Optimizing nutritional care across the continuum from intensive care to recovery: an expert opinion review

Survivorship after critical illness is frequently complicated by muscle wasting and gastrointestinal (GI) dysfunction, driving prolonged functional impairment. Nutrition is a modifiable determinant across the intensive care unit (ICU)-to-home continuum, yet delivery is commonly limited by feeding intolerance and fragmented transitions of care.

This expert opinion review synthesizes evidence identified via a narrative search of MEDLINE/PubMed and key guideline/reference screening, focusing on GI dysfunction as a barrier to enteral nutrition (EN) in the ICU, phase-adapted energy and protein provision, and strategies to restore intake during ward recovery and after discharge, including high-energy, protein-dense oral nutritional supplements (ONS).

Nutrition should be delivered as a structured pathway rather than a single ICU intervention. Early EN with proactive, symptom-targeted management of GI dysfunction, coupled with stepwise protein escalation aligned to metabolic phase and organ function, may help reduce avoidable deficits. The early post-ICU period is an anabolic 'window of opportunity' that warrants intake monitoring, deliberate tapering of tube feeds only once oral intake is reliable, and routine post-discharge ONS for patients at nutritional risk. Research should prioritize pragmatic trials of phase-specific targets and transition-of-care models.