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Muscle wasting and function after muscle activation and early protocol-based physiotherapy: an explorative trial
Tobias Wollersheim1,2, Julius J Grunow1,3, Niklas M Carbon1
1Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
Journal of Cachexia, Sarcopenia and Muscle
|April 25, 2019
Summary
Muscle activating measures did not improve strength or function in critically ill patients with sepsis and ICU-acquired weakness. However, these interventions were found to prevent muscle atrophy, indicating a potential benefit in muscle mass preservation.
Area of Science:
- Critical Care Medicine
- Intensive Care Unit (ICU) Studies
- Muscle Physiology and Pathology
Background:
- Critically ill patients in the intensive care unit (ICU) are at high risk of developing ICU-acquired weakness.
- Early mobilization is known to improve physical independence in general ICU populations.
- This study focuses on a high-risk cohort with sepsis and severe organ dysfunction (SOFA score ≥9).
Purpose of the Study:
- To investigate the clinical and molecular effects of early mobilization combined with muscle-activating measures in a high-risk ICU-acquired weakness cohort.
- To assess the impact on muscle strength, function, wasting, morphology, and homeostasis.
- To compare outcomes with standard early physiotherapy alone.
Main Methods:
- Randomized controlled trial involving 50 patients with SOFA score ≥9.
- Intervention group received early protocol-based physiotherapy plus muscle-activating measures (neuromuscular electrical stimulation or whole-body vibration).
- Control group received early protocol-based physiotherapy alone. Muscle strength (MRC score, handgrip), function (FIM), and muscle biopsies were assessed.
Main Results:
- Muscle activating measures did not significantly improve muscle strength or function at any assessment point (first awakening, ICU discharge, 12-month follow-up).
- Histological analysis revealed no signs of necrosis or inflammatory infiltration.
- Significantly larger myocyte cross-sectional areas were observed in the intervention group compared to controls, indicating prevention of muscle atrophy.
Conclusions:
- In severe sepsis patients at high risk for ICU-acquired weakness, muscle activating measures combined with early physiotherapy did not enhance muscle strength or function.
- These measures were effective in preventing muscle atrophy, as evidenced by larger myocyte size.
- Further research may explore optimizing these interventions for specific patient subgroups.
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