Measurement of skeletal muscle glycogen status in critically ill patients: a new approach in critical care monitoring

Millán, Íñigo San; Hill, John C.; Wischmeyer, Paul E.

doi:10.1186/cc14480

Cited by 8 publications

(8 citation statements)

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“…26 The Perioperative Quality Initiative (POQI) is a previously described collaborative of diverse international experts in anesthesia, nursing, nutrition, and surgery tasked to develop consensus-based recommendations in ERP. 25,27 The format for grading of recommendations is included in Table 1.…”

Section: Methodsmentioning

confidence: 99%

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Nutrition Screening and Therapy Within a Surgical Enhanced Recovery Pathway

Wischmeyer

Carli

Evans

et al. 2018

Anesthesia &Amp; Analgesia

313

327

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Perioperative malnutrition has proven to be challenging to define, diagnose, and treat. Despite these challenges, it is well known that suboptimal nutritional status is a strong independent predictor of poor postoperative outcomes. Although perioperative caregivers consistently express recognition of the importance of nutrition screening and optimization in the perioperative period, implementation of evidence-based perioperative nutrition guidelines and pathways in the United States has been quite limited and needs to be addressed in surgery-focused recommendations. The second Perioperative Quality Initiative brought together a group of international experts with the objective of providing consensus recommendations on this important topic with the goal of (1) developing guidelines for screening of nutritional status to identify patients at risk for adverse outcomes due to malnutrition; (2) address optimal methods of providing nutritional support and optimizing nutrition status preoperatively; and (3) identifying when and how to optimize nutrition delivery in the postoperative period. Discussion led to strong recommendations for implementation of routine preoperative nutrition screening to identify patients in need of preoperative nutrition optimization. Postoperatively, nutrition delivery should be restarted immediately after surgery. The key role of oral nutrition supplements, enteral nutrition, and parenteral nutrition (implemented in that order) in most perioperative patients was advocated for with protein delivery being more important than total calorie delivery. Finally, the role of often-inadequate nutrition intake in the posthospital setting was discussed, and the role of postdischarge oral nutrition supplements was emphasized.

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Section: Methodsmentioning

confidence: 99%

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Nutrition Screening and Therapy Within a Surgical Enhanced Recovery Pathway

Wischmeyer

Carli

Evans

et al. 2018

Anesthesia &Amp; Analgesia

313

327

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“…We used this muscle glycogen ultrasound technology to assess nine ICU patients at varying points in their ICU stay as part of our ICU nutrition program evaluation; that is, in order to carry out quality assessment of our ICU nutrition delivery at University of Colorado (not research as defined by the US Department of Health and Human Services). The muscle glycogen score averaged 4, with seven of the nine patients scoring 0, which we have never observed in any other human population [ 25 ]. Thus, one might equate being in the ICU as similar to continuously running multiple marathons.…”

Section: Are Checklists and Bundles The Answer After The Icu?mentioning

confidence: 84%

Winning the war against ICU-acquired weakness: new innovations in nutrition and exercise physiology

2015

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Over the last 10 years we have significantly reduced hospital mortality from sepsis and critical illness. However, the evidence reveals that over the same period we have tripled the number of patients being sent to rehabilitation settings. Further, given that as many as half of the deaths in the first year following ICU admission occur post ICU discharge, it is unclear how many of these patients ever returned home. For those who do survive, the latest data indicate that 50-70% of ICU "survivors" will suffer cognitive impairment and 60-80% of "survivors" will suffer functional impairment or ICU-acquired weakness (ICU-AW). These observations demand that we as intensive care providers ask the following questions: "Are we creating survivors ... or are we creating victims?" and "Do we accomplish 'Pyrrhic Victories' in the ICU?" Interventions to address ICU-AW must have a renewed focus on optimal nutrition, anabolic/anticatabolic strategies, and in the future employ the personalized muscle and exercise evaluation techniques utilized by elite athletes to optimize performance. Specifically, strategies must include optimal protein delivery (1.2-2.0 g/kg/day), as an athlete would routinely employ. However, as is clear in elite sports performance, optimal nutrition is fundamental but alone is often not enough. We know burn patients can remain catabolic for 2 years post burn; thus, anticatabolic agents (i.e., beta-blockers) and anabolic agents (i.e., oxandrolone) will probably also be essential. In the near future, evaluation techniques such as assessing lean body mass at the bedside using ultrasound to determine nutritional status and ultrasound-measured muscle glycogen as a marker of muscle injury and recovery could be utilized to help find the transition from the acute phase of critical illness to the recovery phase. Finally, exercise physiology testing that evaluates muscle substrate utilization during exercise can be used to diagnose muscle mitochondrial dysfunction and to guide a personalized ideal heart rate, assisting in recovery of muscle mitochondrial function and functional endurance post ICU. In the end, future ICU-AW research must focus on using a combination of modern performance-enhancing nutrition, anticatabolic/anabolic interventions, and muscle/exercise testing so we can begin to create more "survivors" and fewer victims post ICU care.

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“…Glucose is stored as glycogen in muscle and the liver as the primary source of energy and for prevention of hypoglycemia . An 85% majority of glycogen is stored in muscle . Glycogen synthesis and its storage are regulated by insulin, and it is well established that glycogen synthesis is impaired with insulin resistance and in type 2 diabetes.…”

Section: Discussionmentioning

confidence: 99%

“…This appearance cannot be solely explained by excessive adipose infiltration, since in extreme adipose muscle infiltration, it has been reported that the echogenicity actually decreases . On the contrary, studies have shown that glycogen‐depleted muscles also appear hyperechoic, suggesting a US relationship between increased muscle echogenicity and decreased intramuscular glycogen …”

mentioning

confidence: 99%

The Hyperechoic Appearance of the Deltoid Muscle on Shoulder Ultrasound Imaging as a Predictor of Diabetes and Prediabetes

Soliman

Rosen

Williams

et al. 2019

J of Ultrasound Medicine

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Objectives To evaluate whether the ultrasound appearance of the deltoid muscle in diabetic patients differs from that in obese nondiabetic patients. Methods Ultrasound images of the deltoid muscle from 137 type 2 diabetic patients (including 13 prediabetic patients) and 49 obese nondiabetic patients were blindly reviewed by 2 musculoskeletal radiologists, and by a third when arbitration was needed, to determine whether the appearance was “normal,” “suspected diabetes,” or “definite diabetes.” Age, sex, race, body mass index (BMI), insulin use, and hemoglobin A1c were analyzed. This retrospective study included patients presenting between October 2005 and November 2017. Statistical analyses included a 2‐sided sample t test or Wilcoxon rank sum test and a χ2 or Fisher exact test. Statistical significance was defined as P < .05. Results The type 2 diabetic patients included 98 women and 39 men aged 29 to 92 years, and the nondiabetic patients included 19 women and 30 men aged 18 to 75 years. A consensus diagnosis of definite diabetes by the musculoskeletal radiologists based on a hyperechoic deltoid was a powerful predictor of diabetes, with a positive predictive value of 89%. A hyperechoic deltoid was also a powerful predictor of prediabetes. Of the 13 prediabetic patients, all had the same hyperechoic appearance of the diabetic deltoid, regardless of BMI. Although obese diabetic patients more often had a diagnosis of definite diabetes, the BMI alone could not explain the increased echogenicity, as obese nondiabetic patients’ deltoid muscles did not appear as hyperechoic and were correctly categorized as not having definite diabetes with 82% specificity. Conclusions The characteristic hyperechoic deltoid appearance is a strong predictor of both diabetes and prediabetes and differs from that of obese nondiabetic patients.

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Measurement of skeletal muscle glycogen status in critically ill patients: a new approach in critical care monitoring

Cited by 8 publications

References 0 publications

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Nutrition Screening and Therapy Within a Surgical Enhanced Recovery Pathway

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Nutrition Screening and Therapy Within a Surgical Enhanced Recovery Pathway

Winning the war against ICU-acquired weakness: new innovations in nutrition and exercise physiology

The Hyperechoic Appearance of the Deltoid Muscle on Shoulder Ultrasound Imaging as a Predictor of Diabetes and Prediabetes

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