Effect of early mobilization combined with early nutrition on acquired weakness in critically ill patients (EMAS): A dual-center, randomized controlled trial

Abstract

Aim The study aimed to investigate the effect of early mobilization combined with early nutrition (EMN) on intensive care unit-acquired weakness (ICU-AW) in intensive care unit (ICU) settings compared with early mobilization (EM) or routine care. Methods A prospective, dual-center, randomized controlled trial was conducted. The control group underwent standard care without a pre-established routine for mobilization and nutrition. The EM group underwent early, individualized, progressive mobilization within 24 h of ICU admission. The EMN group underwent early mobilization, similar to the EM group plus guideline-based early nutrition (within 48 h of ICU admission). The primary outcome was the occurrence of ICU-AW at discharge from the ICU. Secondary outcomes included muscle strength, functional independence, organ failure, nutritional status, duration of mechanical ventilation (MV), length of ICU stay, and ICU mortality at ICU discharge. Results A total of 150 patients were enrolled and equally distributed into the three groups. Patients undergoing routine care only were more susceptible to ICU-AW upon ICU discharge than those in the EM or EMN groups (16% vs. 2%; p = 0.014 for both), and had a lower Barthel Index than others (control vs. EM/EMN: 57.5 vs 70.0; p = 0.022). The EMN group had improved muscle strength (p = 0.028) and better nutritional status than the control group (p = 0.031). Both interventions were associated with a lower ICU-AW (EM vs. control: p = 0.027, OR [95% CI] = 0.066 [0.006–0.739]; EMN vs. control: p = 0.016, OR [95% CI] = 0.065 [0.007–0.607]). Conclusion EM and EMN had positive effects. There was little difference between the effects of EM and EMN, except for muscle strength improvement. Both EM and EMN may lead to a lower occurrence of ICU-AW and better functional independence than standard care. EMN might benefit nutritional status more than usual care and promote improvement in muscle strength.

The effect of protein provision and exercise therapy on patient‐reported and clinical outcomes in intensive care unit survivors: A systematic review

“…It makes the establishment of causal relations in these studies questionable. This was consistent with other studies that showed comparable associations between protein delivery and mortality, as well as an effect on functional outcomes and muscle mass 17,82–84 . In addition, other studies found that publication bias might be a concern in smaller studies that reported less loss of muscle mass in patients receiving more protein 69 …”

Physical therapy and nutrition therapy: synergistic, antagonistic, or independent interventions?

“…Four of these studies were randomized controlled trials [18][19][20][21], one was a historical control study [22], and one was a pre/post cohort study in a coronavirus disease 2019 (COVID-19) population [23]. Four studies were conducted in Asia [19][20][21][22], and one was conducted in Europe [23], and one in South America [18]. The main type of nutritional interventions included overall nutritional intake with delivery of both calories and proteins.…”

“…Six studies (Table 1) were identified that combined both interventions. Four of these studies were randomized controlled trials [18][19][20][21], one was a historical control study [22], and one was a pre/post cohort study in a coronavirus disease 2019 (COVID-19) population [23]. Four studies were conducted in Asia [19][20][21][22], and one was conducted in Europe [23], and one in South America [18].…”

“…The main type of nutritional interventions included overall nutritional intake with delivery of both calories and proteins. Physical interventions were: early functional rehabilitation in two studies [19,23], electrical muscle stimulation with early goal-directed rehabilitation in two studies [20,22], and two trials tested…”

“…These trials indicated that the combination of physical therapy and nutrition may be synergistic. However, while some of these trials demonstrated the preservation of muscle mass (particularly with high protein delivery) [20,22], or reduced rates of ICU-acquired weakness [19], these benefits did not extend to other outcomes that may be of importance to the health system such as reduced length of mechanical ventilation [21], ICU or hospital stay [20,22]. It is also difficult to determine if the observed effects in muscle mass and volume when using electrical muscle stimulation could be attributed to the electrical muscle stimulation alone.…”