Muscle Mass Loss in the Older Critically Ill Population: Potential Therapeutic Strategies

Abstract

Skeletal muscle plays a critical role in everyday life, and its age‐associated reduction has severe health consequences. The pre‐existing presence of sarcopenia, combined with anabolic resistance, protein undernutrition, and the pro‐catabolic/anti‐anabolic milieu induced by aging and exacerbated in critical care, may accelerate the rate at which skeletal muscle is lost in patients with critical illness. Advancements in intensive care unit (ICU)–care provision have drastically improved survival rates; therefore, attention can be redirected toward other significant issues affecting ICU patients (e.g., length of stay, days on ventilation, nosocomial disease development, etc.). Thus, strategies targeting muscle mass and function losses within an ICU setting are essential to improve patient‐related outcomes. Notably, loading exercise and protein provision are the most compelling. Many older ICU patients seldom meet the recommended protein intake, and loading exercise is difficult to conduct in the ICU. Nevertheless, the incorporation of physical therapy (PT), neuromuscular electrical stimulation, and early mobilization strategies may be beneficial. Furthermore, a number of nutrition practices within the ICU have been shown to improve patient‐related outcomes ((e.g., feeding strategy [i.e., oral, early enteral, or parenteral]), be hypocaloric (∼70%–80% energy requirements), and increase protein provision (∼1.2–2.5 g/kg/d)). The aim of this brief review is to discuss the dysregulation of muscle mass maintenance in an older ICU population and highlight the potential benefits of strategic nutrition practice, specifically protein, and PT within the ICU. Finally, we provide some general guidelines that may serve to counteract muscle mass loss in patients with critical illness.

β-Hydroxy-β-Methylbutrate (HMB) Supplementation and Functional Outcomes in Multi-trauma Patients: A Study Protocol for a Pilot Randomised Clinical Trial (BOOST trial)

“…There is no accepted intervention to prevent or attenuate muscle wasting in critically ill trauma patients (6)(7)(8). Provision of a nutrition intervention over an increased duration may be more likely to attenuate muscle loss and improve patient-centred outcomes when recovering from critical illness (10).…”

“…Various nutritional interventions have been evaluated in attempts to attenuate muscle loss in critically ill patients. However, the effects have been inconsistent (6)(7)(8). This may be because the interventions chosen are truly of no bene t. Alternatively, the lack of effect may be due to the period of study.…”

Optimal Nutritional Factors Influencing the Duration of Mechanical Ventilation Among Adult Patients with Critical Illnesses in an Intensive Care Unit

“…Moreover, most patients received calories target in this study may relate to the fact that adequate energy could reduce mechanical ventilation duration. [18][19][20] This study shows that starting EN as soon as possible or within 24-48 hours after hospitalization or resuscitation and promoting adequate energy may affect mechanical ventilation duration. The reasons are to promote intestinal absorption, to prevent intestinal atrophy, as well as to increase blood circulation in gastrointestinal tract and to reduce incidence of organ failure and immune system.…”

“…Losing of muscle mass directly affects diaphragm muscle causing muscle weakness, especially chest wall muscles which has a direct impact on breathing and difficult to wean off mechanical ventilation. [18][19][20][21] Therefore, time to initial EN should begin as soon as possible or within 48 hours to recover immune systems (immunosuppressive-inflammatory response), produce proteins, restore organs to work normally, [2][3][4] provide daily calories target or adequate energy requirements. These factors are important for critical patients using mechanical ventilation as they need more energy and protein.…”

Prevalence and Associated Factors of Coexistence of Malnutrition and Sarcopenia in Geriatric Rehabilitation

“…Since some patients with a longer stay in an acute care hospital received rehabilitation to regain muscle function, a longer hospital stay did not necessarily mean longer periods of disuse. Some proposed approaches to mitigate muscle mass loss in an acute care setting include physical rehabilitation, neuromuscular electrical stimulation, or early mobilisation strategy [38]. However, as previously reported, it is also possible that the patients who had malnutrition and/or sarcopenia before the disease onset tend to have a longer length of stay [39,40].…”