Scripties UMCG - Rijksuniversiteit Groningen
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Additional enteral protein in combination with early mobilisation does not have an effect on muscle mass in critically ill patients – preliminary results

(2018) Dam, G.K.H. van

Background- Intensive care unit acquired muscle weakness (ICU-AW) is a frequent problem in critically ill patients. It manifests as early and fast muscle mass loss. Consequently, muscle mass loss has a negative impact on mortality, number of ventilation free days, length of stay at the ICU and physical functioning after hospitalisation. ICU-AW can be diagnosed via different methods, in particular ultrasound gained recent interest. Muscle ultrasound is easy, quick and a proven reliable method of analysing muscle mass. In order to limit or even restore loss of muscle mass, early mobilisation and protein supplementation appears to be a rational approach. Aim- To measure the effects of protein supplementation in combination with early mobilisation on muscle mass in critically ill patients who are at risk for ICU-AW. Methods- 16 eligible ICU patients were included in this single-centre, single blinded, randomised controlled study. Nine patients were randomized into the intervention group and seven patients into the control group. All received standard of care with early mobilisation three times per day and target nutritional protein intake of 1.5 g/kg/d. The intervention group received additional protein supplementation of 15 gram within 30 minutes after mobilisation. Muscle thickness ultrasound measurements, MRC-sum score, handgrip force and BIVA measurements were conducted at different times during ICU admission. Results- In both groups muscle mass, as defined by ultrasound, of the upper arm (control:-10.7% vs. intervention:-1.8%) and upper leg (control:-33.4% vs. intervention:-17.5%) declined equally (all p>.508). The intervention group received 48.5% of the planned intervention, mobilisation in combination with protein supplementation. Both groups overall showed a significant muscle mass decline in the first ten days of the fore arm of 8.7% (p<.008) and upper leg of 21.1% (p<.046). There was a significant positive correlation between phase angle corrected for total body water (PhAc) and left handgrip force (rs = 0.729, p< .01) and the right handgrip force (rs = 0.881, p< .001). There were no associations between muscle function and muscle volume. Conclusion- Enteral protein supplementation in combination with early mobilisation does not have a beneficial effect on muscle mass over time in critically ill patients at the ICU. These preliminary results should be interpreted with caution, due to small sample size.

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