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.
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.
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DOI：
10.1186/s13054-021-03737-9
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发表时间：
2021-08-26
期刊：
影响因子：
--
通讯作者：
Callahan LA
中科院分区：
文献类型：
--
作者：
Supinski GS;Netzel PF;Westgate PM;Schroder EA;Wang L;Callahan LA
重症监护病房获得性虚弱是一个严重的问题，导致呼吸衰竭和减少american。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-甲基丁酸酯（HMB）和二十碳五烯酸（EPA）都能增强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膈肌和四头肌力量。对从肯塔基州大学医学重症监护病房招募的83名机械通气患者进行了研究。膈肌强度被评估为由超大磁膈神经刺激（PdiTw）产生的跨脑压。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。通过超声评估膈肌和四头肌厚度。进行肌肉强度和大小的基线测量，然后将患者随机分配到四个治疗组之一（安慰剂，HMB 3 gm/天，EPA 2 gm/天和HMB + EPA）。进入研究后11天重复强度和尺寸测量。使用ANCOVA统计检验来比较四个实验组的变量。与安慰剂相比，治疗未能增加膈肌或四头肌的强度和厚度。此外，治疗也未能减少研究入组后机械通气的持续时间。这些结果表明，HMB和/或EPA的10天疗程不会改善危重机械通气患者的骨骼肌强度。这些发现也证实了以前的报道，即这些患者的膈肌和腿部力量非常低。还需要进一步的研究来检查其他合成代谢药物和创新形式的物理治疗的效果。试验注册：ClinicalTrials.gov，NCT 01270516。2011年1月5日注册，https://clinicaltrials.gov/ct2/show/NCT01270516? term=Supinski&draw=2&rank=4.在线版本包含补充材料，可通过10.1186/s13054-021-03737-9获得。
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. The online version contains supplementary material available at 10.1186/s13054-021-03737-9.
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