Muscle wasting Protein breakdown
Conditions
Interventions
Patients participating in this study will receive a primed continuous
intravenous infusion with non-radioactive stable isotope tracers after a 6 hour
fast. 2H5 phenylalanine, 2H2 tyrosine and 13C gl
Sponsors
Universiteit Maastricht
Eligibility
Age
18 Years to 99 Years
Inclusion criteria
Inclusion criteria: 1) Age >18 0.05-0.25 ug/kg/min 4) Receiving enteral or parenteral nutrition 5) Intubated and Mechanically ventilated - PaO2/FiO2 ratio of >100 and 48 hours, * Sepsis as defined by the third international consensus definitions for sepsis and septic shock [17]: - Suspected infection - SOFA score >= 2
Exclusion criteria
Exclusion criteria: 1) Patients who are moribund (not expected to be in ICU for more than 48 hours due to imminent death) 2) A lack of commitment to full aggressive care during the first week due to severity of illness, comorbidities and potential harm from maximal treatment (anticipated withholding or withdrawing treatments in the first week) 3) Any trauma with severe injury or fracture of any extremity. 4) Rhabdomyolysis 5) Proven (pre-existing) skeletal muscle weakness (e.g. due to neuromuscular disorders or immobility) 6) Renal dysfunction defined as a serum creatinine >171 *mol/L or a urine output of less than 500 ml/last 24 hours 7) Patients requiring chronic veno-venous hemofiltration 8) Patients on any form of extracorporeal life support (ECMO/ELS) 9) Cirrhosis - Child*s class C liver disease 10) Metastatic cancer or Stage IV Lymphoma with life expectancy 30% body surface area) 12) Weight less than 50 kg or greater than 100 kg 13) Pregnant patients or lactating with the intent to breastfeed 14) Previous enrollment in this study 15) Previous participation in a 13C or 2H tracer study within the last year 16) Enrollment in any other interventional study
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Main study parameters will be protein breakdown and glutamine release from the leg (assessed by a two-pool model using AV leg gradients), albumin synthesis assessed by 2H5 phenylalanine incorporation. In addition we will study the incorporation of 13C in urea, glucose and citrate cycle intermediates such as citrate, fumarate, malate in peripheral leukocytes as a marker of glutamine utilization by the immune system. Moreover we will measure 13CO2 enrichment in exhaled air as a measure of total glutamine oxidation. Finally we will quantify muscle loss using repeated ultrasound measurements | — |
Secondary
| Measure | Time frame |
|---|---|
| nvt | — |
Countries
Netherlands
Outcome results
None listed