In contrast, cachexia leads to preferential atrophy of type 2 muscle. For example, muscle disuse can cause atrophy of type 1 muscle as they are sensitive to inactivity, decreased gravity, and denervation and tend to change from slow-twitch to fast-twitch muscles. Moreover, several factors may have different effects on the speeds of atrophy of different muscle type. Therefore, further research is required to determine the differences in the speed of muscle atrophy in men and women admitted in ICU.ĭecrease in muscle strength is caused by polyneuropathy, myopathy, and/or muscle atrophy 14. Studies that discuss sex differences in ICUAW are few 12, 13. (3) Men have more satellite cells and greater hypertrophy and proliferative capacity 11. (2) Women’s myofibrillar synthesis is faster than men’s when supplemented with nutrients 9, although the muscle protein synthesis caused by intermittent exercise is worse than that of men 10. These differences may be due to the following reasons: (1) The proportion of type 1 muscle is higher in women 8.
For example, women are more susceptible to disuse atrophy, but are better protected from inflammation-induced muscle atrophy (such as cancer cachexia) 7. Physiological differences in the muscle cells of men and women affect the speed of recovery in both sexes. This information can be acquired by observing daily muscle changes of patients under regular rehabilitation. Whether the rate of muscle atrophy trend is initially rapid and then gradual (i.e.: whether the slope is changed) due to improved postoperative inflammation or consistently rapid due to prolonged immobilization is unknown. At present, even with popularization of early rehabilitation, the rate of change in muscle mass with the number of days of hospitalization is not well-understood due to a lack of observational research in the field. Due to its profound impact on the prognosis of patients, before or after hospital discharge 3, 4, developed countries have introduced early rehabilitation in the ICU to reduce the occurrence and severity of ICUAW 5, 6. The incidence of intensive care unit-acquired weakness (ICUAW) is up to 80% in critically ill patients 1, 2. Our study depicts the trend of muscle atrophy in the ICU and suggests more discussion in prevention to be conducted especially for women. Protective factors of muscle atrophy included higher BMI and lower initial thickness of the RF and VI. Daily atrophy rates of the RF and VI were approximately three times higher in women than in men. The rate of atrophy was the highest in the third and fourth weeks.
The average daily atrophy rates of the RF and VI were 0.84% and 0.98%, respectively. A linear mixed model was used to calculate the influence of other factors on muscle loss.
Patient characteristics were adjusted using propensity score matching and differences between men and women were analyzed. Daily rates of muscle atrophy were calculated using linear analysis and the ratios of change were plotted against the period of hospitalization. Patients were excluded if there is a wound at the right thigh which hinders the ultrasonography probe from placing.
In this prospective observational study, we used ultrasound to measure the change in muscle thickness of the rectus femoris (RF) and vastus intermedius (VI) in 284 patients who were admitted to the SICU of Taoyuan General Hospital between January 1 and June 30, 2020. Muscle atrophy greatly affects the prognosis of patients in the intensive care unit, but the rate of change remains unclear.
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