Shengli Clinical College of Fujian Medical University, Fuzhou, China.
School of Nursing, Fujian Medical University, No.1 Xuefu North Road, Minhou County, Fuzhou, 35001, China.
Crit Care. 2023 Dec 15;27(1):493. doi: 10.1186/s13054-023-04698-x.
Intensive care unit-acquired weakness (ICU-AW) is a prevalent and severe issue among ICU patients. Resistance training and beta-hydroxy-beta-methylbutyrate (HMB) intervention have demonstrated the potential to enhance muscle function in patients with sarcopenia and in older adults. The purpose of this study was to determine whether resistance training and/or HMB administration would improve physical function, muscle strength, and quality of life in medical ICU patients.
In this multicentre, four-arm, single-blind randomised control trial, a total of 112 adult patients with internal medical diagnoses admitted to the ICU were enrolled. These participants were then randomly assigned to one of four treatment groups: the resistance training group received protocol-based multilevel resistance exercise, the HMB group received 3 g/day of HMBCa, combination group and control groups received standard care, from the ICU to the general ward until discharge. The primary outcomes assessed at discharge included six-minute walking distance (6MWD) and short physical performance battery (SPPB). Secondary outcomes measured included muscle mass, MRC score, grip strength, and health reports quality of life at different time points. Data analysis was performed using a generalised linear mixed model, adhering to the principles of intention-to-treat analysis.
Resistance training and combination treatment groups exhibited significant increases in SPPB scores (3.848 and 2.832 points, respectively) compared to the control group and substantial improvements in 6WMD (99.768 and 88.577 m, respectively) (all with P < 0.01). However, no significant changes were observed in the HMB group. Muscle strength, as indicated by MRC and grip strength tests conducted at both ICU and hospital discharge, showed statistically significant improvements in the resistance training and combination groups (P < 0.05). Nevertheless, no significant differences were found between the treatment groups and usual care in terms of 60-day mortality, prevalence of ICU-AW, muscle mass, quality of life, or other functional aspects.
Resistance training with or without beta-hydroxy-beta-methylbutyrate during the entire hospitalisation intervention improves physical function and muscle strength in medical ICU patients, but muscle mass, quality of life, and 60-day mortality were unaffected.
ChiCTR2200057685 was registered on March 15th, 2022.
重症加强护理病房获得性肌无力（ICU-AW）是 ICU 患者中普遍存在且严重的问题。阻力训练和β-羟基-β-甲基丁酸（HMB）干预已被证明可增强肌少症和老年人的肌肉功能。本研究旨在确定阻力训练和/或 HMB 给药是否会改善内科 ICU 患者的身体功能、肌肉力量和生活质量。
在这项多中心、四臂、单盲随机对照试验中，共纳入了 112 名患有内科诊断的成年 ICU 患者。这些参与者随后被随机分配到四个治疗组之一：阻力训练组接受基于方案的多层次阻力运动，HMB 组每天接受 3 克 HMB-Ca，联合组和对照组接受标准护理，从 ICU 到普通病房直到出院。出院时评估的主要结局包括 6 分钟步行距离（6MWD）和短体物理表现电池（SPPB）。在不同时间点测量的次要结局包括肌肉质量、MRC 评分、握力和健康报告生活质量。使用广义线性混合模型进行数据分析，遵循意向治疗分析的原则。
与对照组相比，阻力训练和联合治疗组的 SPPB 评分（分别增加 3.848 和 2.832 分）显著增加，6WMD（分别增加 99.768 和 88.577m）也显著改善（均 P<0.01）。然而，HMB 组没有观察到显著变化。在 ICU 和出院时进行的 MRC 和握力测试中，肌肉力量显示出阻力训练和联合组的统计学显著改善（P<0.05）。然而，在 60 天死亡率、ICU-AW 患病率、肌肉质量、生活质量或其他功能方面，治疗组与常规护理之间没有发现显著差异。
在整个住院干预期间进行阻力训练和/或β-羟基-β-甲基丁酸可改善内科 ICU 患者的身体功能和肌肉力量，但肌肉质量、生活质量和 60 天死亡率不受影响。
ChiCTR2200057685 于 2022 年 3 月 15 日注册。
