Safety and Feasibility Assessment of Repetitive Vascular Occlusion Stimulus (RVOS) Application to Multi-Organ Failure...

Area of Science:

• Critical Care Medicine
• Muscle Physiology
• Rehabilitation Science

Background:

• Intensive care unit-acquired weakness (ICU-AW) affects 40% of patients, leading to long-term physical disability.
• Muscle wasting is a key factor in ICU-AW pathogenesis.
• Repetitive vascular occlusion stimulus (RVOS) has shown promise in limiting muscle atrophy in other patient populations.

Purpose of the Study:

• To explore the safety, tolerability, feasibility, and acceptability of RVOS in adult multi-organ failure patients.
• To assess the exploratory outcomes of RVOS on muscle mass, clinical status, and blood biomarkers.
• To determine if RVOS can mitigate muscle wasting in the intensive care unit setting.

Main Methods:

• Adult multi-organ failure patients received standard care with or without twice-daily RVOS for 10 days.
• RVOS involved 4 cycles of 5-minute tourniquet inflation (50 mmHg supra-systolic) and 5-minute deflation.
• Outcomes included serious adverse events (SAEs), tolerability, rectus femoris cross-sectional area (RFCSA), echogenicity, clinical scores (SOFA), and blood biomarkers (IGF-1, syndecan-1, IL-4, TNF-RII).

Main Results:

• Recruitment was challenging, with only 12 of 32 participants enrolled; 76.1% of RVOS sessions were delivered to 5 participants, and 2 could not tolerate it.
• No SAEs were reported; RVOS was deemed acceptable by 75% of participants and 82% of staff.
• Both control and intervention groups showed significant decreases in RFCSA and increased echogenicity.
• The intervention group exhibited fewer cases of acute kidney injury (AKI), a greater decrease in SOFA score, increased IGF-1, and reduced syndecan-1, IL-4, and TNF-RII.

Conclusions:

• RVOS application in ICU patients appears safe and acceptable, but requires protocol modifications to improve tolerability and recruitment.
• Preliminary data suggest potential clinical benefits of RVOS in mitigating muscle wasting and improving outcomes in ICU patients.
• Further research with optimized protocols is warranted to confirm the efficacy of RVOS for ICU-AW prevention.