“…Numerous factors, most notably muscle unloading during bedrest, insufficient nutrition, pharmacologic exposures, and imbalanced protein catabolism and synthesis, have been shown to contribute to sepsis-mediated atrophy (Schefold et al, 2010; Schreiber et al, 2018; Eikermann et al, 2006; Spranger et al, 2003; Dres et al, 2017; Yu et al, 2018; Lang et al, 2007; Yang et al, 2018; Vary and Kimball, 1992; Puthucheary et al, 2013; Bouglé et al, 2016). However, clinical interventions with early mobilization (Denehy et al, 2013; Morris et al, 2016; Moss et al, 2016; Tipping et al, 2017) and nutritional support (Goossens et al, 2017; Hermans et al, 2013; Ogilvie and Larsson, 2014) have not improved long-term outcomes, and some studies even show negative effects of high protein delivery on muscle wasting (Puthucheary et al, 2013). Beyond this key issue, muscle weakness is not always accompanied by muscle wasting: they are separate entities that should not be considered synonymously (Schefold et al, 2010; Reid and Moylan, 2011).…”