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Critical Care Medicine:
doi: 10.1097/CCM.0b013e31823295e6
Brief Report

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

Bierbrauer, Jeffrey MD; Koch, Susanne MD; Olbricht, Claudio MD; Hamati, Jida; Lodka, Dörte; Schneider, Joanna MD; Luther-Schröder, Anja; Kleber, Christian MD; Faust, Katharina MD; Wiesener, Solveigh MD; Spies, Claudia D. MD; Spranger, Joachim MD; Spuler, Simone MD; Fielitz, Jens MD; Weber-Carstens, Steffen MD

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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.

© 2012 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins

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