Preventing Muscle Wasting in Critically Ill Patients by Repetitive Vascular Occlusion Stimulus (RVOS): A Pilot Feasibility Trial

Muscle wasting in the intensive care unit (ICU) is common and may impair functional recovery. Ultrasonography (US) presents a modern solution to quantify skeletal muscle size and monitor muscle wasting. However, no standardised methodology for the conduct of ultrasound-derived quadriceps muscle layer thickness or cross-sectional area in this population exists. The aim of this study was to compare methodologies reported for the measurement of quadriceps muscle layer thickness (MLT) and cross-sectional area (CSA) using US in critically ill patients. Databases PubMed, Ovid, Embase, and CINAHL were searched for original research publications that reported US-derived quadriceps MLT and/or CSA conducted in critically ill adult patients. Data were extracted from eligible studies on parameters relating to US measurement including anatomical location, patient positioning, operator technique and image analysis. It was identified that there was a clear lack of reported detail and substantial differences in the reported methodology used for all parameters. A standardised protocol and minimum reporting standards for US-derived measurement of quadriceps muscle size in ICU is required to allow for consistent measurement techniques and hence interpretation of results.

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Muscle wasting in the critically ill patient: how to minimise subsequent disability

British Journal of Hospital Medicine ◽

10.12968/hmed.2020.0045 ◽

2020 ◽

Vol 81 (4) ◽

pp. 1-9

Author(s):

Luke Flower ◽

Zudin Puthucheary

Keyword(s):

Critically Ill ◽

Psychological Health ◽

Critically Ill Patients ◽

Muscle Wasting ◽

Critically Ill Patient ◽

Muscle Loss ◽

Post Discharge ◽

Mortality And Morbidity ◽

Muscle Breakdown ◽

Physical And Psychological Health

Muscle wasting in critically ill patients is the most common complication associated with critical care. It has significant effects on physical and psychological health, mortality and quality of life. It is most severe in the first few days of illness and in the most critically unwell patients, with muscle loss estimated to occur at 2–3% per day. This muscle loss is likely a result of a reduction in protein synthesis relative to muscle breakdown, resulting in altered protein homeostasis. The associated weakness is associated with in an increase in both short- and long-term mortality and morbidity, with these detrimental effects demonstrated up to 5 years post discharge. This article highlights the significant impact that muscle wasting has on critically ill patients' outcomes, how this can be reduced, and how this might change in the future.

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A pilot feasibility trial of allocation of freshest available red blood cells versus standard care in critically ill patients

Transfusion ◽

10.1111/j.1537-2995.2011.03437.x ◽

2011 ◽

Vol 52 (6) ◽

pp. 1196-1202 ◽

Cited By ~ 45

Author(s):

Cecile Aubron ◽

Gillian Syres ◽

Alistair Nichol ◽

Michael Bailey ◽

Jasmin Board ◽

...

Keyword(s):

Red Blood Cells ◽

Critically Ill ◽

Critically Ill Patients ◽

Blood Cells ◽

Standard Care ◽

Feasibility Trial

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Protein metabolism and gene expression in skeletal muscle of critically ill patients with sepsis

Clinical Science ◽

10.1042/cs20110233 ◽

2011 ◽

Vol 122 (3) ◽

pp. 133-142 ◽

Cited By ~ 82

Author(s):

Maria Klaude ◽

Maiko Mori ◽

Inga Tjäder ◽

Thomas Gustafsson ◽

Jan Wernerman ◽

...

Keyword(s):

Gene Expression ◽

Protein Degradation ◽

Critically Ill ◽

Critically Ill Patients ◽

Proteolytic Enzyme ◽

Muscle Wasting ◽

Muscle Protein ◽

Synthesis Rate ◽

Normal Muscle ◽

Enzyme Systems

Muscle wasting negatively affects morbidity and mortality in critically ill patients. This progressive wasting is accompanied by, in general, a normal muscle PS (protein synthesis) rate. In the present study, we investigated whether muscle protein degradation is increased in critically ill patients with sepsis and which proteolytic enzyme systems are involved in this degradation. Eight patients and seven healthy volunteers were studied. In vivo muscle protein kinetics was measured using arteriovenous balance techniques with stable isotope tracers. The activities of the major proteolytic enzyme systems were analysed in combination with mRNA expression of genes related to these proteolytic systems. Results show that critically ill patients with sepsis have a variable but normal muscle PS rate, whereas protein degradation rates are dramatically increased (up to 160%). Of the major proteolytic enzyme systems both the proteasome and the lysosomal systems had higher activities in the patients, whereas calpain and caspase activities were not changed. Gene expression of several genes related to the proteasome system was increased in the patients. mRNA levels of the two main lysosomal enzymes (cathepsin B and L) were not changed but, conversely, genes related to calpain and caspase had a higher expression in the muscles of the patients. In conclusion, the dramatic muscle wasting seen in critically ill patients with sepsis is due to increased protein degradation. This is facilitated by increased activities of both the proteasome and lysosomal proteolytic systems.

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Acute Muscle Wasting Among Critically Ill Patients

JAMA ◽

10.1001/jama.2013.285420 ◽

2014 ◽

Vol 311 (6) ◽

pp. 621 ◽

Cited By ~ 8

Author(s):

Daren Heyland ◽

Carrie Earthman ◽

Charlene Compher

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Muscle Wasting

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Diabetes-Specific Formulae Versus Standard Formulae as Enteral Nutrition to Treat Hyperglycemia in Critically Ill Patients: Protocol for a Randomized Controlled Feasibility Trial

10.2196/preprints.9374 ◽

2017 ◽

Author(s):

Ra'eesa Doola ◽

Alwyn S Todd ◽

Josephine M Forbes ◽

Adam M Deane ◽

Jeffrey J Presneill ◽

...

Keyword(s):

Enteral Nutrition ◽

Critically Ill ◽

Critically Ill Patients ◽

Feasibility Trial ◽

Randomized Controlled

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Effects of synbiotic supplementation on energy and macronutrients homeostasis and muscle wasting of critical care patients: study protocol and a review of previous studies

10.21203/rs.2.16301/v2 ◽

2019 ◽

Author(s):

Najmeh Seifi ◽

Mohammad Safarian ◽

Mohsen Nematy ◽

Reza Rezvani ◽

Majid Khadem-Rezaian ◽

...

Keyword(s):

Critical Care ◽

Gut Microbiota ◽

Critically Ill ◽

Nasogastric Tube ◽

Critically Ill Patients ◽

Muscle Wasting ◽

Control Group ◽

Clinical Prognosis ◽

Synbiotic Supplementation ◽

Critical Care Patients

Abstract Background: Among critically ill patients, regardless of the heterogeneity of disease state, an extreme and persistent dysbiosis occurs. Dysbiosis in critically ill patients may make them prone to hospital-acquired infections, sepsis, multi-organ failure (MOF), energy homeostasis disturbance, muscle wasting, and cachexia. Modulation of gut microbiota through synbiotics can be considered as a potential treatment for muscle wasting and macronutrients homeostasis disturbances. Methods: This is a prospective, single center, double-blind; a parallel randomized controlled trial that aimed to evaluate the effects of synbiotic supplementation on energy and macronutrient ‎homeostasis and muscle wasting in critical care patients.‎ All eligible patients (20 subjects in each group) will receive standard hospital gavage as enteral nutrition through a nasogastric tube (NGT) in the 24-48h after admission. In the intervention group, patients will receive Lactocare (ZistTakhmir) capsules 500 mg every 12h for 14 days. Patients in the control group will receive a placebo capsule which contains only the sterile maize starch and is similar to synbiotic capsules. The synbiotic and placebo capsules will be given through nasogastric tube, separately from gavage, after feeding. Discussion: Gut microbiota modulation through synbiotics is proposed to improve clinical prognosis and reduce infectious complications, ventilator dependency and ICU stay by improving energy and macronutrient homeostasis and reducing muscle protein catabolism. Trials registration: The trial protocol has been approved in Iranian Registry of Clinical Trials at 2019-03-17. The registration reference is IRCT20190227042857N1.

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