Effect of Early Mobilization Combined with Early Nutrition on Acquired Weakness in Critically Ill Patients (EMAS): A Dual-center, Randomized Controlled Trial

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2022 May 26

PMID 35617287

Authors

Wendie Zhou

Lili Yu

Yuying Fan

Baisheng Shi

Xiaohui Wang

Tianling Chen

Haixia Yu

Jie Liu

Xizhen Wang

Caihong Liu

Huijia Zheng

Affiliations

Soon will be listed here.

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.

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References

Singer P, Reintam Blaser A, Berger M, Alhazzani W, Calder P, Casaer M . ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 2018; 38(1):48-79. DOI: 10.1016/j.clnu.2018.08.037. View

MAHONEY F, BARTHEL D . FUNCTIONAL EVALUATION: THE BARTHEL INDEX. Md State Med J. 1965; 14:61-5. View

Allingstrup M, Kondrup J, Wiis J, Claudius C, Pedersen U, Hein-Rasmussen R . Early goal-directed nutrition versus standard of care in adult intensive care patients: the single-centre, randomised, outcome assessor-blinded EAT-ICU trial. Intensive Care Med. 2017; 43(11):1637-1647. DOI: 10.1007/s00134-017-4880-3. View

Schweickert W, Pohlman M, Pohlman A, Nigos C, Pawlik A, Esbrook C . Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009; 373(9678):1874-82. PMC: 9906655. DOI: 10.1016/S0140-6736(09)60658-9. View

Lad H, Saumur T, Herridge M, Santos C, Mathur S, Batt J . Intensive Care Unit-Acquired Weakness: Not just Another Muscle Atrophying Condition. Int J Mol Sci. 2020; 21(21). PMC: 7660068. DOI: 10.3390/ijms21217840. View

Reintam Blaser A, Starkopf J, Alhazzani W, Berger M, Casaer M, Deane A . Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines. Intensive Care Med. 2017; 43(3):380-398. PMC: 5323492. DOI: 10.1007/s00134-016-4665-0. View

Dres M, Dube B, Mayaux J, Delemazure J, Reuter D, Brochard L . Coexistence and Impact of Limb Muscle and Diaphragm Weakness at Time of Liberation from Mechanical Ventilation in Medical Intensive Care Unit Patients. Am J Respir Crit Care Med. 2016; 195(1):57-66. DOI: 10.1164/rccm.201602-0367OC. View

Cheung K, Rathbone A, Melanson M, Trier J, Ritsma B, Allen M . Pathophysiology and management of critical illness polyneuropathy and myopathy. J Appl Physiol (1985). 2021; 130(5):1479-1489. PMC: 8143786. DOI: 10.1152/japplphysiol.00019.2021. View

Talbot D, Massamba V . A descriptive review of variable selection methods in four epidemiologic journals: there is still room for improvement. Eur J Epidemiol. 2019; 34(8):725-730. DOI: 10.1007/s10654-019-00529-y. View

10.

Doig G, Simpson F, Sweetman E, Finfer S, Cooper D, Heighes P . Early parenteral nutrition in critically ill patients with short-term relative contraindications to early enteral nutrition: a randomized controlled trial. JAMA. 2013; 309(20):2130-8. DOI: 10.1001/jama.2013.5124. View

11.

Wakabayashi H, Sakuma K . Rehabilitation nutrition for sarcopenia with disability: a combination of both rehabilitation and nutrition care management. J Cachexia Sarcopenia Muscle. 2014; 5(4):269-77. PMC: 4248414. DOI: 10.1007/s13539-014-0162-x. View

12.

Heyland D, Stapleton R, Mourtzakis M, Hough C, Morris P, Deutz N . Combining nutrition and exercise to optimize survival and recovery from critical illness: Conceptual and methodological issues. Clin Nutr. 2015; 35(5):1196-206. DOI: 10.1016/j.clnu.2015.07.003. View

13.

Zang K, Chen B, Wang M, Chen D, Hui L, Guo S . The effect of early mobilization in critically ill patients: A meta-analysis. Nurs Crit Care. 2019; 25(6):360-367. DOI: 10.1111/nicc.12455. View

14.

Juszczak E, Altman D, Hopewell S, Schulz K . Reporting of Multi-Arm Parallel-Group Randomized Trials: Extension of the CONSORT 2010 Statement. JAMA. 2019; 321(16):1610-1620. DOI: 10.1001/jama.2019.3087. View

15.

Liu Y, Zhao W, Chen W, Shen X, Fu R, Zhao Y . Effects of Early Enteral Nutrition on Immune Function and Prognosis of Patients With Sepsis on Mechanical Ventilation. J Intensive Care Med. 2018; 35(10):1053-1061. DOI: 10.1177/0885066618809893. View

16.

Kou K, Momosaki R, Miyazaki S, Wakabayashi H, Shamoto H . Impact of Nutrition Therapy and Rehabilitation on Acute and Critical Illness: A Systematic Review. J UOEH. 2019; 41(3):303-315. DOI: 10.7888/juoeh.41.303. View

17.

Hodgson C, Bailey M, Bellomo R, Berney S, Buhr H, Denehy L . A Binational Multicenter Pilot Feasibility Randomized Controlled Trial of Early Goal-Directed Mobilization in the ICU. Crit Care Med. 2016; 44(6):1145-52. DOI: 10.1097/CCM.0000000000001643. View

18.

Moss M, Nordon-Craft A, Malone D, Van Pelt D, Frankel S, Warner M . A Randomized Trial of an Intensive Physical Therapy Program for Patients with Acute Respiratory Failure. Am J Respir Crit Care Med. 2015; 193(10):1101-10. PMC: 4872662. DOI: 10.1164/rccm.201505-1039OC. View

19.

Detsky A, Baker J, Mendelson R, Wolman S, Wesson D, Jeejeebhoy K . Evaluating the accuracy of nutritional assessment techniques applied to hospitalized patients: methodology and comparisons. JPEN J Parenter Enteral Nutr. 1984; 8(2):153-9. DOI: 10.1177/0148607184008002153. View

20.

Weng H, Hsueh Y, Messam L, Hertz-Picciotto I . Methods of covariate selection: directed acyclic graphs and the change-in-estimate procedure. Am J Epidemiol. 2009; 169(10):1182-90. DOI: 10.1093/aje/kwp035. View