Nutrition and Exercise in Critical Illness - NEXIS Trial

A new national clinical trial, funded by the National Institutes of Health, is helping reshape the future of recovery research for critically ill patients by providing important new evidence on how rehabilitation and nutritional interventions should be delivered during severe illness.

Researchers found that a combined exercise and nutrition intervention could be delivered safely to critically ill patients and generated valuable insights into recovery following acute respiratory failure. Unlike findings from studies in other patient populations, including frail and older adults, the combined intervention did not improve outcomes compared with standard ICU care.

The Nutrition and Exercise in Critical Illness (NEXIS) Trial, published in the American Journal of Respiratory and Critical Care Medicine, examined whether combining early in-bed cycling with increased protein intake could improve physical recovery in critically ill patients with acute respiratory failure. Conducted across nine US academic medical centres, the trial enrolled 115 patients and represents a landmark investigation into combined rehabilitation and nutritional support during critical illness.

For more than a decade, critical care researchers have identified the combination of exercise and protein supplementation as a promising strategy to address muscle loss, weakness and long-term disability following severe illness. The NEXIS trial was designed to rigorously evaluate this approach across a broad population of patients receiving care in US ICUs.

Recovery from critical illness is complex and advancing medical care requires rigorous research that challenges assumptions and informs future innovation. 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. The 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 one of the most common reasons adults require intensive care. Although advances in treatment have improved survival, many patients experience substantial declines in physical function that can persist long after leaving hospital. Identifying interventions that enhance recovery has therefore become a major focus of critical care research worldwide.

Researchers assessed mobility, muscle strength, physical function, quality of life, cognitive function and other patient-centred outcomes during hospitalisation and for six months following discharge. Although no significant differences in recovery outcomes were observed between the intervention and standard-care groups, the NEXIS trial provides important evidence that will help researchers refine future rehabilitation and nutritional strategies and identify new approaches to improving recovery after critical illness.

Investigators found that substantial physical impairment was common among patients in both groups, highlighting the ongoing need for innovative approaches 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 use supplemental protein effectively during the early stages of critical illness, and improving understanding of individual differences in recovery.

The trial builds on Johns Hopkins Medicine’s internationally recognised leadership in critical care rehabilitation and post-ICU recovery research. For more than two decades, Johns Hopkins investigators have helped define the long-term consequences of critical illness and pioneered new models of ICU rehabilitation, recovery science and patient-centred outcomes research. The NEXIS study adds important evidence to that body of work and provides a strong foundation for future discoveries aimed at helping critically ill patients achieve better recovery following hospitalisation.

Source: American Journal of Respiratory & Critical Care Medicine

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