Chapela S, Martinuzzi A

Language: Spanish
References: 0
Page: 393-416
PDF size: 617.76 Kb.

ABSTRACT

Loss of skeletal muscle mass (LOSMM) in the critically ill patient is the final expression of pathophysiological events unleashed by trauma and injury, inflammation and hypercatabolia. LOSMM might also follow after insufficient intake of energy and nutrients, accentuating the depletion of lean tissues. If not timely intervened, LOSMM might place the patient at risk of ventilatory failure, and hence, intubation and mechanical ventilation, prolongation of hospital stay, and increased costs of hospital and medical care. LOSMM can be recognized by means of functional exploration, anthropometric assessment, and measurement of muscle contraction force through dynamometry. In addition, size of muscle masses can be reconstructed with imagenological techniques such as nuclear magnetic resonance (NMR), and ultrasound (US). Measurement of urinary urea nitrogen (NUU) allows to assess the intensity of hypercatabolia as well as to trace changes in tissue repletion after initiating nutritional intervention. Attenuation of LOSMM along with tissue repletion can be achieved with multimodal therapies combining nutritional support, use of nutrients and drugs specifically aimed to muscle accretion, and promotion of rehabilitation and physical exercise. Promising clinical trials have been completed with agonists of androgens and ghrelin receptors, and inhibitors of FOX transcription factors. As an increasingly higher number of patients admitted to the critical care units already show aging-associated-LOSMM, fostering of guidelines for assessing the size of skeletal muscle mass and quality of muscle contraction force, quantification of metabolic stress and hypercatabolia, and adoption of an effective multimodal program limiting LOSMM, allows for rehabilitation of the patient, and ensures the success of medical surgical actions is becoming imperative.