Exploration of muscle loss and metabolic state during prolonged critical illness: Implications for intervention?

Autoři: Liesl Wandrag aff001;  Stephen J. Brett aff004;  Gary S. Frost aff001;  Vasiliki Bountziouka aff005;  Mary Hickson aff001
Působiště autorů: Section for Nutrition Research, Department of Metabolism, Digestion and Reproduction, Imperial College London, England, United Kingdom aff001;  Department of Nutrition and Dietetics, Guy’s and St Thomas’ NHS Foundation Trust, London, England, United Kingdom aff002;  Department of Critical Care, Guy’s and St Thomas’ NHS Foundation Trust, London, England, United Kingdom aff003;  Centre for Peri-operative Medicine and Critical Care Research, Imperial College Healthcare NHS Trust, London, England, United Kingdom aff004;  Statistical Support Service, Population, Policy and Practice Programme, Institute of Child Health, University College, London, United Kingdom aff005;  Institute of Health and Community, University of Plymouth, Devon, England, United Kingdom aff006
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224565



Muscle wasting in the critically ill is up to 2% per day and delays patient recovery and rehabilitation. It is linked to inflammation, organ failure and severity of illness. The aims of this study were to understand the relationship between muscle depth loss, and nutritional and inflammatory markers during prolonged critical illness. Secondly, to identify when during critical illness catabolism might decrease, such that targeted nutritional strategies may logically be initiated.


This study was conducted in adult intensive care units in two large teaching hospitals. Patients anticipated to be ventilated for >48 hours were included. Serum C-reactive protein (mg/L), urinary urea (mmol/24h), 3-methylhistidine (μmol/24h) and nitrogen balance (g/24h) were measured on days 1, 3, 7 and 14 of the study. Muscle depth (cm) on ultrasound were measured on the same days over the bicep (bicep and brachialis muscle), forearm (flexor compartment of muscle) and thigh (rectus femoris and vastus intermedius).


Seventy-eight critically ill patients were included with mean age of 59 years (SD: 16) and median Intensive care unit (ICU) length of stay of 10 days (IQR: 6–16). Starting muscle depth, 8.5cm (SD: 3.2) to end muscle depth, 6.8cm (SD: 2.2) were on average significantly different over 14 days, with mean difference -1.67cm (95%CI: -2.3 to -1cm), p<0.0001. Protein breakdown and inflammation continued over 14 days of the study.


Our patients demonstrated a continuous muscle depth loss and negative nitrogen balance over the 14 days of the study. Catabolism remained dominant throughout the study period. No obvious ‘nutritional tipping point” to identify anabolism or recovery could be identified in our cohort. Our ICU patient cohort is one with a moderately prolonged stay. This group showed little consistency in data, reflecting the individuality of both disease and response. The data are consistent with a conclusion that a time based assumption of a tipping point does not exist.

Trial registration

International Standard Randomised Controlled Trial Number: ISRCTN79066838. Registration 25 July 2012.

Klíčová slova:

Balance and falls – Inflammation – Intensive care units – Muscle analysis – Muscle proteins – Urea – Catabolism


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2019 Číslo 11