Leucine-enriched essential amino acid supplementation in mechanically ventilated trauma patients: a feasibility study
Abstract Background Critically ill patients lose up to 2% of muscle mass per day. We assessed the feasibility of administering a leucine-enriched essential amino acid (L-EAA) supplement to mechanically ventilated trauma patients with the aim of assessing the effect on skeletal muscle mass and functi...
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| Format: | Article |
| Language: | English |
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BMC
2019-09-01
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| Series: | Trials |
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| Online Access: | http://link.springer.com/article/10.1186/s13063-019-3639-2 |
| _version_ | 1818863198934138880 |
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| author | L. Wandrag S. J. Brett G. S. Frost M. To E. Alves Loubo N. C. Jackson A. M. Umpleby V. Bountziouka M. Hickson |
| author_facet | L. Wandrag S. J. Brett G. S. Frost M. To E. Alves Loubo N. C. Jackson A. M. Umpleby V. Bountziouka M. Hickson |
| author_sort | L. Wandrag |
| collection | DOAJ |
| description | Abstract Background Critically ill patients lose up to 2% of muscle mass per day. We assessed the feasibility of administering a leucine-enriched essential amino acid (L-EAA) supplement to mechanically ventilated trauma patients with the aim of assessing the effect on skeletal muscle mass and function. Methods A randomised feasibility study was performed over six months in intensive care (ICU). Patients received 5 g L-EAA five times per day in addition to standard feed (L-EAA group) or standard feed only (control group) for up to 14 days. C-reactive protein, albumin, IL-6, IL-10, urinary 3-MH, nitrogen balance, protein turnover ([1-13C] leucine infusion), muscle depth change (ultrasound), functional change (Katz and Barthel indices) and muscle strength Medical Research Council (MRC) sum score to assess ICU Acquired Weakness were measured sequentially. Results Eight patients (9.5% of screened patients) were recruited over six months. L-EAA doses were provided on 91/124 (73%) occasions. Inflammatory and urinary marker data were collected; serial muscle depth measurements were lacking due to short length of stay. Protein turnover studies were performed on five occasions. MRC sum score could not be performed as patients were not able to respond to the screening questions. The Katz and Barthel indices did not change. L-EAA delivery was achievable, but meaningful functional and muscle mass outcome measures require careful consideration in the design of a future randomised controlled trial. Conclusion L-EAA was practical to provide, but we found significant barriers to recruitment and measurement of the chosen outcomes which would need to be addressed in the design of a future, large randomised controlled trial. Trial registration ISRCTN Registry, ISRCTN79066838. Registered on 25 July 2012. |
| first_indexed | 2024-12-19T10:11:57Z |
| format | Article |
| id | doaj.art-14efae3cd2a244849997acf733e1f9c7 |
| institution | Directory Open Access Journal |
| issn | 1745-6215 |
| language | English |
| last_indexed | 2024-12-19T10:11:57Z |
| publishDate | 2019-09-01 |
| publisher | BMC |
| record_format | Article |
| series | Trials |
| spelling | doaj.art-14efae3cd2a244849997acf733e1f9c72022-12-21T20:26:20ZengBMCTrials1745-62152019-09-012011610.1186/s13063-019-3639-2Leucine-enriched essential amino acid supplementation in mechanically ventilated trauma patients: a feasibility studyL. Wandrag0S. J. Brett1G. S. Frost2M. To3E. Alves Loubo4N. C. Jackson5A. M. Umpleby6V. Bountziouka7M. Hickson8Nutrition and Dietetic Research Group, Department of Investigative Medicine, Imperial College LondonCentre for Peri-operative Medicine and Critical Care Research, Imperial College Healthcare NHS TrustNutrition and Dietetic Research Group, Department of Investigative Medicine, Imperial College LondonNutrition and Dietetic Research Group, Department of Investigative Medicine, Imperial College LondonNutrition and Dietetic Research Group, Department of Investigative Medicine, Imperial College LondonDepartment of Nutritional Science, University of SurreyDepartment of Nutritional Science, University of SurreyStatistical Support Service, Population, Policy and Practice Programme, Institute of Child Health, University College LondonNutrition and Dietetic Research Group, Department of Investigative Medicine, Imperial College LondonAbstract Background Critically ill patients lose up to 2% of muscle mass per day. We assessed the feasibility of administering a leucine-enriched essential amino acid (L-EAA) supplement to mechanically ventilated trauma patients with the aim of assessing the effect on skeletal muscle mass and function. Methods A randomised feasibility study was performed over six months in intensive care (ICU). Patients received 5 g L-EAA five times per day in addition to standard feed (L-EAA group) or standard feed only (control group) for up to 14 days. C-reactive protein, albumin, IL-6, IL-10, urinary 3-MH, nitrogen balance, protein turnover ([1-13C] leucine infusion), muscle depth change (ultrasound), functional change (Katz and Barthel indices) and muscle strength Medical Research Council (MRC) sum score to assess ICU Acquired Weakness were measured sequentially. Results Eight patients (9.5% of screened patients) were recruited over six months. L-EAA doses were provided on 91/124 (73%) occasions. Inflammatory and urinary marker data were collected; serial muscle depth measurements were lacking due to short length of stay. Protein turnover studies were performed on five occasions. MRC sum score could not be performed as patients were not able to respond to the screening questions. The Katz and Barthel indices did not change. L-EAA delivery was achievable, but meaningful functional and muscle mass outcome measures require careful consideration in the design of a future randomised controlled trial. Conclusion L-EAA was practical to provide, but we found significant barriers to recruitment and measurement of the chosen outcomes which would need to be addressed in the design of a future, large randomised controlled trial. Trial registration ISRCTN Registry, ISRCTN79066838. Registered on 25 July 2012.http://link.springer.com/article/10.1186/s13063-019-3639-2Muscle wastingEssential amino acidsLeucineMuscle ultrasoundCritically illNitrogen balance |
| spellingShingle | L. Wandrag S. J. Brett G. S. Frost M. To E. Alves Loubo N. C. Jackson A. M. Umpleby V. Bountziouka M. Hickson Leucine-enriched essential amino acid supplementation in mechanically ventilated trauma patients: a feasibility study Trials Muscle wasting Essential amino acids Leucine Muscle ultrasound Critically ill Nitrogen balance |
| title | Leucine-enriched essential amino acid supplementation in mechanically ventilated trauma patients: a feasibility study |
| title_full | Leucine-enriched essential amino acid supplementation in mechanically ventilated trauma patients: a feasibility study |
| title_fullStr | Leucine-enriched essential amino acid supplementation in mechanically ventilated trauma patients: a feasibility study |
| title_full_unstemmed | Leucine-enriched essential amino acid supplementation in mechanically ventilated trauma patients: a feasibility study |
| title_short | Leucine-enriched essential amino acid supplementation in mechanically ventilated trauma patients: a feasibility study |
| title_sort | leucine enriched essential amino acid supplementation in mechanically ventilated trauma patients a feasibility study |
| topic | Muscle wasting Essential amino acids Leucine Muscle ultrasound Critically ill Nitrogen balance |
| url | http://link.springer.com/article/10.1186/s13063-019-3639-2 |
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