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

Crit Care. 2008;12(3):R79. doi: 10.1186/cc6929. Epub 2008 Jun 17.

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.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Addison Disease / physiopathology
  • Addison Disease / therapy
  • Adult
  • Body Composition / physiology*
  • Body Mass Index*
  • Critical Illness
  • Fatigue / physiopathology
  • Female
  • Follow-Up Studies
  • Hand Strength / physiology
  • Humans
  • Intensive Care Units
  • Muscular Atrophy / diagnostic imaging
  • Myelinolysis, Central Pontine / physiopathology*
  • Myelinolysis, Central Pontine / therapy
  • Quality of Life
  • Respiratory Muscles / physiology
  • Ultrasonography