Leucine-enriched essential amino acid supplementation in mechanically ventilated trauma patients: a feasibility study.
Adult
Aged
Aged, 80 and over
Amino Acids, Essential
/ administration & dosage
Critical Illness
Dietary Supplements
Feasibility Studies
Female
Humans
Intensive Care Units
Leucine
/ administration & dosage
Male
Middle Aged
Outcome Assessment, Health Care
Prospective Studies
Respiration, Artificial
Wounds and Injuries
/ therapy
Critically ill
Essential amino acids
Leucine
Mechanical ventilation
Muscle ultrasound
Muscle wasting
Nitrogen balance
Protein turnover
Trauma
Journal
Trials
ISSN: 1745-6215
Titre abrégé: Trials
Pays: England
ID NLM: 101263253
Informations de publication
Date de publication:
11 Sep 2019
11 Sep 2019
Historique:
received:
25
04
2019
accepted:
08
08
2019
entrez:
13
9
2019
pubmed:
13
9
2019
medline:
25
2
2020
Statut:
epublish
Résumé
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. 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. 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. 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. ISRCTN Registry, ISRCTN79066838 . Registered on 25 July 2012.
Sections du résumé
BACKGROUND
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
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
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
CONCLUSIONS
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
BACKGROUND
ISRCTN Registry, ISRCTN79066838 . Registered on 25 July 2012.
Identifiants
pubmed: 31511044
doi: 10.1186/s13063-019-3639-2
pii: 10.1186/s13063-019-3639-2
pmc: PMC6737604
doi:
Substances chimiques
Amino Acids, Essential
0
Leucine
GMW67QNF9C
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
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