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Mechanisms for Muscle Health in the Critically Ill Patient

Winkelman, Chris PhD, RN, CCRN, ACNP, FCCM

doi: 10.1097/CNQ.0b013e318275071d
Original Articles

Human skeletal muscles are continually remodeled to match the function required of them. Diameter, strength, and vascular supply are altered when a muscle group experiences contraction and resistance. The purpose of this article is to describe selected muscle signaling pathways that contribute to muscle remodeling. Multiple factors affect the cellular and molecular remodeling of muscles and at least 2 of them—exercise and protein/calorie delivery—are under the direct care of intensive care unit (ICU) clinicians. Activating signaling pathways may promote preservation of muscle mass and function. Interventions to prevent muscle atrophy have potential to reduce ICU-acquired weakness and positively affect quality of life in survivors after ICU hospitalization. Exploring information generated by genomic and proteomic investigations about muscle signaling pathways can help the ICU clinician evaluate the benefits and risks of interventions to maintain muscle health early in critical illness.

Frances Payne Bolton School of Nursing, Case Western Reserve University, and MetroHealth Medical Center, Cleveland Ohio.

Correspondence: Chris Winkelman, PhD, RN, CCRN, ACNP, FCCM, Frances Payne Bolton School of Nursing, Case Western Reserve University, 2121 Emergency Dr, Cleveland, OH (

The author reports past funding from NIH (R21 NR1078a-01A1) 2009-2012 for a research project that explored selected serum cytokines and muscle strength.

The author reports no conflict of interest.

© 2013 Lippincott Williams & Wilkins, Inc.