Sarcopenia in critically ill patients

Kızılarslanoğlu, Muhammet Cemal; Kuyumcu, Mehmet Emin; Yeşil, Yusuf; Halil, Meltem

doi:10.1007/s00540-016-2211-4

Cited by 100 publications

(113 citation statements)

References 63 publications

(63 reference statements)

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“…Sarcopenia can be classified as primary, meaning it is caused from aging itself, and as secondary from inactivity, certain diseases, medication, or malnutrition [21]. Skeletal muscle mass is known to decrease with age, mainly driven by DXA and BIA until now [7,22,23].…”

Section: Discussionmentioning

confidence: 99%

Simple Age Specific Cutoff Value for Sarcopenia Evaluated by Computed Tomography

Kim

Kim²,

Park³

et al. 2017

Ann Nutr Metab

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Objective: Until now, cutoff values of low skeletal muscle mass using computed tomography (CT) were driven by optimal stratification to predict mortality in cancer patients. The aim of the present study was to investigate the simple, age-specific, cutoff value of low skeletal muscle mass by CT in healthy adults. Design: This is a retrospective, observational, single-center study. Setting: This study was performed in the health screening department of a university-affiliated hospital during a 10-year period. Patients: Medical records of 1,422 patients presenting to the health screening department were reviewed. Cross-sectional area of psoas muscle at the level of the third lumbar vertebra on abdominal CT was measured and adjusted by height (mm²/m²). This value (psoas muscle index [PMI]) was assumed to represent whole skeletal muscle mass. We divided the patients according to age, sex, and defined cutoff value of low skeletal muscle mass as 2 SDs below the mean. Intervention: None. Measurements and Main Results: Among 1,422 patients, 550 patients (38.6%) were male. The mean PMI was 896.60 (mm²/m²) for men and 570.54 (mm²/m²) for women. Cutoff values of PMI for men were 592.3 mm²/m² for 20-39 years, 474.0 mm²/m² for 40-49 years, 422.2 mm²/m² for 50-59 years, 374.4 mm²/m² for 60-69 years, and 331.5 mm²/m² for 70-89 years. The values for women were 399.9 mm²/m² for 20-39 years, 287.7 mm²/m² for 40-49 years, 242.5 mm²/m² for 50-59 years, 220.4 mm²/m² for 60-69 years, and 147.6 mm²/m² for 70-89 years. Conclusions: Cutoff values of low skeletal muscle mass using CT differed in healthy adults as age increased. Further studies on the effect of sarcopenia intervention using this cutoff value are needed.

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Section: Discussionmentioning

confidence: 99%

Simple Age Specific Cutoff Value for Sarcopenia Evaluated by Computed Tomography

Kim

Kim²,

Park³

et al. 2017

Ann Nutr Metab

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“…It has previously been reported that muscle loss increases with sustained length of stay in the ICU, a condition known as ICU-acquired weakness that is related to inactivity in the ICU plus the hypermetabolic state of critically ill patients. 29,30 It is possible that the decrease in ICU days resulted in better daily activities (i.e., eating, bathing, dressing, toileting, and walking). 31 The 6MWT is a valid outcome in ICU survivors; it has been used in a prior ICU randomized controlled trial 32 and predicts patient-centered outcomes including mortality and quality of life.…”

Section: Discussionmentioning

confidence: 99%

Safety of Nebulized Epinephrine in Smoke Inhalation Injury

Foncerrada

Lima

Clayton

et al. 2017

Journal of Burn Care & Research

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This pilot study was conducted to profile safety of nebulized racemic epinephrine when used as a therapy for smoke inhalation injury in severely burned children. We enrolled 16 patients who were 7 to 19 years of age ([mean ± SD] 12 ± 4 years) with burns covering over 30% of the total body surface area (55 ± 17%) and smoke inhalation injury, as diagnosed by bronchoscopy at burn center admission. Patients were randomized to receive either standard of care (SOC; n = 8), which consisted of nebulized acetylcysteine, nebulized heparin, and nebulized albuterol, or to receive SOC plus nebulized epinephrine (n = 8). Primary endpoints were death, chest pain, and adverse changes in cardiopulmonary hemodynamics (arrhythmia, arterial blood pressure, electrocardiographic [ST segment] changes, and peak inspiratory pressure). Additional endpoints included total days on ventilator, pulmonary function, and physiological cardiopulmonary measurements at ICU discharge. No adverse events were observed during or after the nebulization of epinephrine, and no deaths were reported that were attributable to the administration of nebulized epinephrine. The groups did not significantly differ with regard to age, sex, burn size, days on ventilator, pulmonary function, or cardiopulmonary fitness. Results of this pilot trial indicate epinephrine to be safe when administered to pediatric burn patients with smoke inhalation injury. Current data warrant future efficacy studies with a greater number of patients.

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“…The overall picture of AA kinetics in the unfed critically ill catabolic patient is one of rapid protein turnover of muscle compartments to supply the splanchnic organs, primarily the liver for supporting gluconeogenesis, and the bone marrow, spleen, and lymph nodes to support immune function and immunoglobulin synthesis 15 , 23 , 24 . With this unidirectional flow of nitrogen substrate from muscle, it is not surprising that a large amount of data now supports the concept that poor outcomes result in a population of ICU patients with sarcopenia or low muscle mass (as demonstrated by axial imaging) 12 , 25 . A reduced lean body tissue to adipose ratio on axial imaging at the level of the third lumbar vertebra has been shown to adversely affect outcomes for colorectal, esophageal, and pancreatic cancer, as well as lymphoma and hepatoma 26 – 28 …”

Section: Protein Kinetics In the Icu—a Confusing Picturementioning

confidence: 99%

Protein Kinetics and Metabolic Effects Related to Disease States in the Intensive Care Unit

et al. 2017

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Evaluating protein kinetics in the critically ill population remains a very difficult task. Heterogeneity in the intensive care unit (ICU) population and wide spectrum of disease processes creates complexity in assessing protein kinetics. Traditionally, protein has been delivered in the context of total energy. Focus on energy delivery has recently come into question, as the importance of supplemental protein in patient outcomes has been shown in several recent trials. The ICU patient is prone to catabolism, immobilization, and impaired immunity, which is a perfect storm for massive loss of lean body tissue with a unidirectional flow of amino acids from muscle to immune tissue for immunoglobulin production, as well as liver for gluconeogenesis and acute phase protein synthesis. The understanding of protein metabolism in the ICU has been recently expanded with the discovery of how the mammalian target of rapamycin complex 1 is regulated. The concept of "anabolic resistance" and identifying the quantity of protein required to overcome this resistance is gaining support among critical care nutrition circles. It appears that a minimum of at least 1.2 g/kg/d with levels up to 2.0 g/kg/d of protein or amino acids appears safe for delivery in the ICU setting and may yield a better clinical outcome.

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Sarcopenia in critically ill patients

Cited by 100 publications

References 63 publications

Simple Age Specific Cutoff Value for Sarcopenia Evaluated by Computed Tomography

Simple Age Specific Cutoff Value for Sarcopenia Evaluated by Computed Tomography

Safety of Nebulized Epinephrine in Smoke Inhalation Injury

Protein Kinetics and Metabolic Effects Related to Disease States in the Intensive Care Unit

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