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A randomized controlled trial to determine whether beta-hydroxy-beta-methylbutyrate and/or eicosapentaenoic acid improves diaphragm and quadriceps strength in critically Ill mechanically ventilated patients
Critical Care ( IF 15.1 ) Pub Date : 2021-08-26 , DOI: 10.1186/s13054-021-03737-9
Gerald S Supinski 1 , Paul F Netzel 1 , Philip M Westgate 2 , Elizabeth A Schroder 1 , Lin Wang 1 , Leigh Ann Callahan 1
Affiliation  

Intensive care unit acquired weakness is a serious problem, contributing to respiratory failure and reductions in ambulation. Currently, there is no pharmacological therapy for this condition. Studies indicate, however, that both beta-hydroxy-beta-methylbutyrate (HMB) and eicosapentaenoic acid (EPA) increase muscle function in patients with cancer and in older adults. The purpose of this study was to determine whether HMB and/or EPA administration would increase diaphragm and quadriceps strength in mechanically ventilated patients. Studies were performed on 83 mechanically ventilated patients who were recruited from the Medical Intensive Care Units at the University of Kentucky. Diaphragm strength was assessed as the trans-diaphragmatic pressure generated by supramaximal magnetic phrenic nerve stimulation (PdiTw). Quadriceps strength was assessed as leg force generated by supramaximal magnetic femoral nerve stimulation (QuadTw). Diaphragm and quadriceps thickness were assessed by ultrasound. Baseline measurements of muscle strength and size were performed, and patients were then randomized to one of four treatment groups (placebo, HMB 3 gm/day, EPA 2 gm/day and HMB plus EPA). Strength and size measurements were repeated 11 days after study entry. ANCOVA statistical testing was used to compare variables across the four experimental groups. Treatments failed to increase the strength and thickness of either the diaphragm or quadriceps when compared to placebo. In addition, treatments also failed to decrease the duration of mechanical ventilation after study entry. These results indicate that a 10-day course of HMB and/or EPA does not improve skeletal muscle strength in critically ill mechanically ventilated patients. These findings also confirm previous reports that diaphragm and leg strength in these patients are profoundly low. Additional studies will be needed to examine the effects of other anabolic agents and innovative forms of physical therapy. Trial registration: ClinicalTrials.gov, NCT01270516. Registered 5 January 2011, https://clinicaltrials.gov/ct2/show/NCT01270516?term=Supinski&draw=2&rank=4 .

中文翻译:

一项随机对照试验,以确定 β-羟基-β-甲基丁酸和/或二十碳五烯酸是否能改善危重机械通气患者的横膈膜和股四头肌力量

重症监护室后天性虚弱是一个严重的问题,会导致呼吸衰竭和活动减少。目前,没有针对这种情况的药物治疗。然而,研究表明,β-羟基-β-甲基丁酸 (HMB) 和二十碳五烯酸 (EPA) 都会增加癌症患者和老年人的肌肉功能。本研究的目的是确定 HMB 和/或 EPA 给药是否会增加机械通气患者的横膈膜和股四头肌力量。对从肯塔基大学内科重症监护病房招募的 83 名机械通气患者进行了研究。隔膜强度被评估为由超最大磁膈神经刺激 (PdiTw) 产生的跨隔膜压力。股四头肌力量被评估为由超大磁股神经刺激 (QuadTw) 产生的腿部力量。通过超声评估隔膜和股四头肌的厚度。对肌肉力量和大小进行基线测量,然后将患者随机分配到四个治疗组之一(安慰剂、HMB 3 克/天、EPA 2 克/天和 HMB 加 EPA)。在进入研究后 11 天重复进行强度和尺寸测量。ANCOVA 统计检验用于比较四个实验组的变量。与安慰剂相比,治疗未能增加隔膜或股四头肌的强度和厚度。此外,治疗也未能减少进入研究后的机械通气持续时间。这些结果表明,为期 10 天的 HMB 和/或 EPA 疗程不会改善危重机械通气患者的骨骼肌强度。这些发现也证实了之前的报告,即这些患者的横膈膜和腿部力量极低。需要进行更多研究来检查其他合成代谢药物和创新形式的物理疗法的效果。试验注册:ClinicalTrials.gov,NCT01270516。2011 年 1 月 5 日注册,https://clinicaltrials.gov/ct2/show/NCT01270516?term=Supinski&draw=2&rank=4。试验注册:ClinicalTrials.gov,NCT01270516。2011 年 1 月 5 日注册,https://clinicaltrials.gov/ct2/show/NCT01270516?term=Supinski&draw=2&rank=4。试验注册:ClinicalTrials.gov,NCT01270516。2011 年 1 月 5 日注册,https://clinicaltrials.gov/ct2/show/NCT01270516?term=Supinski&draw=2&rank=4。
更新日期:2021-08-27
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