Muscle wasting in the critically ill patient: how to minimise subsequent disability

Flower, Luke; Puthucheary, Zudin

doi:10.12968/hmed.2020.0045

Cited by 6 publications

(9 citation statements)

References 58 publications

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“…Given the marked deterioration of general condition or performance status associated with COVID-19, it is likely that muscle strength would be decreased in this setting. In addition, prolonged stay in ICU is known to be associated with muscle wasting, also resulting in reduced muscular strength [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Prevalence and severity of malnutrition in hospitalized COVID-19 patients

Bedock

Lassen

Mathian

et al. 2020

Clinical Nutrition ESPEN

172

187

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Background & aims Nutritional knowledge in patients with SARS-Cov2 infection (COVID-19) is limited. Our objectives were: i) to assess malnutrition in hospitalized COVID-19 patients, ii) to investigate the links between malnutrition and disease severity at admission, iii) to study the impact of malnutrition on clinical outcomes such as transfer to an intensive care unit (ICU) or death. Methods Consecutive patients hospitalized in a medicine ward at a university hospital were included from March 21st to April 24th 2020 (n = 114, 60.5% males, age: 59.9 ± 15.9 years). Nutritional status was defined using Global Leadership Initiative on Malnutrition (GLIM) criteria. Clinical, radiological and biological characteristics of COVID-19 patients were compared according to the presence of malnutrition. Logistic regression was used to assess associations between nutritional parameters and unfavourable outcomes such as transfer to intensive care unit (ICU) or death. Results The overall prevalence of malnutrition was 42.1% (moderate: 23.7%, severe: 18.4%). The prevalence of malnutrition reached 66.7% in patients admitted from ICU. No significant association was found between nutritional status and clinical signs of COVID-19. Lower albumin levels were associated with a higher risk of transfer to ICU (for 10 g/l of albumin, OR [95%CI]: 0.31 [0.1; 0.7]; p < 0.01) and this association was independent of age and CRP levels. Conclusions COVID-19 in medical units dedicated to non-intensive care is associated with a high prevalence of malnutrition, especially for patients transferred from ICU. These data emphasize the importance of early nutritional screening in these patients to adapt management accordingly.

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Section: Discussionmentioning

confidence: 99%

Prevalence and severity of malnutrition in hospitalized COVID-19 patients

Bedock

Lassen

Mathian

et al. 2020

Clinical Nutrition ESPEN

172

187

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“…Furthermore, substrate delivery and utilization are not always linked, as described above. An increased energy intake does not address the underlying components driving the mitochondrial dysfunction and will therefore be unable to restore normal metabolic function 2,5,29,30 …”

Section: Effect Of Critical Illness On Mitochondrial Functionmentioning

confidence: 99%

“…Inflammation and hypoxia disrupt the Pasteur effect, inhibiting pyruvate dehydrogenase 3,22 . As a result, the cell is unable to convert pyruvate to acetyl‐CoA, instead converting it into ethanol, carbon dioxide, and lactic acid 2,19,23,24 . This disrupted system results in the net production of only two ATP molecules (in contrast to the 38 produced through aerobic respiration) and the accumulation of harmful waste products 2,23,24 …”

Section: Effect Of Critical Illness On Mitochondrial Functionmentioning

confidence: 99%

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Should nutrition therapy be modified to account for mitochondrial dysfunction in critical illness?

Flower

Page

Puthucheary

2021

J Parenter Enteral Nutr

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Metabolic dysfunction, and its associated muscle atrophy, remains the most common complication of critical care. At the center of this is mitochondrial dysfunction, secondary to hypoxia and systemic inflammation. This leads to a bioenergetic crisis, with decreased intramuscular adenosine triphosphate content and a reduction in the highly energy‐dependent process of protein synthesis. Numerous methods have been studied to try and reduce these effects, with only limited success. Trials investigating the use of increased energy and protein administration have instead found a decrease in relative lean body mass and a potential increase in morbidity and mortality. Ketone bodies have been proposed as alternative substrates for metabolism in critical illness, with promising results seen in animal models. They are currently being investigated in critical care patients in the Alternative Substrates in the Critically Ill Subjects trial (ASICS). The evidence to date suggests that individualized feeding regimens may be key in the nutrition approach to critical illness. Consideration of individual patient factors will need to be combined with personalized protein content, total energy load received, and the timing of such feeds. This review covers mitochondrial dysfunction in critical illness, how it contributes to muscle wasting and the resultant morbidity and mortality, and the scientific basis of why current nutrition approaches to date have not been successful in negating this effect. These two factors underpin the need for consideration of alternative nutrition strategies in the critically ill patient.

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“…During a critical care admission, deterioration of muscle mass may occur rapidly with up to 2% of muscle mass lost per day 22–25. Loss of muscle mass has been associated with decreased 5-year survival as well as reduced physical function and quality of life up to 5 years after admission to critical care 26. Preexisting low muscle mass may compound those effects.…”

mentioning

confidence: 99%

Mortality and Length of Stay in Critically Ill Patients With Low Muscle Mass

Wedemire

Radler

Zelig

2022

Topics in Clinical Nutrition

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In critical care, low muscle mass is proposed as a risk factor for adverse outcomes that may be modified by nutrition. However, health care providers, including physicians and registered dietitians, may not routinely consider this risk factor in screening, assessing, or designing interventions. A literature search was conducted to compare clinical outcomes in critically ill adult patients with and without low muscle mass upon admission. This narrative review identified a statistically significant association between low muscle mass and increased risk of mortality and length of stay. Health care providers should consider screening for low muscle mass upon admission, as this may inform practice and improve clinical outcomes.

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Muscle wasting in the critically ill patient: how to minimise subsequent disability

Cited by 6 publications

References 58 publications

Prevalence and severity of malnutrition in hospitalized COVID-19 patients

Prevalence and severity of malnutrition in hospitalized COVID-19 patients

Should nutrition therapy be modified to account for mitochondrial dysfunction in critical illness?

Mortality and Length of Stay in Critically Ill Patients With Low Muscle Mass

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