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


CONCLUSIONS
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.
Division of Anaesthesia, University of Cambridge, Box 93, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK. clr42@cam.ac.uk
Clare L
CL
Reid
Peter R
PR
Murgatroyd
Antony
A
Wright
David K
DK
Menon
D000224:Addison Disease / Q000503:physiopathology / Q000628:therapy; D000328:Adult; D001823:Body Composition / Q000502:physiology*; D015992:Body Mass Index; D016638:Critical Illness; D005221:Fatigue / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D007362:Intensive Care Units; D009133:Muscular Atrophy / Q000000981:diagnostic imaging; D017590:Myelinolysis, Central Pontine / Q000503:physiopathology* / Q000628:therapy; D011788:Quality of Life; D012132:Respiratory Muscles / Q000502:physiology; D014463:Ultrasonography