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Winning the war against ICU-acquired weakness: new innovations in nutrition and exercise physiology

机译：在对抗ICU获得性弱点的斗争中获胜：营养和运动生理学的新创新

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Over the last 10 years we have significantly reduced hospital mortality from sepsis and critical illness. However, the evidence reveals that over the same period we have tripled the number of patients being sent to rehabilitation settings. Further, given that as many as half of the deaths in the first year following ICU admission occur post ICU discharge, it is unclear how many of these patients ever returned home. For those who do survive, the latest data indicate that 50-70% of ICU "survivors" will suffer cognitive impairment and 60-80% of "survivors" will suffer functional impairment or ICU-acquired weakness (ICU-AW). These observations demand that we as intensive care providers ask the following questions: "Are we creating survivors ... or are we creating victims?" and "Do we accomplish 'Pyrrhic Victories' in the ICU?" Interventions to address ICU-AW must have a renewed focus on optimal nutrition, anabolic/anticatabolic strategies, and in the future employ the personalized muscle and exercise evaluation techniques utilized by elite athletes to optimize performance. Specifically, strategies must include optimal protein delivery (1.2-2.0 g/kg/day), as an athlete would routinely employ. However, as is clear in elite sports performance, optimal nutrition is fundamental but alone is often not enough. We know burn patients can remain catabolic for 2 years post burn; thus, anticatabolic agents (i.e., beta-blockers) and anabolic agents (i.e., oxandrolone) will probably also be essential. In the near future, evaluation techniques such as assessing lean body mass at the bedside using ultrasound to determine nutritional status and ultrasound-measured muscle glycogen as a marker of muscle injury and recovery could be utilized to help find the transition from the acute phase of critical illness to the recovery phase. Finally, exercise physiology testing that evaluates muscle substrate utilization during exercise can be used to diagnose muscle mitochondrial dysfunction and to guide a personalized ideal heart rate, assisting in recovery of muscle mitochondrial function and functional endurance post ICU. In the end, future ICU-AW research must focus on using a combination of modern performance-enhancing nutrition, anticatabolic/anabolic interventions, and muscle/exercise testing so we can begin to create more "survivors" and fewer victims post ICU care.
机译：在过去的十年中，我们已大大降低了败血症和重大疾病导致的医院死亡率。但是，证据表明，在同一时期内，我们将送往康复场所的患者数量增加了两倍。此外，考虑到ICU入院后第一年有多达一半的死亡发生在ICU出院后，因此尚不清楚这些患者中有多少曾返回家中。对于那些存活下来的人，最新数据表明，ICU“幸存者”中有50-70％会遭受认知功能障碍，而“幸存者”中有60-80％会遭受功能性障碍或ICU获得性弱点（ICU-AW）。这些观察结果要求我们作为重症监护室的提供者提出以下问题：“我们是在创造幸存者……还是在创造受害者？”和“我们是否在ICU中完成了'Pyrrhy胜利'？”解决ICU-AW的干预措施必须重新关注最佳营养，合成代谢/抗代谢策略，并在将来采用精英运动员使用的个性化肌肉和运动评估技术来优化表现。具体来说，策略必须包括最佳蛋白质传输（1.2-2.0 g / kg /天），这是运动员通常采用的。但是，正如精英运动项目所清楚表明的那样，最佳营养是最基本的，但仅靠营养通常是不够的。我们知道烧伤患者在烧伤后2年内可以保持分解代谢;因此，抗催化剂（即β受体阻滞剂）和合成代谢剂（即氧雄龙）可能也必不可少。在不久的将来，可以利用诸如超声在床边评估瘦体重来确定营养状况以及超声测量的肌肉糖原作为肌肉损伤和恢复的标志物的评估技术，以帮助从关键时期的急性期过渡。病到康复阶段。最后，评估运动过程中肌肉底物利用率的运动生理学测试可用于诊断肌肉线粒体功能障碍，并指导个性化理想心率，帮助ICU后恢复肌肉线粒体功能和功能耐力。最后，未来的ICU-AW研究必须集中于使用现代性能增强营养，抗分解代谢/合成代谢干预和肌肉/锻炼测试的组合，以便我们可以开始创建更多的“幸存者”，并减少ICU护理后的受害者。

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