A new national clinical trial, funded by the National Institutes of Health, is helping reshape the future of recovery research for critically ill patients, providing important new evidence about how rehabilitation and nutrition interventions should be delivered during severe illness and informing the next generation of research to improve ICU survivors' outcomes.
Researchers found that the combined exercise and nutrition intervention could be safely delivered to critically ill patients and generated important insights into recovery after acute respiratory failure. Contrary to research conducted in other patient groups, such as frail or older adults, this combined intervention did not improve outcomes compared to usual ICU care, helping set a new direction for future research in the field.
The Nutrition and Exercise in Critical Illness (NEXIS) Trial, published July 13 in the American Journal of Respiratory and Critical Care Medicine, examined whether combining early in-bed cycling exercise with added protein nutritional intake could improve physical recovery for critically ill patients with acute respiratory failure. Conducted across nine U.S. academic medical centers, the trial enrolled 115 patients and represents a landmark study of combined rehabilitation and nutrition during critical illness.
For more than a decade, critical care researchers have identified the combination of exercise and protein supplementation as a key area for investigation because of its potential to address muscle loss, weakness and long-term disability that often follow serious illness. The NEXIS trial was designed to rigorously evaluate that concept across a range of patients in U.S. ICUs.
"Recovery from critical illness is complex and advancing medical care requires rigorous research that challenges assumptions and informs future innovation," said Dale Needham, M.D., Ph.D., professor of pulmonary and critical care medicine and physical medicine and rehabilitation at the Johns Hopkins University School of Medicine and first author of the study. "The NEXIS trial helps answer an important question for the field and provides a stronger foundation for the next generation of rehabilitation and nutrition research. Ultimately, our goal is to identify the right interventions, for the right patients, at the right time to improve recovery after critical illness."
Acute respiratory failure is among the most common reasons adults require intensive care. Although advances in treatment have improved survival, many patients experience significant declines in their physical function that can persist long after they leave the hospital. Identifying interventions that improve recovery has become a major focus of critical care research worldwide.
Researchers evaluated mobility, strength, physical function, quality of life, cognitive function and other patient-centered outcomes during hospitalization and for six months after discharge. While the study found no significant differences in recovery outcomes between the two groups, the NEXIS trial provides valuable evidence that will help researchers refine future rehabilitation and nutrition strategies and focus on new approaches to improving recovery after critical illness.
"Studies like NEXIS are essential because they move the field forward," Needham said. "By carefully evaluating novel strategies in a rigorous clinical trial, we better understand the best care to provide in the ICU and advance the field to focus in new directions that have the greatest potential to improve patients' lives."
Investigators noted that substantial physical impairment was common among patients in both study groups, underscoring the continued need for innovative solutions to help ICU survivors regain strength and physical function after discharge. The research team identified several priorities for future investigation, including addressing anabolic resistance, a biological phenomenon that may limit the body's ability to effectively use supplemental protein during the early stages of critical illness—and better understanding individual differences in recovery.
The trial builds on Johns Hopkins Medicine's internationally recognized leadership in clinical care and research in the areas of critical care rehabilitation and post-ICU recovery. For more than two decades, Johns Hopkins investigators have helped define the long-term effects of critical illness and pioneered new models of ICU rehabilitation, recovery science and patient-centered outcomes research. The NEXIS study adds important evidence to that legacy and provides a foundation for future discoveries aimed at helping critically ill patients recover more fully after hospitalization.
