#013 - The link between muscle mass and critical illness.
I really enjoyed reading James’ article on grip strength in June and it got me thinking about my patients that I look after regularly on the intensive care unit.
There are some cohorts of critically unwell patients you admit to intensive care who you know will probably do ok, i.e. they will survive until discharge and have minimal functional decline from their baseline. Unsurprisingly a lot of these patients have looked after themselves throughout their lives: they’re strong, fit and physically resilient, regardless of their age.
Other patients unfortunately do not do as well and some of this can be attributed to muscle mass on admission to ICU. A long-term study of Australian patients admitted to intensive care found that greater limb muscle mass was related to an improved survival at 28 days after admission1.
Another study has shown that the actual decline of strength results in increased mortality, regardless of original muscle mass/strength2.
And to really top it off this study demonstrated that more than twice as many critical illness survivors with a low muscle mass on admission to ICU, compared to those with preserved muscle mass, were discharged to a nursing home3.
Sarcopenia (age-related loss of muscle mass and function) is a real issue as we grow older and on average critically ill patients lose nearly 2% of skeletal muscle per day during the first week of ICU admission.
So what can I do to safeguard the health of myself and my loved ones?
Simple:
Follow the advice here on Future Proof and do everything you can to build and maintain muscle and strength throughout your life.
Dr Jack Maynard - Medical
References
1. Thackeray, M., Mohebbi, M., Orford, N. et al. Lean mass as a risk factor for intensive care unit admission: an observational study. Crit Care 25, 364 (2021). https://doi.org/10.1186/s13054-021-03788-y
2. The Journals of Gerontology: Series A, Volume 57, Issue 10, 1 October 2002, Pages B359–B365, https://doi.org/10.1093/gerona/57.10.B359
3. Weijs P.J. Low skeletal muscle area is a risk factor for mortality in mechanically ventilated critically ill patients. Crit Care. 2014;18:R12. doi: 10.1186/cc13189