Early exercise and attenuation of myopathy in the patient with sepsis in ICU

Abstract

Background: Many survivors of severe illness and intensive care admission have decreased quality of life of which decreased physical recovery plays a major part. Those with sepsis syndromes in particular have been shown to have increased mortality and poor quality of life compared to other survivors in intensive care. Objectives: This review aimed to discuss mechanics of myopathy in sepsis and examine the evidence that these are able to be prevented by early activity in intensive care. Major findings: There are a number of exercise trials conducted in general intensive care patients. These have positive findings indicating that early intervention with exercise is able to prevent critical illness weakness syndromes, and loss of muscle mass, decrease duration of mechanical ventilation, length of hospital and intensive care unit (ICU) stay and improve overall quality of life. Specific changes and mechanisms responsible for decreases in muscle force and muscle mass in sepsis syndromes and possible interventions are discussed. As many of these findings are extrapolated from animal studies, there is a need for further research into mechanisms of myopathy in intensive care patients. Conclusions: Controlled clinical trials need to be conducted specifically on patients with sepsis syndromes. Longer term outcomes such as health related quality of life, mortality, duration of ventilation and length of ICU stay are important to investigate. It is also important to identify specific effects of exercise on the mechanisms of myopathy in sepsis. Once this has been proven, research needs to be undertaken so specific levels of exercise can be safely recommended.