Figure 1 - uploaded by Nobuto Nakanishi
Content may be subject to copyright.
Source publication
Critically ill patients exhibit prominent muscle atrophy, which occurs rapidly after ICU admission and leads to poor clinical outcomes. The extent of atrophy differs among muscles as follows: upper limb: 0.7%–2.4% per day, lower limb: 1.2%–3.0% per day, and diaphragm 1.1%–10.9% per day. This atrophy is caused by numerous risk factors such as inflam...
Contexts in source publication
Context 1
... is the main cause of muscle atrophy in the early course of critical illness ( Fig. 1) (40). In patients who develop ICU-AW, the level of inflammatory cytokines, including interleukin 6, 8, and 10, was significantly higher (OR, 1.35 ; 95% CI, 1.18-1.55) in the first 4 days after ICU admission (41). Intramuscular inflammation causes catabolism and impairs anabolic signaling with consequent muscle mass reduction (42,43). ...
Context 2
... is the main cause of muscle atrophy in the early course of critical illness ( Fig. 1) (40). In patients who develop ICU-AW, the level of inflammatory cytokines, including interleukin 6, 8, and 10, was significantly higher (OR, 1.35 ; 95% CI, 1.18-1.55) in the first 4 days after ICU admission (41). Intramuscular inflammation causes catabolism and impairs anabolic signaling with consequent muscle mass reduction (42,43). ...
Similar publications
Titin is a giant protein that functions as a molecular spring in sarcomeres. Titin interconnects the contraction of actin-containing thin filaments and myosin-containing thick filaments. Titin breaks down to form urinary titin N-fragments, which are measurable in urine. Urinary titin N-fragment was originally reported to be a useful biomarker in th...
Citations
... Atrophy of lower-limb skeletal muscle can occur at a rate of 1.2-3.0% per day [4]. Persistent atrophy and impaired contractility contribute to permanent weaknesses in critical illness survivors and cause long-lasting physical functional impairments, a reduction in quality of life, and significant increases in health resource utilization [5]. 2 of 11 Neuromuscular Electrical Stimulation (NMES) can preserve the strength and physical function of patients in the intensive care unit (ICU) [6] and can also be used post-ICU in rehabilitation programs. ...
We assessed the feasibility of implementing a virtually guided Neuromuscular Electrical Stimulation (NMES) protocol over the tibialis anterior (TA) muscle while collecting heart rate (HR), Numeric Pain Rating Scale (NPRS), and quality of contraction (QoC) data. We investigated if HR, NPRS, and QoC differ ON and OFF the TA motor point and explored potential relationships between heart rate variability (HRV) and the NPRS. Twelve healthy adults participated in this cross-sectional study. Three NMES trials were delivered ON and OFF the TA motor point. HR, QoC, and NPRS data were collected. There was no significant difference in HRV ON and OFF the motor point (p > 0.05). The NPRS was significantly greater OFF the motor point (p < 0.05). The QoC was significantly different between motor point configurations (p < 0.05). There was no correlation between the NPRS and HRV (p > 0.05, r = −0.129). We recommend non-electrical methods of measuring muscle activity for future studies. The NPRS and QoC can be administered virtually. Time-domain HRV measures could increase the validity of the protocol. The variables should be explored further virtually to enhance the protocol before eventual ICU studies.
... EMS was applied to the bilateral upper and lower limb muscles (biceps brachii, quadriceps femoris, and gastrocnemius muscles: middle of the upper arm and approximately 2 cm above the cubital fossa for biceps brachii, approximately 5 cm below the inguinal fold and 3 cm above the upper patella border for the quadriceps femoris, and approximately 3 cm below the popliteal fossa and immediately above the proximal end of the Achilles tendon for the gastrocnemius muscles) with a stimulator (Solius; Minato Medical Science, Osaka, Japan) using selfadhesive surface electrodes (40 × 80 mm). The EMS intervention included as part of the standard rehabilitation therapy for patients with respiratory or circulatory failure and postoperative patients in the ICU in our institution was reported previously [20][21][22] . We applied EMS with a variable-frequency train that began with high-frequency bursts (200 Hz), followed by low-frequency stimulation (20 Hz), and EMS was applied as a symmetrical biphasic square wave with 0.4-s pulses of direct current followed by a 0.6-s pause. ...
We investigated the effects of acute-phase intensive electrical muscle stimulation (EMS) on physical function in COVID-19 patients with respiratory failure requiring invasive mechanical ventilation (IMV) in the intensive care unit (ICU). Consecutive COVID-19 patients requiring IMV admitted to a university hospital ICU between January and April 2022 (EMS therapy group) or between March and September 2021 (age-matched historical control group) were included in this retrospective observational case–control study. EMS was applied to both upper and lower limb muscles for up to 2 weeks in the EMS therapy group. The study population consisted of 16 patients undergoing EMS therapy and 16 age-matched historical controls (median age, 71 years; 81.2% male). The mean period until initiation of EMS therapy after ICU admission was 3.2 ± 1.4 days. The EMS therapy group completed a mean of 6.2 ± 3.7 EMS sessions, and no adverse events occurred. There were no significant differences between the two groups in Medical Research Council sum score (51 vs. 53 points, respectively; P = 0.439) or ICU mobility scale at ICU discharge. Addition of upper and lower limb muscle EMS therapy to an early rehabilitation program did not result in improved physical function at ICU discharge in severe COVID-19 patients.
... The practice of early mobilization (EM) in the ICU is becoming increasingly proactive (1)(2)(3)(4)(5). However, even in a recent meta-analysis, the advantages of EM have yet to be conclusively demonstrated (1). ...
Objectives
To ascertain whether a mobile patient lift facilitates early mobilization in ventilated ICU patients.
Design
A single-center, open-label, randomized controlled trial.
Setting
An academic ICU in Tokyo.
Patients
Eighty patients were admitted to ICU and expected ventilation for at least 48 hours.
Interventions
In the intervention group, in addition to the rehabilitation protocol received by the control group, patients were assisted in sitting, standing, transfers, and walking using the mobile patient lift.
Measurements and Main Results
The intervention group predominantly stood faster than the control group (1.0 vs. 3.0 d, p < 0.01). The Intervention group also had significantly higher Functional Status Score-ICU scores at ICU discharge. However, the Medical Research Council score and Barthel index at discharge, length of ICU stay, and number of ventilator-free days did not differ between the two groups.
Conclusions
The use of mobile patient lifts facilitates the earlier standing of patients on ventilators. This may contribute to patients improved physical function in the ICU.
Trial Registration
The study protocol was registered with the University Hospital Medical Information Network (UMIN) under the registration number UMIN000044965. Registered July 30, 2021.
... for lower limbs and 0.7-2.4% for upper limbs. 6 In a more recent meta-analysis, Fazzini et al. demonstrated that muscle mass of rectus femoris decreased by approximately 2% daily in critically ill patients. 24 Our results of a TM atrophy rate of 2.0% per day are consistent with these findings. ...
Objective
This study investigates temporal muscle atrophy in out-of-hospital cardiac arrest patients post-resuscitation, seeking associations with neurological outcomes and factors associated with atrophy.
Methods
Using data from six Japanese intensive care units, adult patients’ post-resuscitation who underwent head computed tomography scans on admission and two to five days post-admission were assessed. Temporal muscle area, thickness, and density were quantified from a single cross-sectional image. Patients were categorized into 'atrophy' or 'no atrophy' groups based on median daily temporal muscle atrophy rates. The primary outcome was changes in temporal muscle dimensions between admission and follow-up two to five days later. Secondary outcomes included assessing the impact of temporal muscle atrophy on 30-day survival, as well as identifying any clinical factors associated with temporal muscle atrophy.
Results
A total of 185 patients were analyzed. Measurements at follow-up revealed significant decreases in temporal muscle area (214 vs. 191 mm², p < 0.001), thickness (4.9 vs. 4.7 mm, p < 0.001), and density (46 vs. 44 HU, p < 0.001) compared to those at admission. The median daily rate for temporal muscle area atrophy was 2.0% per day. There was no significant association between temporal muscle atrophy and 30-day survival (hazard ratios, 0.71; 95% CI, 0.41–1.23, p = 0.231). Multivariable logistic regression found no clinical factors significantly associated with temporal muscle atrophy.
Conclusions
Temporal muscle atrophy in post-resuscitation patients occurs rapidly at 2.0% per day. However, there was no significant association with 30-day mortality or any identified clinical factors. Further investigation into its long-term functional implications is warranted.
... Several authors agree that the loss of muscle mass in ICU patients with invasive mechanical ventilation can be affected by factors such as immobilization during sedation, the use of neuromuscular relaxants, corticosteroids, sepsis, hyperglycemia, and the use of insulin (13)(14)(15) . In this study, an important prevalence of these factors was observed, with 69% of the patients requiring sedation, 41% neuromuscular relaxation, 63% vasopressor support and, in some cases, insulin infusion for better metabolic control as therapeutic management. ...
Background: Patients with severe forms of COVID-19 (coronavirus disease 2019) present a systemic inflammatory response and hypermetabolism. The objective of this study was to identify the change in rectus femoris and vastus medialis muscle mass in patients with severe COVID-19 who required invasive mechanical ventilation, and to establish the correlation between the change in muscle size and the amount of calories and proteins administered. Materials & methods: This prospective observational longitudinal study was conducted in the adult intensive care unit in a tertiary care clinic. Muscle mass was measured with ultrasound from admission, at seven-day intervals, until discharge from the unit. Anthropometric and biochemical data as well as the amount of calories and proteins administered were taken into account. Results: A total of 39 patients were included (59.6 ± 11.3 years; 79.5% men) with a median BMI of 27.7 kg/m2 (IQR 24.2–29.7). The size of the rectus femoris and vastus medialis muscles had diminished significantly at seven days of hospitalization: right middle third 0.38 cm (IQR 0.16-0.47), left middle third 0. 29 cm (IQR 0.08-0.54) and right middle third 0.37 cm (IQR 0.11-0.71) left middle third 0.25 cm (IQR 0.09-0.52), respectively. The changes in both muscles were directly correlated with caloric and protein intake during nutritional support. Conclusions: Critically ill patients with COVID-19 were found to lose muscle mass progressively as a result of lower coverage of caloric and protein requirements.
... MRC, Medical Research Council; SPPB, short physical performance battery; 5STS, five-times sit-tostand test; 6MWD, 6-minutes walking distance in muscle thickness of approximately 20% over 7 or 10 days 14) . In addition, a 15% cutoff value for the rate of decrease in the thicknesses of the RF and vastus intermedius for each muscle has been reported in critically ill patients with severe muscle weakness 15) . ...
Introduction:
Early implementation of neuromuscular electrical stimulation (NMES) has been reported to prevent muscle atrophy and physical functional decline in patients requiring mechanical ventilation. However, its effect in patients with acute exacerbation of interstitial lung disease (ILD) remains unclear. We herein report our experience using the NMES combined with mobilization in a patient with an acute exacerbation of rheumatoid arthritis-associated ILD (RA-ILD) requiring mechanical ventilation.
Case presentation:
A 74-year-old man was admitted to the intensive care unit (ICU) and put on mechanical ventilation due to severe acute exacerbation of RA-ILD. Early mobilization and the NMES using a belt electrode skeletal muscle electrical stimulation system were started on day 7 of hospitalization (day 2 of ICU admission). The NMES duration was 20 min, performed once daily. The patient could perform mobility exercises on day 8 and could walk on day 16. We assessed his rectus femoris and quadriceps muscle thicknesses using ultrasound imaging, and found decreases of 4.5% and 8.4%, respectively, by day 14. On day 27, he could independently visit the lavatory, and the NMES was discontinued. He was instructed to start long-term oxygen therapy on day 49 and was discharged on day 63. His 6-minute walk distance was 308 m and his muscle thickness recovered to levels comparable to those at the initial evaluation at the time of discharge.
Conclusion:
Combining the NMES and mobilization started in the early phase and continued after ICU discharge was safe and effective in a patient with a severe acute exacerbation of RA-ILD.
... Muscular thickness and the cross-sectional areas (CSAs) of the muscles could be good indicators of ICU-AW. 4) However, muscular echogenicity has not been fully investigated in patients admitted to the ICU; furthermore, it is still unknown whether the findings of muscular echogenicity can predict functional outcomes. This study aimed to investigate whether the degree of muscular echogenicity in ICU patients can facilitate early detection of ICU-AW and the prediction of physical function at hospital discharge. ...
Objectives:
This retrospective observational study investigated whether the degree of muscular echogenicity in patients admitted to the intensive care unit (ICU) could help with the early detection of ICU-acquired weakness (ICU-AW) and predict physical function at hospital discharge.
Methods:
Twenty-five patients who were mechanically ventilated for more than 48 h in the ICU were enrolled. We also enrolled 23 outpatients with nonmuscular diseases as the control group. The target sites for measuring muscular echogenicity were the upper arm and lower leg. First, the muscular echogenicity was compared between surviving nonsurgical patients admitted to the ICU and stable outpatients with nonmuscular diseases. Second, we investigated the relationship between muscular echogenicity and clinical features, e.g., the manual muscle test (MMT), Medical Research Council (MRC) sum score, and Functional Independence Measure (FIM).
Results:
Muscular echogenicity in the upper arm in the ICU group was significantly higher than that in the control group. In the ICU group, the degree of muscular echogenicity of the upper arm was inversely correlated with the MMT of elbow flexion (P=0.006; r=-0.532) and the MRC sum score (P=0.002; r=-0.591). However, muscular echogenicity of the upper arm did not correlate with functional FIM (P=0.100; r=-0.344) at hospital discharge.
Conclusions:
Critically ill patients can experience pathological muscle weakness associated with increased muscular echogenicity in the upper arm. Additionally, the degree of muscular echogenicity in the upper arm correlated with the MRC sum score and can facilitate early detection of ICU-AW. The relationship between echogenicity and functional outcome at discharge requires elucidation.
... Hyperglycemia, nutritional deprivation, immobilization, sepsis, multiple organ dysfunction syndrome, catecholamines, corticosteroids, and neuromuscular blockers are risk factors for muscle weakness and atrophy [9]. Muscle weakness in severe cases can lead to tetraplegia, reduction or loss of tendon reflex, delay in weaning from mechanical ventilation, and physical disability. ...
... In addition, the study of Thomas et al. showed that even after 12 months of discharge from the intensive care unit, the improvement of physical and cognitive function and quality of life has not been completely achieved [4]. Early intervention in the early hours of admission to the ICU, rehabilitation, early mobilization, respiratory physiotherapy, limb physiotherapy, nutritional support, and electrical muscular stimulation help maintain muscle mass [9]. Therefore, the use of strategies and interventions to reduce such complications in ICU patients seems necessary. ...
Background
Atrophy and muscle weakness is a common problem in critically ill patients admitted to the intensive care unit (ICU). Muscle weakness in severe cases can lead to tetraplegia, reduced or lost tendon reflexes, delayed weaning from mechanical ventilation, physical disability, and increased mortality. The aim of this study was to compare the effects of range of motion exercises (ROM) and massage on muscle strength of the patients admitted to ICUs.
Methods
This study was a single-blinded randomized controlled trial conducted in ICUs of Afzalipour hospital in Kerman, southeastern Iran. Ninety conscious ICU patients were randomly divided into three groups (massage, ROM exercises and control). The researcher/co-researcher massaged or did ROM exercises on the patients’ extremities once a day for seven consecutive days. Using a hand-held dynamometer, the co-researcher, rated the muscle strength before, on the fourth and seventh days of intervention at 8 p.m.
Results
The mean muscles strength of the right arm in the ROM exercise and massage groups increased by 0.63 kg, and 0.29 kg, respectively after the intervention compared with before the intervention. The muscle strength of the right arm in the control group reduced by 0.55 kg. The mean muscles strength of the left arm in the ROM exercise and massage groups increased by 0.61 kg and 0.28 kg after the intervention, respectively while it reduced by 0.56 kg in the control group. The mean muscles strength of the right leg in the ROM exercise and massage groups increased by 0.53 kg and 0.27 kg after the intervention compared with before the intervention while it reduced by 0.70 kg in the control group. The mean muscles strength of the left leg in the ROM exercise and massage groups increased by 0.54 kg and 0.26 kg after the intervention compared with before the intervention while it reduced by 0.71 kg in the control group.
Conclusion
The results of the present study showed that ROM exercises and massage were effective interventions in increasing muscle strength of the critically ill patients admitted to intensive care units.
... Critically ill patients experience atrophy of various muscles, including respiratory muscles [1]. Respiratory muscle dysfunction seems to occur much more rapidly than general limb muscles [2,3]. ...
... Since muscle atrophy occurs 1.2-3.0% per day in clinically ill patients [27], a high discrepancy will cause substantial influence on the results. Our result indicates that accurate measurement requires an understanding of these results and sufficient training. ...
Ultrasound has become widely used as a means to measure the rectus femoris muscle in the acute and chronic phases of critical illness. Despite its noninvasiveness and accessibility, its accuracy highly depends on the skills of the technician. However, few ultrasound phantoms for the confirmation of its accuracy or to improve technical skills exist. In this study, the authors created a novel phantom model and used it for investigating the accuracy of measurements and for training. Study 1 investigated how various conditions affect ultrasound measurements such as thickness, cross-sectional area, and echogenicity. Study 2 investigated if the phantom can be used for the training of various health care providers in vitro and in vivo. Study 1 showed that thickness, cross-sectional area, and echogenicity were affected by probe compression strength, probe angle, phantom compression, and varying equipment. Study 2 in vitro showed that using the phantom for training improved the accuracy of the measurements taken within the phantom, and Study 2 in vivo showed the phantom training had a short-term effect on improving the measurement accuracy in a human volunteer. The new ultrasound phantom model revealed that various conditions affected ultrasound measurements, and phantom training improved the measurement accuracy.
