Mechanisms of Chronic Muscle Wasting and Dysfunction after an Intensive Care Unit Stay. A Pilot Study

Santos, Claudia C. dos; Hussain, Sabah N. A.; Mathur, Sunita; Picard, Martin; Herridge, Margaret S.; Correa, Judy; Bain, A. D.; Guo, Yeting; Advani, Andrew; Advani, Suzanne L.; Tomlinson, George; Katzberg, Hans D.; Streutker, Catherine; Cameron, Jill I.; Schols, Annemie; Gosker, Harry R.; Batt, Jane

doi:10.1164/rccm.201512-2344oc

Cited by 191 publications

(225 citation statements)

References 52 publications

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“…In this issue of the Journal, dos Santos and colleagues (pp. 821-830) studied a prospectively recruited cohort of patients who required mechanical ventilation for 1 week or longer after discharge from their index admission, which had lasted between 9 and 88 days (5). From an initial pool of 82 eligible and 27 consented patients, 11 were studied at both 7 days and 6 months.…”

confidence: 99%

“…Satellite cells are sparse, and it has been estimated that a minimum of 50 type I and 75 type II fibers should be assessed to draw meaningful conclusions even in young adults (7). dos Santos and colleagues were obliged to accept those specimens with 50 or more visible fibers only, presumably because biopsies from patients in the ICU are necessarily difficult to obtain (5). With this reservation, their finding that patients with demonstrable muscle atrophy at 6 months had fewer satellite cells than those without atrophy at this time point is relevant, because it implies that a reduced ability to regenerate impairs restoration of muscle mass after critical illness and explains variation between individuals.…”

confidence: 99%

“…Helping each revolution are useful conceptual simplifications that cognitively organized previously disparate problems and practices. In the first revolution: "shock" (3), "resuscitation," and "acute respiratory distress syndrome" (4); in the second: a "good death" and "acute care of the dying" (5).…”

Section: Advancing a Third Revolution In Critical Carementioning

confidence: 99%

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Muscle Regeneration after Critical Illness: Are Satellite Cells the Answer?

Polkey

Griffiths

Kemp

2016

Am J Respir Crit Care Med

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could be the use of prophylactic Pneumocystis-active agents in patients receiving long-term, high-dose inhaled or oral corticosteroid therapy. Unraveling these complex issues ought to be possible in larger longitudinal cohort-based studies.A possible weakness of the current study is that it employed crude extracts from murine P. murina infections, which may not be entirely consistent with human P. jirovecii antigen sensitization and are not suitable for skin hypersensitivity testing. To further develop the tools and approaches needed to further define the role on Pneumocystis in asthma, systematic definition of human Pneumocystis antigens could be very useful, opening a door to direct sensitization studies, assessment of individual cellar responses, and therapeutic vaccination. n

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confidence: 99%

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Muscle Regeneration after Critical Illness: Are Satellite Cells the Answer?

Polkey

Griffiths

Kemp

2016

Am J Respir Crit Care Med

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“…Patient frailty [13] may be an important predictor of outcome regardless of age or comorbid illness [14]. Further, assessment of muscle contractile capacity and not just muscle mass may be prognostically valuable [15].…”

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confidence: 99%

Long-term physical morbidity in ARDS survivors

Mehta

Póvoa

2016

Intensive Care Med

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Survivors of ARDS have significant morbidity. Thanks to innovative investigators, we have started to accumulate robust data regarding long-term physical and neuropsychological consequences of ARDS. These prognostic data are important for clinicians, patients and family members; and will be invaluable in the development of ICU and post-ICU multi-component interventions which will reduce short-and long-term morbidity.Herridge and her colleagues have led the way in ICU outcomes research. Their data paint a vivid and startling picture of profound-primarily extra-pulmonary-disability in survivors of critical illness [1][2][3]; and depressive symptoms in caregivers [4]. In ARDS survivors they showed exercise limitation, physical and psychological sequelae, decreased physical quality of life, and increased costs and use of healthcare services persisting over 5 years [1,2]. More recently their Towards RECOVER Study described outcomes of 391 ICU survivors mechanically ventilated for at least 7 days [3]. Using recursive partitioning modeling, the authors could stratify patients into four disability risk groups based on age and ICU length of stay (LOS); these four groups determine 1-year recovery and healthcare utilization independent of admitting diagnosis and illness severity. Patients older than 66 years with ICU LOS longer than 2 weeks sustained the worse disability and had 40 % 1-year mortality. They subsequently validated the four risk groups in their ARDS cohort [5].In an article recently published in Intensive Care Medicine, Pfoh and her colleagues contribute valuable data to the existing literature on ICU outcomes, with 5-year follow-up data from the Improving Care of All Patients (ICAP) study [6]. The ICAP study followed 222 acute lung injury (ALI) survivors for physical morbidity. At discharge 36 % had muscle weakness, with most improving within 12 months [7]; weakness was associated with impairments in physical function and quality of life that persisted at 24 months. Duration of bedrest during critical illness was consistently associated with weakness throughout the 24-month follow-up.The current study reports the trajectory of physical decline of the ICAP cohort over 5 years, and risk factors for decline. In 193 ALI survivors three measures of physical status were evaluated annually: muscle strength using Medical Resource Council (MRC) sumscore, exercise capacity as reflected in the 6 Minute Walk Test (6MWT), and the physical functioning questions of the Short Form SF36 Health Survey. Approximately 1/3 of followup assessments were conducted in patients' homes. For each measure, a patient was considered 'declined' if the score decreased more than the 'Reliable Change Index' at follow-up. Over 5 years, 64 patients (33 %) died and were categorized as 'declined' in all three measures. Overall 86 % of patients experienced death or decline in at least one measure; when decedents were excluded 69 % experienced decline. In the multivariable model, older age was associated with declines in muscle strength, exercise ca...

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“…There needs to be a better understanding of the actual pathophysiology of the impairments i.e., the effect of critical illness, the systemic inflammation, sedation, infection and how these events cause weakness, cognitive problems and psychological problems. Work is progressing on this aspect, with both recognition within critical care units of the long term effect of interventions, and the actual mechanisms involved (17)(18)(19)(20). Impairments may additionally persist for many years and intervention may need to continue beyond the 12 months period to demonstrate efficacy.…”

mentioning

confidence: 99%

Dealing with the critical care aftermath: where to from here?

Paratz

2016

J. Thorac. Dis.

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Mechanisms of Chronic Muscle Wasting and Dysfunction after an Intensive Care Unit Stay. A Pilot Study

Cited by 191 publications

References 52 publications

Muscle Regeneration after Critical Illness: Are Satellite Cells the Answer?

Muscle Regeneration after Critical Illness: Are Satellite Cells the Answer?

Long-term physical morbidity in ARDS survivors

Dealing with the critical care aftermath: where to from here?

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