Critical illness myopathy and timely electrical muscle stimulation

我们正在研究重症肌病（CIM），这是ICU患者的一种毁灭性的消耗性疾病，导致神经和肌肉变性。IIa型和IIb型快肌纤维的肌膜不兴奋性和肌球蛋白丢失发生在ICU入院的一周内，这段时间内几乎不可能针对CIM进行评估和治疗。我们最近发现肌电刺激（EMS）在CIM发作时可以在预防和治疗方面发挥作用。我们现在的目标是在一项前瞻性随机试验中，研究EMS在CIM早期对神经肌肉功能、肌膜兴奋性、肌肉成分结构变化（粗丝丢失）和萎缩基因表达调节（MURF-I和Atrogin）的影响。由于其他人和我们观察到早期CIM中涉及碳水化合物代谢的早期代谢变化，我们还将研究EMS对早期危重疾病中胰岛素敏感性、胰岛素信号传导和肌肉代谢的影响。

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.