Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
Berlin Institute of Health (BIH), Berlin, Germany.
J Cachexia Sarcopenia Muscle. 2019 Aug;10(4):734-747. doi: 10.1002/jcsm.12428. Epub 2019 Apr 23.
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.
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.
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.
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.
在普通重症监护病房（ICU）队列中，早期活动可提高危重病患者出院时的身体独立性。我们旨在调查早期活动和肌肉激活措施在高危 ICU 获得性肌无力患者中的临床和分子益处或危害。
50 名患者在 ICU 入院后 72 小时内 SOFA 评分≥9，随机分为肌肉激活措施组（如神经肌肉电刺激或全身振动），外加早期基于方案的物理治疗（干预）或早期基于方案的物理治疗（对照组）。肌肉力量和功能通过 Medical Research Council（MRC）评分、握力和功能独立性测量在首次觉醒、ICU 出院和 12 个月随访时进行评估。患者在第 15 天进行开放性外科肌肉活检。我们调查了除早期基于方案的物理治疗外，肌肉激活措施对脓毒症和 ICU 获得性肌无力患者的肌肉力量和功能以及肌肉萎缩、形态和内稳态的影响。我们将数据与早期接受常规物理治疗（CPP）的患者进行了比较。
ICU 获得性肌无力在整个队列中均存在，肌肉激活措施并不能改善首次觉醒时的肌肉力量或功能（MRC 中位数[IQR]：CPP 3.3[3.0-4.3]；对照组 3.0[2.7-3.4]；干预组 3.0[2.1-3.8]；所有 P 值均>0.05），ICU 出院时（MRC 中位数[IQR]：CPP 3.8[3.4-4.4]；对照组 3.9[3.3-4.0]；干预组 3.6[2.8-4.0]；所有 P 值均>0.05）和 12 个月随访时（MRC 中位数[IQR]：对照组 5.0[4.3-5.0]；干预组 4.8[4.3-5.0]；所有 P 值均=0.342）。组织学分析未发现坏死或炎症浸润的迹象。与对照组相比，干预组肌细胞横截面积明显增大（I 型+10%；IIa 型+13%；IIb 型+3%；所有 P 值均<0.001）和 CPP（I 型+36%；IIa 型+49%；IIb 型+65%；所有 P 值均<0.001）。这种增加伴随着肌球蛋白重链基因表达的上调（倍数变化中位数[IQR]：MYH1 2.3[1.1-2.7]；MYH2 0.7[0.2-1.8]；MYH4 5.1[2.2-15.3]），而 TRIM63、TRIM62 和 FBXO32 的基因表达不受影响。
在我们的脓毒症综合征高危患者中，除早期基于方案的物理治疗外，肌肉激活措施并不能改善首次觉醒、ICU 出院或 12 个月随访时的肌肉力量或功能。然而，它可以预防肌肉萎缩。
