Impact of Very Early Physical Therapy During Septic Shock on Skeletal Muscle: A Randomized Controlled Trial

Hickmann, C.; Castanares-Zapatero, Diego; Deldicque, Louise; Bergh, Peter Van den; Caty, Gilles; Robert, Annie; Roeseler, Jean; Francaux, Marc; Laterre, Pierre‐François

doi:10.1097/ccm.0000000000003263

Cited by 89 publications

(86 citation statements)

References 42 publications

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“…These findings are in line with recently published data by Hickmann et al presenting a pilot trial where very early mobilization including bed cycling of septic patients led to preservation of myocyte cross-sectional area. 24 Interestingly, our finding cannot be attributed to an intervention-associated suppression of muscle protein degradation, because MuRF-1 and Atrogin-1 gene expression and protein content were increased in the control and intervention group. It rather can be attributed to an increase in myosin heavy chain gene expression indicating that the muscle protein synthesis pathway was activated.…”

Section: Discussionmentioning

confidence: 57%

“…In this special patient cohort, there is no evidence regarding the molecular effect of early mobilization except a pilot trial by Hickmann et al . lacking clinical data . Our randomized trial is unique because it is the first that enables the interpretation of a broad molecular characterization in the light of clinical outcome data.…”

Section: Discussionmentioning

confidence: 99%

“…These findings are in line with recently published data by Hickmann et al . presenting a pilot trial where very early mobilization including bed cycling of septic patients led to preservation of myocyte cross‐sectional area …”

Section: Discussionmentioning

confidence: 99%

“…9,11,23 In this special patient cohort, there is no evidence regarding the molecular effect of early mobilization except a pilot trial by Hickmann et al lacking clinical data. 24 Our randomized trial is unique because it is the first that enables the interpretation of a broad molecular characterization in the light of clinical outcome data. Additionally, the high standard of early protocol-based physiotherapy utilized in the intervention and control group as well as the retrieval of open surgical muscle biopsies in patients with MODS distinguish our trial from previous investigations.…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Muscle wasting and function after muscle activation and early protocol‐based physiotherapy: an explorative trial

Wollersheim

Grunow

Carbon

et al. 2019

J cachexia sarcopenia muscle

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Background Early mobilization improves physical independency of critically ill patients at hospital discharge in a general intensive care unit (ICU)‐cohort. We aimed to investigate clinical and molecular benefits or detriments of early mobilization and muscle activating measures in a high‐risk ICU‐acquired weakness cohort. Methods Fifty patients with a SOFA score ≥9 within 72 h after ICU admission were randomized to muscle activating measures such as neuromuscular electrical stimulation or whole‐body vibration in addition to early protocol‐based physiotherapy (intervention) or early protocol‐based physiotherapy alone (control). Muscle strength and function were assessed by Medical Research Council (MRC) score, handgrip strength and Functional Independence Measure at first awakening, ICU discharge, and 12 month follow‐up. Patients underwent open surgical muscle biopsy on day 15. We investigated the impact of muscle activating measures in addition to early protocol‐based physiotherapy on muscle strength and function as well as on muscle wasting, morphology, and homeostasis in patients with sepsis and ICU‐acquired weakness. We compared the data with patients treated with common physiotherapeutic practice (CPP) earlier. Results ICU‐acquired weakness occurs within the entire cohort, and muscle activating measures did not improve muscle strength or function at first awakening (MRC median [IQR]: CPP 3.3 [3.0–4.3]; control 3.0 [2.7–3.4]; intervention 3.0 [2.1–3.8]; P > 0.05 for all), ICU discharge (MRC median [IQR]: CPP 3.8 [3.4–4.4]; control 3.9 [3.3–4.0]; intervention 3.6 [2.8–4.0]; P > 0.05 for all), and 12 month follow‐up (MRC median [IQR]: control 5.0 [4.3–5.0]; intervention 4.8 [4.3–5.0]; P = 0.342 for all). No signs of necrosis or inflammatory infiltration were present in the histological analysis. Myocyte cross‐sectional area in the intervention group was significantly larger in comparison with the control group (type I +10%; type IIa +13%; type IIb +3%; P < 0.001 for all) and CPP (type I +36%; type IIa +49%; type IIb +65%; P < 0.001 for all). This increase was accompanied by an up‐regulated gene expression for myosin heavy chains (fold change median [IQR]: MYH1 2.3 [1.1–2.7]; MYH2 0.7 [0.2–1.8]; MYH4 5.1 [2.2–15.3]) and an unaffected gene expression for TRIM63 , TRIM62 , and FBXO32 . Conclusions In our patients with sepsis syndrome at high risk for ICU‐acquired weakness muscle activating measures in addition to early protocol‐based physiotherapy did not improve muscle strength or function at first awakening, ICU discharge, or 12 month follow‐up. Yet it prevented muscle atrophy.

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Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Muscle wasting and function after muscle activation and early protocol‐based physiotherapy: an explorative trial

Wollersheim

Grunow

Carbon

et al. 2019

J cachexia sarcopenia muscle

View full text Add to dashboard Cite

show abstract

“…Early mobilization, or exercise after recovery, is a well-known prevention method to prevent sepsis complications (6) and the American College of Critical Care Medicine (ACCM) emphasizes that early mobilization plays a key role for preventing delirium (7). Early mobilization is de ned as applied physical activity within the rst 2 to 5 days of critical illness or injury (8), and a recent randomized, clinical study revealed that early mobilization during septic shock prevents muscle atrophy (9). Implicated pathways for muscle atrophy during sepsis include the mammalian target of rapamycin (MTor)(10), interleukin-6 (IL-6)(11), and tumor necrosis factor-alpha (TNF-α) (12).…”

Section: Introductionmentioning

confidence: 99%

Establishment of a murine, lipopolysaccharide-induced sepsis model for testing anaerobic exercise thresholds and early mobilization

Matsuishi

Shimojo

Hoshino

et al. 2020

Preprint

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Background: Several methods have been proposed to prevent post intensive care syndrome (PICS) after sepsis, including early mobilization, but controversy remains in mechanisms and outcomes. Translational studies are required to fully reveal the optimal exercise intensity during acute phase sepsis. The aim of this study is to establish a septic mouse model and and classify exercise intensi ties during the acute phase of sepsis. Methods: Adult, male C57/B6 mice received lipopolysaccharide (LPS) injections (20mg/kg). We recorded survival rates and metabolic changes, such as resting energy expenditure (REE) compared with controls up to 72h after LPS administration. We also observed vital signs (rectal temperature and weight change) and inflammation (TNF-αand IL-6). We detected exercise intensity via metabolic monitoring treadmill, analyzed the anaerobic threshold (AT) by V-Slope Method and classified the intensity levels according to American College of Sports Medicine (ACSM) guidelines.Result: Around 30% of the mice survived 72h after LPS induction with REE and rectal temperatures lowest at around 22-24h later (REE at 22h: 2.26±0.34 kcal/day p<0.05 vs. baseline; Rectal temperature at 24h: 29.17±0.48℃, p<0.05 vs. baseline). Gradual recovery was seen out to 72h. Blood concentrations of TNF-α were highest at the 12h timepoint (41.23±24.39 pg/ml, p<0.05 vs. baseline) and IL-6 was highest at 24h after LPS induction (1476.5±274.7 pg/ml, p<0.05 vs. baseline). Using the V‐Slope method, we observed the AT at each timepoint (6h:14m/min,12h: 9m/min, 24h:4m/min,36h:10m/min, 48h:16m/min,60h:20m/min,72h:22m/min) and classified these into very low intensity exercise training (VLIT), low intensity exercise training (LIT), or moderate intensity exercise training (MIT) at each timepoint. Conclusion: We classified exercise intensities out to 72h after sepsis recovery using a mouse model. These data may serve as a bridge to clinical studies to fill gaps in best practice for sepsis rehabilitation.

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Protein and energy intake in intensive care unit survivors during the first year of recovery: A descriptive cohort study

Beumeler,

Visser,

Buter

et al. 2023

J Parenter Enteral Nutr

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PurposeMany ICU survivors suffer long‐term health issues, affecting their quality of life. Nutritional inadequacy can limit their rehabilitation potential. This study investigates nutritional intake and support during ICU admission and recovery.MethodsIn this prospective cohort study, 81 adult ICU patients with stays ≥ 48 hours were included. Data on dietary intake, feeding strategies, baseline/ICU characteristics, and one‐year outcomes (physical health and readmission rates) were collected. The number of patients achieving 1.2 g/kg/d protein and 25 kcal/kg/d at 3, 6, and 12 months post‐ICU was recorded. The impact of dietary supplementation during the year was assessed. Baseline characteristics, intake barriers, and rehabilitation's influence on nutritional intake at 12 months were evaluated, along with inadequate intake's effect on outcomes.ResultsAfter 12 months, only 10% of 60 patients achieved 1.2 g/kg/d protein intake, while 28% reached the advised 25 kcal/kg/d energy target. Supplementary feeding significantly increased protein intake at 3, 6, and 12 months (p=0.003, p=0.012, p=0.033) and energy intake at 3 months (p=0.003). A positive correlation was found between female sex and energy intake at 12 months post‐ICU (β=4.145, p=0.043), and taste issues independently associated with higher protein intake (β=0.363, p=0.036). However, achieving upper quartile protein or energy intake did not translate into improved physical health outcomes.ConclusionThis study shows that protein and energy intake is below recommendations in the majority of ICU survivors during the first year of recovery. Continuous and improved nutritional care is urgently needed to support patients in reaching nutritional adequacy.This article is protected by copyright. All rights reserved.

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Impact of Very Early Physical Therapy During Septic Shock on Skeletal Muscle: A Randomized Controlled Trial

Abstract: Supplemental Digital Content is available in the text.

Cited by 89 publications

References 42 publications

Muscle wasting and function after muscle activation and early protocol‐based physiotherapy: an explorative trial

Muscle wasting and function after muscle activation and early protocol‐based physiotherapy: an explorative trial

Establishment of a murine, lipopolysaccharide-induced sepsis model for testing anaerobic exercise thresholds and early mobilization

Protein and energy intake in intensive care unit survivors during the first year of recovery: A descriptive cohort study

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