Abstract
Purpose
The purpose of this study was to assist clinicians to identify critically ill patients
at greatest risk of acute muscle loss and to analyse the associations between protein
intake and exercise on acute muscle loss.
Materials and methods
Secondary analysis of a single-centre randomised clinical trial of in-bed cycling
using a mixed effects model was undertaken to examine the association between key
variables and rectus femoris cross-sectional area (RFCSA). Groups were combined, and
key variables for the cohort were modified Nutrition Risk in the Critically Ill (mNUTRIC)
scores within the first days following intensive care unit admission, longitudinal
RFCSA measurements, percent of daily recommended protein intake, and group allocation
(usual care, in-bed cycling). RFCSA ultrasound measurements were taken at baseline
and days 3, 7, and 10 to quantify acute muscle loss. All patients received usual care
nutritional intake while in the intensive care unit. Patients allocated to the cycling
group commenced in-bed cycling once safety criteria were met.
Results
Analysis included all 72 participants, of which 69% were male, with a mean (standard
deviation) age of 56 (17) years. Patients received a mean (standard deviation) of
59% (26%) of the minimum protein dose recommended for critically ill patients. Mixed-effects
model results indicated that patients with higher mNUTRIC scores experienced greater
RFCSA loss (estimate = −0.41; 95% confidence interval [CI] = −0.59 to −0.23). RFCSA
did not share a statistically significant association with cycling group allocation
(estimate = −0.59, 95% CI = −1.53 to 0.34), the percentage of protein requirements
received (estimate = −0.48; 95% CI = −1.16 to 0.19), or a combination of cycling group
allocation and higher protein intake (estimate = 0.33, 95% CI = −0.76 to 1.43).
Conclusions and relevance
We found that a higher mNUTRIC score was associated with greater muscle loss, but
we did not observe a relationship between combined protein delivery and in-bed cycling
and muscle loss. The low protein doses achieved may have impacted the potential for
exercise or nutrition strategies to reduce acute muscle loss.
Trial registration
Australian and New Zealand Clinical Trials Registry (ACTRN 12616000948493)
Keywords
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Article info
Publication history
Published online: February 28, 2023
Accepted:
December 31,
2022
Received in revised form:
December 23,
2022
Received:
April 23,
2022
Publication stage
In Press Corrected ProofFootnotes
☆Study Location: Princess Alexandra Hospital, Intensive Care Unit, Brisbane, Australia.
Identification
Copyright
Crown Copyright © 2023 Published by Elsevier Ltd on behalf of Australian College of Critical Care Nurses Ltd. All rights reserved.
