A comment on “Improving rehabilitation following critical illness through outpatient physiotherapy classes and essential amino acid supplement: a randomised, controlled trial”

2015 ◽  
Vol 30 (5) ◽  
pp. 1135
Author(s):  
Hidetaka Wakabayashi
Keyword(s):  
Amino Acid ◽  
Critical Illness ◽  
Randomised Controlled Trial ◽  
Essential Amino Acid ◽  
Controlled Trial ◽  
Amino Acid Supplement ◽  
Acid Supplement ◽  
Randomised Controlled

scholarly journals Nutrition and Exercise in Critical Illness Trial (NEXIS Trial): a protocol of a multicentred, randomised controlled trial of combined cycle ergometry and amino acid supplementation commenced early during critical illness

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e027893 ◽  
Author(s):  
Daren K Heyland ◽  
Andrew Day ◽  
G John Clarke ◽  
Catherine (Terri) Hough ◽  
D Clark Files ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Amino Acid ◽  
Critical Illness ◽  
Randomised Controlled Trial ◽  
Protein Intake ◽  
Controlled Trial ◽  
Cycle Ergometry ◽  
Amino Acid Supplementation ◽  
Acid Supplementation ◽  
Randomised Controlled

IntroductionSurvivors of critical illness often experience significant morbidities, including muscle weakness and impairments in physical functioning. This muscle weakness is associated with longer duration mechanical ventilation, greater hospital costs and increased postdischarge impairments in physical function, quality of life and survival. Compared with standard of care, the benefits of greater protein intake combined with structured exercise started early after the onset of critical illness remain uncertain. However, the combination of protein supplementation and exercise in other populations has demonstrated positive effects on strength and function. In the present study, we will evaluate the effects of a combination of early implementation of intravenous amino acid supplementation and in-bed cycle ergometry exercise versus a ‘usual care’ control group in patients with acute respiratory failure requiring mechanical ventilation in an intensive care unit (ICU).Methods and analysisIn this multicentre, assessor-blinded, randomised controlled trial, we will randomise 142 patients in a 1:1 ratio to usual care (which commonly consists of minimal exercise and under-achievement of guideline-recommended caloric and protein intake goals) versus a combined intravenous amino acid supplementation and in-bed cycle ergometery exercise intervention. We hypothesise that this novel combined intervention will (1) improve physical functioning at hospital discharge; (2) reduce muscle wasting with improved amino acid metabolism and protein synthesis in-hospital and (3) improve patient-reported outcomes and healthcare resource utilisation at 6 months after enrolment. Key cointerventions will be standardised. In-hospital outcome assessments will be conducted at baseline, ICU discharge and hospital discharge. An intent-to-treat analysis will be used to analyse all data with additional per-protocol analyses.Ethics and disseminationThe trial received ethics approval at each institution and enrolment has begun. These results will inform both clinical practice and future research in the area. We plan to disseminate trial results in peer-reviewed journals, at national and international conferences, and via nutritional and rehabilitation-focused electronic education and knowledge translation platforms.Trial registration numberNCT03021902; Pre-results.

scholarly journals Leucine-enriched essential amino acid supplementation in mechanically ventilated trauma patients: a feasibility study

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
L. Wandrag ◽  
S. J. Brett ◽  
G. S. Frost ◽  
M. To ◽  
E. Alves Loubo ◽  
...  
Keyword(s):  
Amino Acid ◽  
Randomised Controlled Trial ◽  
Muscle Mass ◽  
Protein Turnover ◽  
Essential Amino Acid ◽  
Controlled Trial ◽  
Trauma Patients ◽  
Mechanically Ventilated ◽  
Sum Score ◽  
Randomised Controlled

Abstract Background Critically ill patients lose up to 2% of muscle mass per day. We assessed the feasibility of administering a leucine-enriched essential amino acid (L-EAA) supplement to mechanically ventilated trauma patients with the aim of assessing the effect on skeletal muscle mass and function. Methods A randomised feasibility study was performed over six months in intensive care (ICU). Patients received 5 g L-EAA five times per day in addition to standard feed (L-EAA group) or standard feed only (control group) for up to 14 days. C-reactive protein, albumin, IL-6, IL-10, urinary 3-MH, nitrogen balance, protein turnover ([1-13C] leucine infusion), muscle depth change (ultrasound), functional change (Katz and Barthel indices) and muscle strength Medical Research Council (MRC) sum score to assess ICU Acquired Weakness were measured sequentially. Results Eight patients (9.5% of screened patients) were recruited over six months. L-EAA doses were provided on 91/124 (73%) occasions. Inflammatory and urinary marker data were collected; serial muscle depth measurements were lacking due to short length of stay. Protein turnover studies were performed on five occasions. MRC sum score could not be performed as patients were not able to respond to the screening questions. The Katz and Barthel indices did not change. L-EAA delivery was achievable, but meaningful functional and muscle mass outcome measures require careful consideration in the design of a future randomised controlled trial. Conclusion L-EAA was practical to provide, but we found significant barriers to recruitment and measurement of the chosen outcomes which would need to be addressed in the design of a future, large randomised controlled trial. Trial registration ISRCTN Registry, ISRCTN79066838. Registered on 25 July 2012.

scholarly journals Essential Amino Acid Supplement Lowers Intrahepatic Lipid despite Excess Alcohol Consumption

Nutrients ◽  
2020 ◽  
Vol 12 (1) ◽  
pp. 254
Author(s):  
Melynda S. Coker ◽  
Kaylee R. Ladd ◽  
Jimin Kim ◽  
Carl J. Murphy ◽  
Ryan DeCort ◽  
...  
Keyword(s):  
Body Composition ◽  
Amino Acid ◽  
Alcohol Consumption ◽  
Essential Amino Acid ◽  
Blood Lipids ◽  
High Dose ◽  
Amino Acid Supplement ◽  
Acid Supplement ◽  
Intrahepatic Lipid ◽  
Excess Alcohol Consumption

Excess alcohol consumption is a top risk factor for death and disability. Fatty liver will likely develop and the risk of liver disease increases. We have previously demonstrated that an essential amino acid supplement (EAAS) improved protein synthesis and reduced intrahepatic lipid in the elderly. The purpose of this exploratory pilot study was to initiate the evaluation of EAAS on intrahepatic lipid (IHL), body composition, and blood lipids in individuals with mild to moderate alcohol use disorder (AUD). Following consent, determination of eligibility, and medical screening, 25 participants (18 males at 38 ± 15 years/age and 7 females at 34 ± 18 years/age) were enrolled and randomly assigned to one of two dosages: a low dose (LD: 8 g of EAAS twice/day (BID)) or high dose (HD: 13 g of EAAS BID). Five of the twenty-five enrolled participants dropped out of the intervention. Both groups consumed the supplement BID for 4 weeks. Pre- and post-EAAS administration, IHL was determined using magnetic resonance imaging/spectroscopy, body composition was analyzed using dual-energy X-ray absorptiometry, and blood parameters were measured by LabCorp. T-tests were used for statistical analysis and considered significant at p < 0.05. While there was no significant change in IHL in the LD group, there was a significant 23% reduction in IHL in the HD group (p = 0.02). Fat mass, lean tissue mass, bone mineral content, and blood lipids were not altered. Post-EAAS phosphatidylethanol was elevated and remained unchanged in LD at 407 ± 141 ng/mL and HD at 429 ± 196 ng/mL, indicating chronic and excess alcohol consumption. The HD of the proprietary EAAS formulation consumed BID seemed to lower IHL in individuals with mild to moderate AUD. We suggest that further studies in a larger cohort be conducted to more completely address this important area of investigation.

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