Acute and Critical Care

Original Article

CPR/Resuscitation
Lower limb muscle matters in patients with hypoxic brain injury following out-of-hospital cardiac arrest: Dong-Hyun Jang, Seung Min Park, Dong Keon Lee, Dong Won Kim, Chang Woo Im, You Hwan Jo, Kui Ja Lee; Acute Crit Care. 2023;38(1):104-112. Published online February 27, 2023; DOI: https://doi.org/10.4266/acc.2022.01389

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Abstract PDF Supplementary Material: Background
There are conflicting results regarding the association between body mass index and the prognosis of cardiac arrest patients. We investigated the association of the composition and distribution of muscle and fat with neurologic outcomes at hospital discharge in successfully resuscitated out-of-hospital cardiac arrest (OHCA) patients. Methods: This prospective, single-centre, observational study involved adult OHCA patients, conducted between April 2019 and June 2021. The ratio of total skeletal muscle, upper limb muscle, lower limb muscle, and total fat to body weight was measured using InBody S10, a bioimpedance analyser, after achieving the return of spontaneous circulation. Restricted cubic spline curves with four knots were used to examine the relationship between total skeletal muscle, upper limb muscle, and lower limb muscle relative to total body weight and neurologic outcome at discharge. Multivariable logistic regression analysis was performed to assess an independent association. Results: A total of 66 patients were enrolled in the study. The proportion of total muscle and lower limb muscle positively correlated with the possibility of having a good neurologic outcome. The proportion of lower limb muscle showed an independent association in the multivariable analysis (adjusted odds ratio, 2.29; 95% confidence interval, 1.06–13.98), and its optimal cut-off value calculated through receiver operating characteristic curve analysis was 23.1%, which can predict a good neurological outcome. Conclusions: A higher proportion of lower limb muscle to body weight was independently associated with the probability of having a good neurologic outcome in OHCA patients.

Review

Mechanisms of Muscle Wasting in Patients with Sepsis: Gi Dong Lee, Ho Cheol Kim; Korean J Crit Care Med. 2010;25(1):9-15.; DOI: https://doi.org/10.4266/kjccm.2010.25.1.9

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Muscle wasting is commonly seen in patients with sepsis as a consequence of the catabolic response in skeletal muscle. Muscle wasting can occur in cases that have an imbalance between degradation and synthesis of muscle proteins. Although decrements in the synthesis of muscle proteins may contribute to sepsis-induced muscle wasting, it has been recognized that increments in its degradation play a more essential role in muscle wasting. Muscle wasting in sepsis patients has some significant clinical consequences such as reduced ambulation and exercise tolerance, and an increased risk for pulmonary and thromboembolic complications. Several mechanisms have been proposed for sepsis-induced muscle wasting. Increased proteolysis via the ubiquitin-proteasome pathway and the calpains system is one of the principal mechanisms of muscle wasting induced by sepsis. Calpains are activated by calcium, which increases in patients with sepsis. The activation of the calpains system disrupts the sarcomere of the myofibrils, resulting in the release of myofilaments that are subsequently ubiquitinated and degraded by the 26S proteasome complex. Recent studies have suggested that transcriptional factors such as NF-kappaB and FoxO, and the apoptosis and autophagy-lysosome pathways may also be involved in sepsis-induced muscle wasting. This review briefly summarizes the contribution of these mechanisms of muscle wasting in patients with sepsis and the possible therapeutic agents to treat it.

Citations

Citations to this article as recorded by

Role of IL-15 in Sepsis-Induced Skeletal Muscle Atrophy and Proteolysis
Ho Cheol Kim, Hee-Young Cho, Young-Sool Hah
Tuberculosis and Respiratory Diseases.2012; 73(6): 312. CrossRef

Randomized Controlled Trial

Succinylcholine-Induced Fasciculation is Prevented by Mivacurium-Precurarization: Kum Hee Chung, Jeong Wan Kang, Jong Yeon Lee; Korean J Crit Care Med. 1999;14(1):31-36.

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Abstract PDF: BACKGOUND: Succinylcholine (SCC) injection may be associated with adverse effects including elevated serum potassium (K ) and creatinine phosphokinase (CPK) level, and postoperative myalgia. Many studies have been made to prevent these adverse effects such as pretreatment with non-depolarizing muscle relaxants. The effects of the pretreatment with vecuronium or mivacurium, a new non-depolarizing neuromuscular blocker, on SCC-induced fasciculation, serum K and CPK level was investigated in this study.
METHODS
ASA physical status I or II, 40 patients were allocated randomly into 4 groups. Group I as a control group received SCC 1 mg/kg only, while the other groups were pretreated with vecuronium 0.02 mg/kg (0.4 x ED95) (group II), mivacurium 0.02 mg/kg (0.25 x ED95) (group III) and 0.03 mg/kg (0.4 x ED95) (group IV) before the SCC 1.5 mg/kg injection, respectively. Serum K concentration was measured just before anesthetic induction and 5 minute after SCC injection, and serum CPK was estimated before induction and at 24~36 hours postoperatively. And the fasciculation after SCC injection was graded by Cullen's suggestion.
RESULTS
Serum K concentration was increased in group I and decreased in pretreated groups, but the difference was not significant within each group and between the groups. Serum CPK level was increased in group I, II and IV but these changes were also insignificant between all groups. The grade of SCC-induced fasciculation was attenuated in group II and IV (p<0.05).
CONCLUSIONS
Like vecuronium, mivacurium 0.03 mg/kg is effective to reduce fasciculation after SCC injection, but 0.02 mg/kg is not. However, any complication does not occur in the two dosages.

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