Muscle Wasting in Critical Illness

Zudin Puthucheary MBBS B.Med.Sci D.UHM EDICM MRCP FHEA NIHR Research Fellow, Respiratory and Critical Care Institute of Health and Human Performance, UCL Post-CCT Fellow in Trauma and Critical Care, Kings College HospitalMedicalResearch.com Interview with:
Zudin Puthucheary MBBS B.Med.Sci D.UHM EDICM MRCP FHEA
NIHR Research Fellow, Respiratory and Critical Care
Institute of Health and Human Performance, UCL
Post-CCT Fellow in Trauma and Critical Care,
Kings College Hospital

MedicalResearch.com: What are the main findings of the study?

Answer: That muscle wasting occurs rapidly and early in critical illness, with up to 2-3% loss of muscle mass per day. This is related to the numbers of organs failed, and is made worse by the degree of acute lung injury, and increased protein delivery. Muscle wasting is the result of both decreased muscle protein synthesis and increased muscle protein breakdown. In addition 40% of these patients developed muscle necrosis over the study period.

MedicalResearch.com: Were any of the findings unexpected?

Answer: We did not expect to find the association with increased protein delivery, or to see muscle protein synthesis recover by day 7. Further, the high incidence of myonecrosis was unexpected.

MedicalResearch.com: What should clinicians and patients take away from your report?

Answer: Patients should be aware that muscle wasting is incredibly rapid, and that increasing nutrition will only make this worse. Clinicians should consider use of organ failure scoring for stratifying patients for early mobilization, should reconsider the need for aggressive early feeding as it exacerbates muscle wasting.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Answer:

1. We need to further understand the relationship between muscle wasting and nutritional delivery in the first week, so we can alter practice.

2 .We do not know the implications of muscle necrosis.

3. We need to consider alternative feeding regimes.

Citation:

Acute Skeletal Muscle Wasting in Critical Illness
Puthucheary ZA, Rawal J, McPhail M, et al. Acute Skeletal Muscle Wasting in Critical Illness. JAMA. 2013;():-. doi:10.1001/jama.2013.278481

 

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