Chhetri Ismita, Hunt Julie E A, Mendis Jeewaka R, Forni Lui G, Kirk-Bayley Justin, White Ian, Cooper Jonathan, Somasundaram Karthik, Shah Nikunj, Patterson Stephen D, Puthucheary Zudin A, Montgomery Hugh E, Creagh-Brown Benedict C
Intensive Care Unit, Royal Surrey County Hospital, NHS Foundation Trust, Guildford GU2 7XX, UK.
Faculty of Health and Medical Sciences, School of Biosciences & Medicine, University of Surrey, Guildford GU2 7XH, UK.
J Clin Med. 2022 Jul 6;11(14):3938. doi: 10.3390/jcm11143938.
Muscle wasting is implicated in the pathogenesis of intensive care unit acquired weakness (ICU-AW), affecting 40% of patients and causing long-term physical disability. A repetitive vascular occlusion stimulus (RVOS) limits muscle atrophy in healthy and orthopaedic subjects, thus, we explored its application to ICU patients. Adult multi-organ failure patients received standard care +/- twice daily RVOS {4 cycles of 5 min tourniquet inflation to 50 mmHg supra-systolic blood pressure, and 5 min complete deflation} for 10 days. Serious adverse events (SAEs), tolerability, feasibility, acceptability, and exploratory outcomes of the rectus femoris cross-sectional area (RFCSA), echogenicity, clinical outcomes, and blood biomarkers were assessed. Only 12 of the intended 32 participants were recruited. RVOS sessions (76.1%) were delivered to five participants and two could not tolerate it. No SAEs occurred; 75% of participants and 82% of clinical staff strongly agreed or agreed that RVOS is an acceptable treatment. RFCSA fell significantly and echogenicity increased in controls ( = 5) and intervention subjects ( = 4). The intervention group was associated with less frequent acute kidney injury (AKI), a greater decrease in the total sequential organ failure assessment score (SOFA) score, and increased insulin-like growth factor-1 (IGF-1), and reduced syndecan-1, interleukin-4 (IL-4) and Tumor necrosis factor receptor type II (TNF-RII) levels. RVOS application appears safe and acceptable, but protocol modifications are required to improve tolerability and recruitment. There were signals of possible clinical benefit relating to RVOS application.
肌肉萎缩与重症监护病房获得性肌无力（ICU-AW）的发病机制有关，影响40%的患者并导致长期身体残疾。重复性血管闭塞刺激（RVOS）可限制健康受试者和骨科患者的肌肉萎缩，因此，我们探索了其在ICU患者中的应用。成年多器官功能衰竭患者接受标准治疗，每天两次接受或不接受RVOS{4个周期，每个周期为5分钟，将止血带充气至收缩压以上50 mmHg，然后5分钟完全放气}，持续10天。评估了严重不良事件（SAE）、耐受性、可行性、可接受性以及股直肌横截面积（RFCSA）、回声性、临床结局和血液生物标志物等探索性结局。在计划招募的32名参与者中，仅招募到12名。RVOS疗程（76.1%）施用于5名参与者，2名无法耐受。未发生SAE；75%的参与者和82%的临床工作人员强烈同意或同意RVOS是一种可接受的治疗方法。对照组（n = 5）和干预组（n = 4）的RFCSA显著下降，回声性增加。干预组急性肾损伤（AKI）发生率较低，序贯器官衰竭评估（SOFA）总分下降幅度更大，胰岛素样生长因子-1（IGF-1）增加，而多配体蛋白聚糖-1、白细胞介素-4（IL-4）和肿瘤坏死因子受体II型（TNF-RII）水平降低。RVOS的应用似乎是安全且可接受的，但需要修改方案以提高耐受性和招募率。有迹象表明RVOS的应用可能具有临床益处。
