Muscle wasting and function after muscle activation and early protocol-based physiotherapy: an explorative trial.
Early mobilization
ICU-acquired weakness
Neuromuscular electrical stimulation
Protocol-based physiotherapy
Sepsis
Whole-body vibration
Journal
Journal of cachexia, sarcopenia and muscle
ISSN: 2190-6009
Titre abrégé: J Cachexia Sarcopenia Muscle
Pays: Germany
ID NLM: 101552883
Informations de publication
Date de publication:
08 2019
08 2019
Historique:
received:
28
11
2018
accepted:
01
03
2019
pubmed:
25
4
2019
medline:
21
7
2020
entrez:
25
4
2019
Statut:
ppublish
Résumé
Early mobilization improves physical independency of critically ill patients at hospital discharge in a general intensive care unit (ICU)-cohort. We aimed to investigate clinical and molecular benefits or detriments of early mobilization and muscle activating measures in a high-risk ICU-acquired weakness cohort. Fifty patients with a SOFA score ≥9 within 72 h after ICU admission were randomized to muscle activating measures such as neuromuscular electrical stimulation or whole-body vibration in addition to early protocol-based physiotherapy (intervention) or early protocol-based physiotherapy alone (control). Muscle strength and function were assessed by Medical Research Council (MRC) score, handgrip strength and Functional Independence Measure at first awakening, ICU discharge, and 12 month follow-up. Patients underwent open surgical muscle biopsy on day 15. We investigated the impact of muscle activating measures in addition to early protocol-based physiotherapy on muscle strength and function as well as on muscle wasting, morphology, and homeostasis in patients with sepsis and ICU-acquired weakness. We compared the data with patients treated with common physiotherapeutic practice (CPP) earlier. ICU-acquired weakness occurs within the entire cohort, and muscle activating measures did not improve muscle strength or function at first awakening (MRC median [IQR]: CPP 3.3 [3.0-4.3]; control 3.0 [2.7-3.4]; intervention 3.0 [2.1-3.8]; P > 0.05 for all), ICU discharge (MRC median [IQR]: CPP 3.8 [3.4-4.4]; control 3.9 [3.3-4.0]; intervention 3.6 [2.8-4.0]; P > 0.05 for all), and 12 month follow-up (MRC median [IQR]: control 5.0 [4.3-5.0]; intervention 4.8 [4.3-5.0]; P = 0.342 for all). No signs of necrosis or inflammatory infiltration were present in the histological analysis. Myocyte cross-sectional area in the intervention group was significantly larger in comparison with the control group (type I +10%; type IIa +13%; type IIb +3%; P < 0.001 for all) and CPP (type I +36%; type IIa +49%; type IIb +65%; P < 0.001 for all). This increase was accompanied by an up-regulated gene expression for myosin heavy chains (fold change median [IQR]: MYH1 2.3 [1.1-2.7]; MYH2 0.7 [0.2-1.8]; MYH4 5.1 [2.2-15.3]) and an unaffected gene expression for TRIM63, TRIM62, and FBXO32. In our patients with sepsis syndrome at high risk for ICU-acquired weakness muscle activating measures in addition to early protocol-based physiotherapy did not improve muscle strength or function at first awakening, ICU discharge, or 12 month follow-up. Yet it prevented muscle atrophy.
Sections du résumé
BACKGROUND
Early mobilization improves physical independency of critically ill patients at hospital discharge in a general intensive care unit (ICU)-cohort. We aimed to investigate clinical and molecular benefits or detriments of early mobilization and muscle activating measures in a high-risk ICU-acquired weakness cohort.
METHODS
Fifty patients with a SOFA score ≥9 within 72 h after ICU admission were randomized to muscle activating measures such as neuromuscular electrical stimulation or whole-body vibration in addition to early protocol-based physiotherapy (intervention) or early protocol-based physiotherapy alone (control). Muscle strength and function were assessed by Medical Research Council (MRC) score, handgrip strength and Functional Independence Measure at first awakening, ICU discharge, and 12 month follow-up. Patients underwent open surgical muscle biopsy on day 15. We investigated the impact of muscle activating measures in addition to early protocol-based physiotherapy on muscle strength and function as well as on muscle wasting, morphology, and homeostasis in patients with sepsis and ICU-acquired weakness. We compared the data with patients treated with common physiotherapeutic practice (CPP) earlier.
RESULTS
ICU-acquired weakness occurs within the entire cohort, and muscle activating measures did not improve muscle strength or function at first awakening (MRC median [IQR]: CPP 3.3 [3.0-4.3]; control 3.0 [2.7-3.4]; intervention 3.0 [2.1-3.8]; P > 0.05 for all), ICU discharge (MRC median [IQR]: CPP 3.8 [3.4-4.4]; control 3.9 [3.3-4.0]; intervention 3.6 [2.8-4.0]; P > 0.05 for all), and 12 month follow-up (MRC median [IQR]: control 5.0 [4.3-5.0]; intervention 4.8 [4.3-5.0]; P = 0.342 for all). No signs of necrosis or inflammatory infiltration were present in the histological analysis. Myocyte cross-sectional area in the intervention group was significantly larger in comparison with the control group (type I +10%; type IIa +13%; type IIb +3%; P < 0.001 for all) and CPP (type I +36%; type IIa +49%; type IIb +65%; P < 0.001 for all). This increase was accompanied by an up-regulated gene expression for myosin heavy chains (fold change median [IQR]: MYH1 2.3 [1.1-2.7]; MYH2 0.7 [0.2-1.8]; MYH4 5.1 [2.2-15.3]) and an unaffected gene expression for TRIM63, TRIM62, and FBXO32.
CONCLUSIONS
In our patients with sepsis syndrome at high risk for ICU-acquired weakness muscle activating measures in addition to early protocol-based physiotherapy did not improve muscle strength or function at first awakening, ICU discharge, or 12 month follow-up. Yet it prevented muscle atrophy.
Identifiants
pubmed: 31016887
doi: 10.1002/jcsm.12428
pmc: PMC6711421
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
734-747Informations de copyright
© 2019 The Authors Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of Society on Sarcopenia, Cachexia and Wasting Disorders.
Références
Crit Care Med. 2014 May;42(5):1178-86
pubmed: 24351373
Crit Care. 2010;14(3):R119
pubmed: 20565863
Crit Care Med. 2018 Sep;46(9):e825-e873
pubmed: 30113379
Am J Respir Crit Care Med. 2016 May 15;193(10):1101-10
pubmed: 26651376
JAMA. 2016 Jun 28;315(24):2694-702
pubmed: 27367766
Crit Care. 2013 Jul 24;17(4):R156
pubmed: 23883525
J Cachexia Sarcopenia Muscle. 2019 Aug;10(4):734-747
pubmed: 31016887
Intensive Care Med. 2014 Apr;40(4):528-38
pubmed: 24531339
Crit Care Med. 2018 Sep;46(9):1436-1443
pubmed: 29957714
Crit Care Med. 2008 Aug;36(8):2238-43
pubmed: 18596631
Crit Care Med. 2009 Sep;37(9):2499-505
pubmed: 19623052
Lancet. 2016 Oct 1;388(10052):1377-1388
pubmed: 27707496
Crit Care. 2016 Jan 29;20:30
pubmed: 26825278
JAMA. 2018 Jul 24;320(4):368-378
pubmed: 30043066
Lancet. 2009 May 30;373(9678):1874-82
pubmed: 19446324
Cochrane Database Syst Rev. 2009 Jan 21;(1):CD006832
pubmed: 19160304
Am J Med Sci. 2011 May;341(5):373-7
pubmed: 21358312
J Physiother. 2017 Jan;63(1):4-10
pubmed: 27989729
J Cachexia Sarcopenia Muscle. 2017 Dec;8(6):1081-1083
pubmed: 29098794
J Crit Care. 2015 Feb;30(1):32-9
pubmed: 25307979
Anaesthesist. 2015 Dec;64 Suppl 1:1-26
pubmed: 26335630
J Crit Care. 2017 Aug;40:76-82
pubmed: 28364678
Intensive Care Med. 2015 May;41(5):865-74
pubmed: 25851383
Crit Care Med. 2017 Feb;45(2):205-215
pubmed: 27661864
J Appl Physiol (1985). 2007 Nov;103(5):1744-51
pubmed: 17823296
J Appl Physiol (1985). 2006 Nov;101(5):1442-50
pubmed: 16840578
Am J Respir Crit Care Med. 2016 Oct 1;194(7):821-830
pubmed: 27058306
J Rehabil Med. 2017 Jan 19;49(1):40-48
pubmed: 28101565
PLoS One. 2014 Dec 04;9(12):e113637
pubmed: 25474696
JAMA. 2013 Oct 16;310(15):1591-600
pubmed: 24108501