William Harvey Research Institute, Barts and The London School of Medicine & Dentistry, Queen Mary University of London.
Adult Critical Care Unit, Royal London Hospital, London, UK.
Curr Opin Crit Care. 2023 Apr 1;29(2):108-113. doi: 10.1097/MCC.0000000000001020. Epub 2023 Jan 30.
Muscle wasting in critical illness has proven to be refractory to physical rehabilitation, and to conventional nutritional strategies. This presents one of the central challenges to critical care medicine in the 21st century. Novel strategies are needed that facilitate nutritional interventions, identify patients that will benefit and have measurable, relevant benefits.
Drug repurposing was demonstrated to be a powerful technique in the coronavirus disease 2019 pandemic, and may have similar applications to address the metabolic derangements of critical illness. Newer biological signatures may aid the application of these techniques and the association between changes in urea:creatinine ratio and the development of skeletal muscle wasting is increasing. A core outcome set for nutrition interventions in critical illness, supported by multiple international societies, was published earlier this year should be adopted by future nutrition trials aiming to attenuate muscle wasting.
The evidence base for the lack of efficacy for conventional nutritional strategies in preventing muscle wasting in critically ill patients continues to grow. Novel strategies such as metabolic modulators, patient level biological signatures of nutritional response and standardized outcome for measurements of efficacy will be central to future research and clinical care of the critically ill patient.
危重病患者的肌肉减少已被证明对物理康复和常规营养策略具有抗性。这是 21 世纪重症监护医学的核心挑战之一。需要新的策略来促进营养干预，确定将受益且具有可衡量、相关益处的患者。
药物再利用在 2019 年冠状病毒病大流行中被证明是一种强大的技术，并且可能具有类似的应用，以解决危重病的代谢紊乱。新的生物学特征可能有助于这些技术的应用，尿素：肌酐比值的变化与骨骼肌减少症的发展之间的关联正在增加。今年早些时候，由多个国际协会支持的危重病营养干预的核心结局集已发布，应被旨在减轻肌肉减少症的未来营养试验采用。
越来越多的证据表明，常规营养策略在预防危重病患者肌肉减少方面缺乏疗效。代谢调节剂、营养反应的患者水平生物学特征以及疗效测量的标准化结局等新策略将是未来危重病患者研究和临床护理的核心。
