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Muscle mass and physical recovery in ICU

innovations for targeting of nutrition and exercise

Wischmeyer, Paul E.a,b; Puthucheary, Zudinc; San Millán, Iñigod; Butz, Daniele,f; Grocott, Michael P.W.g,h,i

Current Opinion in Critical Care: August 2017 - Volume 23 - Issue 4 - p 269–278
doi: 10.1097/MCC.0000000000000431
METABOLIC SUPPORT: Edited by Kenneth B. Christopher

Purpose of review We have significantly improved hospital mortality from sepsis and critical illness in last 10 years; however, over this same period we have tripled the number of ‘ICU survivors’ going to rehabilitation. Furthermore, as up to half the deaths in the first year following ICU admission occur post-ICU discharge, it is unclear how many of these patients ever returned home or a meaningful quality of life. For those who do survive, recent data reveals many ‘ICU survivors’ will suffer significant functional impairment or post-ICU syndrome (PICS). Thus, new innovative metabolic and exercise interventions to address PICS are urgently needed. These should focus on optimal nutrition and lean body mass (LBM) assessment, targeted nutrition delivery, anabolic/anticatabolic strategies, and utilization of personalized exercise intervention techniques, such as utilized by elite athletes to optimize preparation and recovery from critical care.

Recent findings New data for novel LBM analysis technique such as computerized tomography scan and ultrasound analysis of LBM are available showing objective measures of LBM now becoming more practical for predicting metabolic reserve and effectiveness of nutrition/exercise interventions. 13C-Breath testing is a novel technique under study to predict infection earlier and predict over-feeding and under-feeding to target nutrition delivery. New technologies utilized routinely by athletes such as muscle glycogen ultrasound also show promise. Finally, the role of personalized cardiopulmonary exercise testing to target preoperative exercise optimization and post-ICU recovery are becoming reality.

Summary New innovative techniques are demonstrating promise to target recovery from PICS utilizing a combination of objective LBM and metabolic assessment, targeted nutrition interventions, personalized exercise interventions for prehabilitation and post-ICU recovery. These interventions should provide hope that we will soon begin to create more ‘survivors’ and fewer victim's post-ICU care.

aDepartment of Anesthesiology and Surgery, Duke University School of Medicine

bDuke Clinical Research Institute, Durham, North Carolina, USA

cCentre for Human Health and Performance, University College London, London, UK

dDepartment of Physical Medicine and Rehabilitation, University of Colorado, Denver, Colorado

eDepartment of Animal Sciences, University of Wisconsin

fIsomark LLC, Madison, Wisconsin

gRespiratory and Critical Care Research Area, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust

hIntegrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK

iMorpheus Collaboration, Department of Anesthesiology Duke University School of Medicine, Durham, North Carolina, USA

Correspondence to Paul E. Wischmeyer, MD, EDIC, Professor of Anesthesiology and Surgery, Duke University School of Medicine, 2400 Pratt Street, NP 7060, Durham, NC 27705, USA. Tel: +1 919 668 3063; e-mail:

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