stress, often at a point when they are keen to return home to their normal lives.

Finally – discharged from ICU – but often only the beginning of recovery

Our hope is to see our patients returning home and resuming normal life as soon as possible. But when so much body strength has been lost during their time in hospital, that recovery period can be longer and more difficult. This has an impact not only on the patient and their families, but also on our already overstretched healthcare resources.”

Dr. Riccardo Caccialanza, Head of Dietetics and Clinical Nutrition Unit at the IRCCS
Policlinico San Matteo Foundation, Pavia (Italy)

Ready to resume their pre-corona lives, but severely weakened, some patients find readjusting to life outside of hospital an uphill struggle. Physical tasks that used to be easy – for example brushing teeth, going for a walk, preparing food – can feel difficult or sometimes impossible.7 These factors can affect quality of life – even the ability to carry on living independently.8,9

Once home, it might be assumed that a patient will be able to regain strength through a normal diet, supported by moderate physical exercise,10 but patients can face issues as a direct result of their ICU stay that can affect their daily food intake. Loss of appetite, feeling full after just one or two bites of food, as well as physical weakness, are all common side effects of a long period of hospitalization.11 For those who have been on a ventilator, it may take some time to re-learn how to swallow food and drinks safely.12 To compound things, it is also common for patients to feel anxious and depressed after their experience, which can further affect their appetite and overall relationship with food.13

The power of nutrition

Patients admitted to ICU for COVID-19 may have already benefitted from nutritional support. Medical nutrition in the ICU setting, administered in line with clinical guidance and provided as liquid, nutrient-dense drinks or complete nutrition through a feeding tube, has the aim of meeting the nutritional needs of these ICU patients and thereby reducing muscle loss and maintaining nutritional status.14 Medical nutrition that is high in protein and energy is particularly important for maintaining and/or rebuilding muscle and is linked to improved survival rates and a fewer health complications. 5,15-17

Nutricia supports research into recovery of COVID-19 patients after hospital discharge

Whilst there is a lot of scientific evidence to support the benefits of nutritional care during hospitalization,5,14-17 there is currently little research into the complex nutritional needs of COVID-19 patients post ICU and the potential benefits of medical nutrition on their recovery and quality of life. Without this evidence, guidance for clinical care in supporting patients once discharged from ICU following COVID-19, is difficult to develop and implement.

Nutricia believes in the power of nutrition to make a positive difference to health. In conjunction with physical exercise, medical nutrition could be a key contributing factor in COVID-19 recovery. That’s why we are supporting new, independent research that will help enable the development of evidence-based clinical guidance to help healthcare professionals improve patient recovery and quality of life following their stay in ICU for COVID-19. 


  1. Stam HK, Stucki G, Bickenbach J, et al. COVID-19 and post intensive care syndrome: a call for action. J. Rehabil Med. 2020;52(4). 
  2. Choon-Huat G, Hoenig H. How should the rehabilitation community prepare for 2019-nCoV?. Archives of Physical Medicine and Rehabilitation 2020, in press. 
  3. Puthucheary ZA.  An update on muscle wasting in ICU. SIGNA VITAE. 2017;13(3): 30-31.
  4. Puthucheary ZA, Rawal J, McPhail M, et al. Acute skeletal muscle wasting in critical illness. JAMA. 2013; 310:1591-1600.
  5. Demling RH. Nutrition, Anabolism, and the Wound Healing Process: An Overview. Journal of Plastic Surgery. 2009;9(e9):65-94.
  6. Herridge MS, Cheung AM, Tansey CM, et al. One-Year Outcomes in Survivor of the Acute Respiratory Distress Syndrome. N Engl J Med. 2003;348(8);683-93.
  7. Hopkins RO, Suchyta MR, Kamdar BB, et al. Instrumental activities of daily living after critical illness: a systematic review. Annals of the American Thoracic Society. 2017;14(8):1332-34.
  8. Cheung AM, Tansey CM, Tomlinson G, et al. Two-year outcomes, health care use, and costs of survivors of acute respiratory distress syndrome. Am J Respir Crit Care Med; 2006,174(5):538–44. 
  9. Iwashyna TJ, Ely EW, Smith DM, et al. Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA, 2010; 304(16):1787–94. 
  10. Zanten van ARH, Waele de E, Wischmeyer PE. Nutrition therapy and critical illness: practical guidance for the ICU, post-ICU, and long-term convalescence phases. Critical Care. 2019; 23:368.
  11. Merriweather, J, Smith, P & Walsh, T 2014, 'Nutritional rehabilitation after ICU - does it happen: a qualitative interview and observational study', Journal of Clinical Nursing, vol. 23, no. 5-6, pp. 654-62. https://doi.org/10.1111/jocn.12241
  12. Barazzoni R, Bischoff SC, Krznaric Z, Pirlich M, Singer P: Espen statement and practical guidance for individuals with sars-cov-2 infection; Clinical Nutrition, March 2020; DOI.org/10.1016/j.clnu.2020.03.2020
  13. Needham DM, Davidson J, Cohen H, et al. Improving longtermoutcomes after discharge from intensive care unit: report from a stakeholders’ conference. Critical Care Medicine. 2012;40(2):502–9
  14. McClave SA, Taylor BE, Martindale RG, et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN. 2016;40(2):159–211
  15. Weijs PJM, Mogensen KM, Rawd JD, et al. Protein Intake, Nutritional Status and Outcomes in ICU Survivors: A Single Center Cohort Study. J Clin Med. 2019;8(1):E43. 
  16. Weijs PJM, Looijaard W, Beishuizen A, et al. Critical Care. 2014;18:701-10.
  17. Allingstrup MJ, Esmailzadeh N, Knudsen W, et al. Clinical Nutrition. 2012;31:462-8.

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