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

Clare L Reid, Peter R Murgatroyd, Antony Wright, David K Menon, Clare L Reid, Peter R Murgatroyd, Antony Wright, David K Menon

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.

Figures

Figure 1
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.
Figure 2
Figure 2
Changes in body mass and composition. Change in mass relative to the time of intensive care unit (ICU) discharge. A, pre-illness weight, 69 kg; B, weight at discharge from the intensive care unit, 58.3 kg; C, weight at 12 months after ICU discharge, 67.1 kg.
Figure 3
Figure 3
Changes in functional recovery during the 12-month follow up. Change in respiratory muscle and hand-grip strength. MIP, maximal inspiratory pressure.
Figure 4
Figure 4
Changes in the quality of life. Changes reported using the 36-item Short-form Health Survey. Physical fx, physical functioning; Limits phys health, role limitations due to physical problems; Limits emotional, role limitations due to emotional problems; Fatigue, energy and vitality; Emotional WB, emotional well-being/mental health; Social fx, social functioning; Pop norms, population norms [24].

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