Evaluation of Effectiveness of Combining High Protein Intake With Early Physical Exercise During Critical Illness
- Registration Number
- NCT05877989
- Lead Sponsor
- Tanta University
- Brief Summary
Assessment of Effectiveness of combined high protein intake with early physical exercise by ultrasound measurement of rectus femoris muscle thickness in Intensive Care Unite mechanically ventilated patients.
- Detailed Description
Muscle wasting and weakness is a frequent finding in critically ill patients and is associated with worse short- and long-term outcomes like delayed liberation from mechanical ventilation, longer Intensive Care Unit and hospital stay, worse physical function and quality of life.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 70
- Patients in age group 18-60 years
- Expected Intensive Care Unit stay >4days after enrolment (to permit adequate exposure to the proposed intervention)
- Previously healthy, Well-nourished, subjects (nutric score=0)
- Renal, liver or heart disease or chronic obstructive pulmonary disease
- Previous immune abnormalities (including treatment with corticosteroids)
- Past history of nutritional problems, chronic use of drugs (as drugs inducing myopathies) or orthopedic problems (such as skeletal fractures or immobilization) in the previous 2 years
- Neuromuscular diseases and patients with amputated lower limbs
- Past or recent history of cancer
- Long term critically ill patients shifted from other hospitals
- Pregnant patients
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Standard care Amino Acid Patients will receive usual care in Intensive Care Unit (prescription of a standard nutrition formula (at approximately 20 -25 kcal/ kg/day and protein intake 1.2 g/kg/day) once patients are hemodynamically stable. Protein and exercise group Physical exercise patients will receive the amino acid intervention that is provided in addition to 'usual care' enteral and/or parenteral nutrition either enteral or parenteral to target a total protein delivery of 2.0g/kg/day. The physical exercise intervention will be delivered by trained nursing staff, and started as close to the time of randomization as feasible (within 24hours of randomization). The intervention group will receive exercise sessions, for up to 20 min duration (as tolerated by patient). The implementation of physical exercise intervention will be protocolized to provide passive exercise early before weaning and shift to active exercise after weaning and also graduated resistance during each session and between daily sessions. Protein and exercise group Amino Acid patients will receive the amino acid intervention that is provided in addition to 'usual care' enteral and/or parenteral nutrition either enteral or parenteral to target a total protein delivery of 2.0g/kg/day. The physical exercise intervention will be delivered by trained nursing staff, and started as close to the time of randomization as feasible (within 24hours of randomization). The intervention group will receive exercise sessions, for up to 20 min duration (as tolerated by patient). The implementation of physical exercise intervention will be protocolized to provide passive exercise early before weaning and shift to active exercise after weaning and also graduated resistance during each session and between daily sessions.
- Primary Outcome Measures
Name Time Method Quantitative changes (cross-section diameter) of rectus femoris muscle Up to 30 days of Surgical Intensive Care Unit stay. Rectus femoris cross-sectional area (RFCSA) will be measured by B-mode ultrasonography using a 3 to 12 MHz transducer array. Patient will be positioned supine in 30° upper body elevation, with legs extended and muscles relaxed. The point that represented 60% of the distance from the anterior superior iliac spine to the superior border of the patella will be identified. The ultrasound probe will be positioned perpendicularly along the superior aspect of the right thigh and transverse images of the rectus femoris will be obtained. A copious amount of gel will be applied to minimize tissue compression. The inner echogenic line of the Rectus Femoris will be traced manually on a frozen image and RFCSA will be calculated by planimetric technique.
- Secondary Outcome Measures
Name Time Method Functional capacity. Up to 30 days of Surgical Intensive Care Unit stay. Ultrasound evaluation of the rectus femoris muscle
Length of Surgical Intensive Care Unit stay. Up to 30 days Length of Surgical Intensive Care Unit stay.
Duration of mechanical ventilation. Up to 30 days of Surgical Intensive Care Unit stay. Duration of mechanical ventilation.
Mortality rate in Surgical Intensive Care Unit Up to 30 days Rate of death in Surgical Intensive Care Unit
Rate of hospital acquired infection. Up to 30 days Rate of hospital acquired infection.
Trial Locations
- Locations (1)
Tanta University
🇪🇬Tanta, Egypt