Critical illness myopathy and timely electrical muscle stimulation

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We are studying critical illness myopathy (CIM), a devastating wasting disease of ICU patients that leads to nerve and muscle degeneration. Muscle membrane inexcitability and myosin loss in typ IIa and IIb fast twitch muscle fibers occurs within a week of ICU admission, a time interval where assessment and treatment directed at CIM are almost impossible. We recently found that electrical muscle stimulation (EMS) at onset of CIM could be of utility in terms of prevention and treatment. We now aim to investigate the impact of EMS during early CIM on neuromuscular function, muscle membrane excitability, structural changes of muscle composition (thick filament loss), and regulation of atrophy gene expression (MURF-I and Atrogin), in a prospective randomized trial. Since others and we observed early metabolic changes involving carbohydrate metabolism in early CIM, we will also investigate the impact of EMS on insulin sensitivity, insulin signaling, and muscle metabolism during early critical illness.