Muscle weakness and nutrition therapy in ICU

作者：Casaer Michael P^*

来源：Current Opinion in Clinical Nutrition and Metabolic Care, 2015, 18(2): 162-168.

DOI：10.1097/MCO.0000000000000150

• autophagy
• body composition
• critical illness
• ICU-acquired muscle weakness
• muscle wasting
• nutrition
• physical function

Purpose of review
Muscle wasting is common in severe critical illness. ICU-acquired weakness (ICU-AW) contributes to acute and long-term morbidity and mortality. The question remains whether nutrition therapy in ICU can prevent or attenuate these complications. This review aims at integrating the most recent clinical data in order to answer this important clinical and research question. Clinical evidence was obtained from randomized controlled trials (RCTs). Results from animal experiments and observational studies are referred to when respectively - providing possible explanatory mechanisms or new hypotheses.
Recent findings
Although muscle wasting has been reproducibly quantified early in ICU, its relationship with ICU-AW has not yet been convincingly established. All recent RCTs evaluating increased energy/protein intake during ICU week 1 failed to demonstrate a protective effect against ICU-AW or physical function limitations. In one RCT, early parenteral nutrition increased the incidence of ICU-AW. The latter finding might be explained by suppressed autophagy.
Summary
Current evidence does not support improved physical function with increased energy/protein provision in the first ICU week. Future RCTs aimed at reducing the burden of ICU-AW and improving long-term function should particularly focus on nutrition beyond the acute phase of critical illness and on non-nutritional interventions such as early mobilization.

• 出版日期2015-3