Every dietitian can do prevention
A big part of this year’s Dietitians Week is showing that ALL dietitians do prevention, even if we don’t all use the same terminology when talking about it. Of all the dietetic specialisms, Critical Care probably seems the most distant from the prevention agenda, dealing as they do with very seriously ill people often in an immediate crisis. However, as Critical Care Specialist Group Member Louise Albrich explains, not only do critical care dietitians do prevention, they do all kinds.
Recovery and Mental Health
People who have survived a critical illness have enduring psychological effects on top of the cognitive impairments, physical after effects, and sleep disturbance. Suffering with depression, anxiety or post-traumatic stress disorder can affect patient’s motivation and perspective of the importance of nutrition during their recovery.
These after-effects may interplay with an altered physiology or symptoms such as reduced appetite which may affect nutrition, although the impact is still unclear. However, studies report patients often not receiving sufficient nutrition in their ward-based recovery due to them adapting to their confusing environment and the lack of healthcare staff identifying their need for guidance and assistance. Dietitians are ideally placed to be a listening ear to acknowledge these struggles and guide the patient through good nutritional options which are conducive to recovery.
Rehab and Reablement
Critical illness can cause physical or functional impairments in over two thirds of Intensive Care Unit (ICU) survivors, requiring prompt and ongoing physical rehabilitation as part of their recovery. The extent of this ICU-acquired weakness is determined by pre-morbid health, age and aspect of their critical care. Muscle wasting forms part of this weakness, quickly amounting up to a loss of 18% by day 10, with many patients not reaching their pre-illness weight event after a year.
ICU-acquired weakness also often affects swallowing early in their recovery. The recovering patient therefore need the skills of a dietitian to formulate a safe, optimal nutrition support plan to achieve lean body weight regain, whilst being mindful of the impact of fatigue, shortness of breath, low motivation and possible cognitive decline. We are also well placed to work with other allied healthcare professionals to deliver recovery packages that provide for all our patients recovery needs.
Public Health and Primary Prevention
It is increasingly clear that health status and functional capacity pre-critical illness impact greatly on the how quickly a patient recovers after critical illness. Together with the evident improved outcome with pre-habilitation of surgical patients, it demonstrates the importance for the general population to follow diet choices which facilitate optimal health alongside being physical activity to avoid metabolic imbalance and deconditioning.
Healthy Conversations and Making Every Contact Count
Nutrition is part of the puzzle of good health and dietitians, like other health professionals, have the knowledge and motivational skills to guide patient to healthier lifestyle choices. During recovery from critical illness, patients are often emotionally labile and can easily feel overwhelmed, with a limited capacity to absorb and process advice. Dietitians are ideally placed to touch on prudent alcohol consumption as part of healthy nutritional choices, as well as keeping active and avoiding smoking to optimise respiratory health.