THE INFLUENCE OF NUTRITION ON MUSCLE WASTING IN CRITICALLY ILL PATIENTS – A PILOT STUDY
Introduction:Adequate nutrition is necessary to prevent muscle wasting in critically ill patients. Decision about enteral or parenteral nutrition is always questionable. Objective: The aim of our study was to assess the impact of nutrition on muscle wasting in critically ill patients with trauma injury. Material and methods: The study was conducted in the period from January to December 2017 and included 30critically ill patients with trauma injury hospitalized on the Intensive care unit (ICU) of the University clinic for anesthesiology and intensive care in Skopje. Included patients were divided into two groups: group E - patients where enteral nutrition was conducted after the third day of their admission in ICU and group P - patients where total parenteral nutrition was implemented in the first 24 hours of their admission.
The study monitored the impact of two different types of nutrition on muscle wasting evaluated by ultrasound measurements of m.quadriceps femoris thickness and biochemical measurements of the serum creatinine level. Results: In group E there was statistically significant muscle wasting evaluated by ultrasound between the1st and the 3rd and the1st and the 7th day. Difference in measured muscle thickness was 1.90 ± 1.49 mm between the 1st and the 3rd (p = 0.015) and 4.46 ± 2.81 mm between the 1st and the 7th day (p = 0.006). In group P muscle wasting in the same period was without statistical significance. Both groups showed statistically significant decrease in serum creatinine levels between the 1st and the 3rd(p = 0.003, p = 0.03) and the 1st and 7th (p = 0.003) day. The values of differences between the 1st and the 3rd and the 1st and the 7th day were 7.57 ± 4.12 mg/dl and 10.71 ± 5.79mg/dl in group E and 11.43 ± 10.66 mg/dl and 15.28 ± 8.28 mg/dl in group P.
Conclusion: In our study we determined a significant decrease of muscle mass evaluated by ultrasound measurements of m.quadriceps femoris thickness in patients with enteral nutrition after the third day.
Herridge MS, Tansey CM, Matté A, Tomlinson G, Diaz-Granados N, Cooper A et al. Functional disability 5 years after acute respiratory distress syndrome. N engl J Med.2011;364(14):1293-304.
Iwashyna TJ, Ely EW, Smith DM, Langa KM. Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA. 2010;304(16):1787-94.
Souba WW, Klimberg VS, Plumley DA, Salloum RM, Flynn TC, Bland KI et al. The role of glutamine in maintaining a healthy gut and supporting the metabolic response to injury and infection. J Surg Res.1990; 48(4):383-91.
Lacey JM, Wilmore DW. Is glutamine a conditionally essential amino acid? Nutr Rev. 1990; 48(8): 297-309.
Aziz M, Choudhary TJ, Shafiq M, Qureshi KH. Nutrition in surgical patients; role of partial parenteral nutritrition and total parenteral nutrition in immediate post operative period. Professional Med J. 2017;24(3):441-4.
Marik PE, Pinsky M. Death by parenteral nutrition. Intensive Care Med. 2003;29(6):867-9.
Weiman A, Adra J, Sablotzki A. Nutrition in the critically ill. Dtsch Med Wochenschr.
Prado CM, Heymsfeld SB. Lean tissue imaging: a new era for nutritional assessment and intervention. J Parenter Enteral Nutr. 2014;38(8):940-53.
Reid CL, Campbell IT, Little RA. Muscle wasting and energy balance in critical illness. Clin Nutr. 2004;23(2):273-80.
Parry SM, El-Ansary D, Cartwright MS, Sarwal A, Berney S, Koopman R et al. Ultrasonography in the intensive care setting can be used to detect changes in the quality and quantity of muscle and is related to muscle strength and function. J Crit Care. 2015;30(5):1151.e9-e14.
Tonelli M, Klarenbach SW, Lloyd AM, James MT, Bello AK, Manns BJ, et al. Higher estimated glomerular filtration rates may be associated with increased risk of adverse outcomes, especially with concomitant proteinuria. Kidney international. 2011;80(12):1306-14.
Puthucheary ZA, Rawal J, McPhail M, Connolly B, Ratnayake G, Chan P et al. Acute skeletal muscle wasting in critical illness. JAMA. 2013;310(15):1591-600.
Andrews R, Greenhaff P, Curtis S, Perry A, Cowley AJ. The effect of dietary creatine supplementation on skeletal muscle metabolism in congestive heart failure. Eur Heart J. 1998; 19(4): 617-22.
Thongprayoon C, Cheungpasitporn W, Akhoundi A, Ahmed AH, Kashani KB. Actual versus ideal body weight for acute kidney injury diagnosis and classifcation in critically ill patients. BMC Nephrol. 2014; 15: 176.
Schutte JE, Longhurst JC, Gaffney FA, Bastian BC, Blomqvist CG. Total plasma creatinine: an accurate measure of total striated muscle mass. J Appl Physiol Respir Environ Exerc Physiol. 1981; 51(3): 762-6.
Palmer C. Major trauma and the injury severity score-where should we set the bar. Annu Proc Assoc Adv Automot Med.2007; 51: 13–29.
Morton RW, McGlory C, Phillips SM. Nutritional interventions to augment resistance training-induced skeletal muscle hypertrophy. Front Physiol.2015;6: 245.
Hoffer LJ, Bistrian BR: Appropriate protein provision in critical illness: a systematic and narrative review.Am J Clin Nutr. 2012; 96(3):591–600.
Alberda C, Gramlich L, Jones N, Jeejeebhoy K, Day AG, Dhaliwal R, et al. The relationship between nutritional intake and clinical outcomes in critically ill patients: Results of an international multicenter observational study.Intensive Care Med. 2009;35(10): 1728–37.
Heyland DK, Schroter-Noppe D, Drover JW, Jain M, Keefe L, Dhaliwal R, et al. Nutrition support in the critical care setting: Current practice in Canadian ICUs—Opportunities for improvement?. JPEN J Parenter Enteral Nutr. 2003; 27(1): 74–83.
RiceTW, Swope T, Bozeman S, Wheeler AP. Variation in enteral nutrition delivery in mechanically ventilated patients. Nutrition. 2005;21(7-8): 786–92.
Stapleton RD, Jones N, Heyland DK. Feeding critically ill patients: What is the optimal amount of energy?Crit Care Med.2007;35(9 suppl):S535–40.
Bellomo R, Cass A, Cole L, Finfer S, Gallagher M, Lee J, et al. Calorie intake and patient outcomes in severe acute kidney injury: Findings from the Randomized Evaluation of Normal vs. Augmented Level of Replacement Therapy (RENAL) study trial. Crit Care. 2014;18(2): R45.
Weijs PJ, Looijaard WG, Beishuizen A, Girbes AR, Oudemans-van Straaten HM. Early high protein intake is associated with low mortality and energy overfeeding with high mortality in non-septic mechanically ventilated critically ill patients.Crit Care. 2014;18(6): 701.
Artinian V, Krayem H, DiGiovine B. Effects of early enteral feeding on the outcome of critically ill mechanically ventilated medical patients.Chest.2006; 129(4): 960–7.
Harvey SE, Parrott F, Harrison DA, Bear DE, Segaran E, Beale R, Bellingan G et al. Trial of the route of early nutritional support in critically ill adults.. N Engl J Med. 2014;371(18): 1673–84.
Puthucheary ZA, Rawal J, McPhail M, Connolly B, Ratnayake G, Chan P et al. Acute skeletal muscle wasting in critical illness.JAMA. 2013;310(15): 1591–600.
Ferrie S, Allman-Farinelli M, Daley M, Smith K . Protein requirements in the critically ill: a randomised controlled trial using parenteral nutrition. JPEN J Parenter Enteral Nutr. 2016; 40(6):795-805.
Casaer M, Mesotten D, Hermans G, Wouters R, Schetz M, Meyfroidt G et al. Early versus late parenteral nutrition in critically Ill adults. N Engl J Med 2011; 365(6):506-17.
Hermans G, Casaer MP, Clerckx B, Güiza F, Vanhullebusch T, Derde S, et al. Effect of tolerating macronutrient deficit on the development of intensive-care unit acquired weakness: A subanalysis of the EPaNIC trial. Lancet Respir Med. 2013;1(8): 621–9.
Doig GS, Simpson F, Sweetman EA, Finfer SR, Cooper DJ, Heighes PT, et al.Early parenteral nutrition in critically ill patients with short-term relative contraindications to early enteral nutrition: A randomized controlled trial.. JAMA. 2013;309(20): 2130–8.
Preiser C, van Zanten AR, Berger MM, Biolo G, Casaer MP, Doig GS, et al. Metabolic and nutritional support of critically ill patients: Consensus and controversies.Crit Care. 2015;19: 35.
Dellinger P, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, Sevransky JE et al. Surviving sepsis campaign guidelines committee including The pediatric subgroup, surviving sepsis campaign: International guidelines for management of severe sepsis and septic shock, 2012.Intensive Care Med. 2013; 39(2):165–228.
Manning EM, Shenkin A. Nutritional assessment in the critically ill. Crit Care Clin. 1995; 11(3): 603–34.
Chi-Fishman G, Hicks JE, Cintas HM, Sonies BC, Gerber LH. Ultrasound imaging distinguishes between normal and weak muscle. Arch Phys Med Rehabil. 2004; 85(6): 980–6.
Bleakney R, Maffulli N. Ultrasound changes to intramuscular architecture of the quadriceps following intramedullary nailing. J Sports Med Phys Fitness. 2002; 42(1): 120–5.
Uremovic M, Pasic MB, Seric V, Solter VV, Budic R, Bosnjak B, et al. Ultrasound measurement of the volume of musculus quadriceps after knee joint injury. Coll Antropol. 2004; 28 (Suppl 2): 227–33.
Abe T, Kawakami Y, Suzuki Y, Gunji A, Fukunaga T. Effects of 20 days bed rest on muscle morphology. J Gravit Physiol. 1997; 4(1): S10–4.
Ellis S, Kirby LC, Greenleaf JE. Lower extremity muscle thickness during 30-day 6 degrees head-down bed rest with isotonic and isokinetic exercise training. Aviat Space Environ Med. 1993; 64(11): 1011–5.
Ohata K, Tsuboyama T, Ichihashi N, Minami S. Measurement of muscle thickness as quantitative muscle evaluation for adults with severe cerebral palsy. Phys Ther. 2006; 86(9): 1231–9.
Akima H, Kawakami Y, Kubo K, Sekiguchi C, Ohshima H, Miyamoto A, et al. Effect of short-duration spaceflight on thigh and leg muscle volume. Med Sci Sports Exerc. 2000; 32(10): 1743–7.
Park J, Mehrotra R, Rhee CM, Molnar MZ, Lukowsky LR, Patel SS et al. Serum creatinine level, a surrogate of muscle mass, predicts mortality in peritoneal dialysis patients. Nephrol Dial Transplant. 2013;28(8):2146-55.
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