Towards optimised nutrition therapy after critical illness: a position statement and research framework by the global research initiative on post-intensive care nutrition (GRIP) consortium

Rosseel et al. Critical Care (2025) 29:460 https://doi.org/10.1186/s13054-025-05710-2 CO N S E N S U S A R T I C L E Critical Care Open Access Towards optimised nutrition therapy after critical illness: a position statement and research framework by the global research initiative on post-intensive care nutrition (GRIP) consortium Zenzi Rosseel1,2,3*†, Noortje M. P. Overwater4,5†, Maridi Aerts1,6, Lee-anne S. Chapple7,8,9, Dechang Chen10, Krista L. Haines11, Jiao Liu12, Imre W.K. Kouw4,5, Lu Ke12,13, Claude Pichard14, Emma J. Ridley7,15, Pierre Singer16, Dan L. Waitzberg17, Weiqin Li12,13, Paul E. Wischmeyer18, Youzhong An19, Arthur R. H. van Zanten4,5 and Elisabeth De Waele1,3 Abstract Background While mortality for critically ill patients has decreased, many survivors face persistent physical, cognitive, and psychological impairments, collectively known as post-intensive care syndrome, which significantly reduce health-related quality of life (HRQoL). Nutrition is a crucial component of recovery, yet evidence-based strategies for post-intensive care unit (ICU) nutritional management remain underdeveloped. Methods The Global Research Initiative on Post-ICU Nutrition (GRIP) was established to address this gap by advancing research, education, and clinical practice in post-ICU nutrition. International experts in the field of critical care nutrition were invited to a diagnostic matrix meeting, to develop a definition of post-ICU patients relevant to GRIP, discuss emerging evidence regarding post-ICU nutritional management, and identify core research domains to guide future research. Results The consortium consensus was achieved. A post-ICU patient is defined as any adult patient who has been admitted to an ICU for more than 48 h and is in the post-ICU recovery phase, which begins after the first ICU discharge and continues for up to one year, regardless of hospital length of stay, readmissions, or discharge destination. Ten core nutrition research domains were identified, including: (1) pathophysiology of post-ICU recovery, (2) phenotyping and personalised nutrition strategies, (3) timing and delivery of nutrition, (4) nutritional intake monitoring and optimisation, (5) nutrition interventions and effectiveness, (6) long-term functional and health-related quality of † Zenzi Rosseel and Noortje M.P Overwater contributed equally as first author *Correspondence: Zenzi Rosseel Full list of author information is available at the end of the article © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creati vecommons.org/licenses/by-nc-nd/4.0/. Rosseel et al. Critical Care (2025) 29:460 Page 2 of 12 life outcomes, (7) digital tools and remote monitoring, (8) education and healthcare professional engagement, (9) implementation science and system integration, and (10) patient and family involvement. Conclusion GRIP envisions a future in which patients post-ICU receive personalised, timely, and effective nutritional care to enhance recovery, reduce complications, and improve long-term HRQoL. By identifying knowledge gaps, initiating targeted research projects, and supporting global educational efforts, GRIP aims to generate robust evidence, foster international collaboration, and strengthen clinical capacity to improve global post-ICU nutritional care. Keywords ICU, Nutrition, Global research initiative on Post-ICU nutrition, Post-ICU patient Introduction Despite improved survival rates, patients admitted to the intensive care unit (ICU) frequently experience substantial physiological and physical deterioration during their stay. Within the first week of ICU admission, 10–20% loss of skeletal muscle mass is common, and even more pronounced in patients with multiple organ failure [1]. This decline in muscle mass and strength, referred to as ICU-acquired weakness (ICU-AW) [2], is associated with adverse clinical outcomes, including prolonged mechanical ventilation, extended ICU and hospital lengths of stay, increased rates of hospital readmission, and higher mortality both during and after hospitalisation [3, 4]. Survivors of critical illness face a demanding recovery journey, frequently involving new or worsening physical, cognitive, or mental health impairments arising from critical illness, collectively termed post-intensive care syndrome (PICS) [5]. These long-term sequelae substantially diminish health-related quality of life (HRQoL), and impose a considerable socioeconomic burden. Patients often require extensive rehabilitation and demonstrate a higher risk of nursing home admission [6, 7]. Up to 50% of patients are unable to fully resume work within six months following ICU discharge [8], demonstrating the persistent nature of these impairments [9–13]. Effective recovery from critical illness demands a comprehensive, interdisciplinary approach. Nutritional support is increasingly recognised as a potential determinant of recovery trajectories [14]. However, meeting nutritional needs after ICU discharge remains challenging. As patients transition from the ICU to hospital wards, rehabilitation centres, or their homes, they often continue to struggle with physical and emotional impairments, all of which might complicate adequate nutritional intake [15, 16]. Despite its importance, post-ICU nutrition remains under-researched and is often overlooked in ICU aftercare. Evidence to guide optimal nutritional treatment strategies is lacking, and current evidence supporting their effectiveness remains limited. These evidentiary deficiencies present a significant challenge in understanding why patients post-ICU fail to meet their nutritional needs, thereby hindering the development of clear, evidence-based guidelines. Addressing these knowledge gaps is crucial for enhancing the quality and consistency of nutritional care in post-ICU patients. In response to these needs, the Global Research Initiative on Post-ICU Nutrition (GRIP) has been established. This multidisciplinary collaboration aims to advance research, clinical practice, and education (...truncated)