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Crit Care Med. 2012 Feb;40(2):647-50. doi: 10.1097/CCM.0b013e31823295e6.

Early type II fiber atrophy in intensive care unit patients with nonexcitable muscle membrane.

Author information

1
Department of Anesthesiology and Operative Intensive Care Medicine, Campus Virchow-Klinikum & Campus Mitte, Charité University Medicine, Berlin, Germany.

Abstract

OBJECTIVE:

Intensive care unit-acquired weakness indicates increased morbidity and mortality. Nonexcitable muscle membrane after direct muscle stimulation develops early and predicts intensive care unit-acquired weakness in sedated, mechanically ventilated patients. A comparison of muscle histology at an early stage in intensive care unit-acquired weakness has not been done. We investigated whether nonexcitable muscle membrane indicates fast-twitch myofiber atrophy during the early course of critical illness.

DESIGN:

Prospective observational study.

SETTING:

Two intensive care units at Charité University Medicine, Berlin.

PATIENTS:

Patients at increased risk for development of intensive care unit-acquired weakness, indicated by Sepsis-related Organ Failure Assessment scores ≥8 on 3 of 5 consecutive days within their first week in the intensive care unit.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Electrophysiological compound muscle action potentials after direct muscle stimulation and muscle biopsies were obtained at median days 7 and 5, respectively. Patients with nonexcitable muscle membranes (n = 15) showed smaller median type II cross-sectional areas (p < .05), whereas type I muscle fibers did not compared with patients with preserved muscle membrane excitability (compound muscle action potentials after direct muscle stimulation ≥3.0 mV; n = 9). We also observed decreased mRNA transcription levels of myosin heavy chain isoform IIa and a lower densitometric ratio of fast-to-slow myosin heavy chain protein content.

CONCLUSION:

We suggest that electrophysiological nonexcitable muscle membrane predicts preferential type II fiber atrophy in intensive care unit patients during early critical illness.

PMID:
21963579
DOI:
10.1097/CCM.0b013e31823295e6
[Indexed for MEDLINE]

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