The impact of extended bed rest on the musculoskeletal system in the critical care environment

Extreme Physiology & Medicine

Zudin A. Puthucheary¹  Selina M. Parry² 

[1] Institute of Health and Human Performance, University College London, London, UK;Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Level 7 Alan Gilbert Building, Parkville, Melbourne 3010, VIC, Australia

关键词: Bed rest;    Rehabilitation;    Muscle protein turnover;    Sepsis;    Intensive care unit-acquired weakness;    Muscle wasting;    Critical illness;   

Others  :  1231861
DOI  :  10.1186/s13728-015-0036-7

 received in 2015-08-05, accepted in 2015-09-30,  发布年份 2015

【 摘 要 】

Prolonged immobility is harmful with rapid reductions in muscle mass, bone mineral density and impairment in other body systems evident within the first week of bed rest which is further exacerbated in individuals with critical illness. Our understanding of the aetiology and secondary consequences of prolonged immobilization in the critically ill is improving with recent and ongoing research to establish the cause, effect, and best treatment options. This review aims to describe the current literature on bed rest models for examining immobilization-induced changes in the musculoskeletal system and pathophysiology of immobilisation in critical illness including examination of intracellular signalling processes involved. Finally, the review examines the current barriers to early activity and mobilization and potential rehabilitation strategies, which are being, investigated which may reverse the effects of prolonged bed rest. Addressing the deleterious effects of immobilization is a major step in treatment and prevention of the public health issue, that is, critical illness survivorship.

【 授权许可】

   
2015 Parry and Puthucheary.

【 图 表 】

Fig.1.

【 参考文献 】

• [1]Needham D et al.. Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders’ conference. Crit Care Med. 2012; 40:502-509.
• [2]Iwashyna T, Netzer G. The burdens of survivorship: an approach to thinking about long-term outcomes after critical illness. Semin Respir Crit Care Med. 2012; 33(4):327-338.
• [3]Needham D, Feldman D, Kho M. The functional costs of ICU survivorship. Collaborating to improve post-ICU disability. Am J Respir Crit Care Med. 2011; 183(8):962-964.
• [4]Iwashyna T. Survivorship will be the defining challenge of critical care in the 21st century—editorial. Ann Intern Med. 2010; 153:204-205.
• [5]Herridge M et al.. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med. 2011; 364(14):1293-1304.
• [6]de Rooij S et al.. Cognitive, functional, and quality-of-life outcomes of patients aged 80 and older who survived at least 1 year after planned or unplanned surgery or medical intensive care treatment. J Am Geriatr Soc. 2008; 56(5):816-822.
• [7]Hopkins R, Jackson J. Short- and long-term cognitive outcomes in intensive care unit survivors. Clin Chest Med. 2009; 30(1):143-153, ix.
• [8]Brower R. Consequences of bed rest. Crit Care Med. 2009; 37(10 Suppl):S422-S428.
• [9]Griffiths R, Jones C. Seven lessons from 20 years of follow-up of intensive care unit survivors. Curr Opin Crit Care. 2007; 13(5):6.
• [10]Pavy-Le Traon A et al.. From space to Earth: advances in human physiology from 20 years of bed rest studies (1986–2006). EurJ Appl Physiol. 2007; 101:143-194.
• [11]Allen C, Glasziou P, Del Marc C. Bed rest: a potentially harmful treatment needing more careful evaluation. Lancet. 1999; 354:1229-1233.
• [12]Topp R et al.. The effect of bed rest and potential of prehabilitation on patients in the intensive care unit. AACN Clin Issues. 2002; 13(2):14.
• [13]Preiser JC et al.. Effects of bedrest on muscle metabolism. Pratic Anesth Reanim. 2010; 14(2):80-84.
• [14]Bloomfield S. Changes in musculoskeletal structure and function with prolonged bed rest. Med Sci Sports Exerc. 1997; 29(2):197-206.
• [15]de Boer MD et al.. The temporal responses of protein synthesis, gene expression and cell signalling in human quadriceps muscle and patellar tendon to disuse. J Physiol. 2007; 585(Pt 1):241-251.
• [16]Adams GR, Caiozzo VJ, Baldwin KM. Skeletal muscle unweighting: spaceflight and ground-based models. J Appl Physiol. 2003; 95(6):2185-2201.
• [17]Hespel P et al.. Oral creatine supplementation facilitates the rehabilitation of disuse atrophy and alters the expression of muscle myogenic factors in humans. J Physiol. 2001; 536(Pt 2):625-633.
• [18]Thom JM et al.. Effect of 10-day cast immobilization on sarcoplasmic reticulum calcium regulation in humans. Acta Physiol Scand. 2001; 172(2):141-147.
• [19]Gibson JN et al.. Decrease in human quadriceps muscle protein turnover consequent upon leg immobilization. Clin Sci (Lond). 1987; 72(4):503-509.
• [20]Gibson JN, Smith K, Rennie MJ. Prevention of disuse muscle atrophy by means of electrical stimulation: maintenance of protein synthesis. Lancet. 1988; 2(8614):767-770.
• [21]Kortebein P et al.. Functional impact of 10 days of bed rest in healthy older adults. J Gerontol A Biol Sci Med Sci. 2008; 63(10):1076-1081.
• [22]Ferrando AA et al.. Magnetic resonance imaging quantitation of changes in muscle volume during 7 days of strict bed rest. Aviat Space Environ Med. 1995; 66(10):976-981.
• [23]Greenleaf J, Kozlowski S. Physiological consequences of reduced physical activity during bed rest. Exerc Sports Sci Rev. 1982; 10:84-119.
• [24]Bruton A. Muscle plasticity: response to training and detraining. Physiotherapy. 2002; 88(7):398-408.
• [25]Berg H, Larsson L, Tesch P. Lower limb skeletal muscle function after 6 weeks of bed rest. J Appl Physiol. 1997; 82(1):182-188.
• [26]Winkleman C. Bed rest in health and critical illness—a body systems approach. AACN Adv Crit Care. 2009; 20(3):254-266.
• [27]Puthucheary Z et al.. Structure to function: muscle failure in critically ill patients. J Physiol. 2010; 588(Pt 23):4641-4648.
• [28]LeBlanc A et al.. Changes in intervertebral disc cross-sectional area with bed rest and space flight. Spine. 1994; 19(7):812-817.
• [29]Rawal J et al.. A pilot study of change in fracture risk in patients with acute respiratory distress syndrome. Crit Care. 2015; 19(1):165.
• [30]Saltin B et al.. Response to exercise after bed rest and after training. Circulation. 1968; 38(5):V111-V1178.
• [31]Convertino V. Cardiovascular consequences of bed rest: effect on maximal oxygen uptake. Med Sci Sports Exerc. 1997; 29(2):6.
• [32]Convertino V, Bloomfield S, Greenleaf J. An overview of the issues: physiological effects of bed rest and restricted physical activity. Med Sci Sports Exerc. 1997; 29(2):4.
• [33]Convertino V et al.. Cardiovascular responses to exercise in middle-aged men after 10 days of bed rest. Circulation. 1982; 65(1):134-140.
• [34]Convertino VA. Cardiovascular consequences of bed rest: effect on maximal oxygen uptake. Med Sci Sports Exerc. 1997; 29(2):191-196.
• [35]Koo K, Fan E. ICU-acquired weakness and early rehabilitation in the critically ill. JCOM. 2013; 20(5):223-231.
• [36]Norrenberg M, Vincent J. A profile of European intensive care physiotherapists. Intensive Care Med. 2000; 26:7.
• [37]Stevens R et al.. A framework for diagnosing and classifying intensive care unit-acquired weakness. Crit Care Med. 2009; 37(10 Suppl):S299-S308.
• [38]Ali N et al.. Acquired weakness, handgrip strength, and mortality in critically ill patients. Am J Respir Crit Care Med. 2008; 178(3):261-268.
• [39]De Jonghe B et al.. Does ICU-acquired paresis lengthen weaning from mechanical ventilation? Intensive Care Med. 2004; 30(5):1117-1121.
• [40]Sharshar T et al.. Presence and severity of intensive care unit-acquired paresis at time of awakening are associated with increased intensive care unit and hospital mortality. Crit Care Med. 2009; 37(12):3047-3053.
• [41]De Jonghe B et al.. Paresis acquired in the intensive care unit: a prospective multicenter study. J Am Med Assoc. 2002; 288(9):2859-2867.
• [42]Griffiths R, Hall J. Intensive care unit-acquired weakness. Crit Care Med. 2010; 38(3):779-787.
• [43]Puthucheary Z, Harridge S, Hart N. Skeletal muscle dysfunction in critical care: wasting, weakness, and rehabilitation strategies. Crit Care Med. 2010; 38(10 Suppl):S676-S682.
• [44]Witt N et al.. Peripheral nerve function in sepsis and multiple organ failure. Chest. 1991; 99:176-184.
• [45]Leitjen F et al.. Critical illness polyneuropathy in multiple organ dysfunction syndrome and weaning from the ventilator. Intensive Care Med. 1996; 22:856-861.
• [46]Denehy L et al.. Exercise rehabilitation for patients with critical illness: a randomized controlled trial with 12 months follow up. Crit Care. 2013; 17(4):R156.
• [47]Connolly B et al.. Clinical predictive value of manual muscle strength testing during critical illness: an observational cohort study. Crit Care. 2013; 17(5):R229.
• [48]Tennila A et al.. Early signs of critical illness polyneuropathy in ICU patients with systemic inflammatory response syndrome or sepsis. Intensive Care Med. 2000; 26(9):1360-1363.
• [49]De Jonghe B et al.. Acquired neuromuscular disorders in critically ill patients: a systematic review. Intensive Care Med. 1998; 24:9.
• [50]Fan E et al.. An Official American Thoracic Society clinical practice guideline: the diagnosis of intensive care unit-acquired weakness in adults. Am J Respir Crit Care Med. 2014; 190(12):1437-1446.
• [51]Hough C, Lieu B, Caldwell E. Manual muscle strength testing of critically ill patients: feasibility and interobserver agreement. Crit Care. 2011; 15(1):R43.
• [52]Parry S et al.. A new two-tier strength assessment approach to the diagnosis of weakness in intensive care: an observational study. Crit Care. 2015; 19(1):52.
• [53]Truong A et al.. Bench-to-bedside review: mobilizing patients in the intensive care unit—from pathophysiology to clinical trials. Crit Care. 2009; 13:216.
• [54]de Sèze M et al.. Critical illness polyneuropathy. A 2-year follow-up study in 19 severe cases. Eur Neurol. 2000; 43:61-69.
• [55]de Letter M et al.. Risk factors for the development of polyneuropathy and myopathy in critically ill patients. Crit Care Med. 2001; 29:2281-2286.
• [56]Nanas S et al.. Predisposing factors for critical illness polyneuromyopathy in a multidisciplinary intensive care unit. Acta Neurol Scand. 2008; 118(3):175-181.
• [57]Bednarik J et al.. Risk factors for critical illness polyneuromyopathy. J Neurol. 2005; 252:343-351.
• [58]Puthucheary Z et al.. Acute skeletal muscle wasting in critical illness. JAMA. 2013; 310(15):1591-1600.
• [59]Hermans G et al.. Impact of intensive insulin therapy on neuromuscular complications and ventilator dependency in the medical intensive care unit. Am J Respir Crit Care Med. 2007; 175:10.
• [60]Fan E et al.. Critical illness neuromyopathy and muscle weakness in patients in the intensive care unit. AACN Adv Crit Care. 2008; 20(3):243-253.
• [61]Brealey D et al.. Association between mitochondrial dysfunction and severity and outcome of septic shock. Lancet. 2002; 360(9328):219-223.
• [62]Puthucheary Z et al.. Neuromuscular blockade and skeletal muscle weakness in critically ill patients: time to rethink the evidence? Am J Respir Crit Care Med. 2012; 185(9):911-917.
• [63]Papazian L et al.. Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med. 2010; 363(12):1107-1116.
• [64]Puthucheary Z, Hart N, Montgomery H. Neuromuscular blockers and ARDS. N Engl J Med. 2010; 363(26):2563.
• [65]Trapani G et al.. Propofol in anesthesia. Mechanism of action, structure-activity relationships, and drug delivery. Curr Med Chem. 2000; 7(2):249-271.
• [66]Rang HP, Dale MM, Ritter JM. Pharmacology. Churchill Livingstone, London; 1999.
• [67]Jentsch TJ et al.. Molecular structure and physiological function of chloride channels. Physiol Rev. 2002; 82(2):503-568.
• [68]Urazaev AK et al.. Muscle NMDA receptors regulate the resting membrane potential through NO-synthase. Physiol Res. 1995; 44(3):205-208.
• [69]MacDonald RL, Barker JL. Enhancement of GABA-mediated postsynaptic inhibition in cultured mammalian spinal cord neurons: a common mode of anticonvulsant action. Brain Res. 1979; 167(2):323-336.
• [70]Malomouzh AI et al.. NMDA receptors at the endplate of rat skeletal muscles: precise postsynaptic localization. Muscle Nerve. 2011; 44(6):987-989.
• [71]Florini JR et al.. Stimulation of myogenic differentiation by a neuregulin, glial growth factor 2. J Biol Chem. 1996; 271(22):12699-12702.
• [72]Lebrasseur NK et al.. Regulation of neuregulin/ErbB signaling by contractile activity in skeletal muscle. Am J Physiol Cell Physiol. 2003; 284(5):C1149-C1155.
• [73]Strom T, Martinussen T, Toft P. A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomised trial. Lancet. 2010; 375(9713):475-480.
• [74]Schweickert WD et al.. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009; 373(9678):1874-1882.
• [75]Girard TD et al.. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial. Lancet. 2008; 371(9607):126-134.
• [76]Kress JP. Daily interruption of sedative infusions in critically ill patients. N Engl J Med. 2000; 343(11):814-815.
• [77]Millward D. Protein turnover in cardiac and skeletal muscle during normal growth and hypertrophy. In: Degradative processes in skeletal and cardiac muscle. Wildenthal K, editor. North Holland, Amsterdam; 1980: p.161-200.
• [78]Temparis S, Asensi M, Taillandier D, Aurousseau E, Larbaud D, Obled A, Bechet D, Ferrara M, Estrela JM, Attaix D. Increased ATP-ubiquitin-dependent proteolysis in skeletal muscles of tumor-bearing rats. Cancer Res. 1994; 54:5568-5573.
• [79]Rennie MJ. Muscle protein turnover and the wasting due to injury and disease. Br Med Bull. 1985; 41(3):257-264.
• [80]Flück M. Regulation of protein synthesis in skeletal muscle. Dtsch Z Sportmed. 2012; 63(3):75-80.
• [81]Stewart C, Rittweger J. Adaptive processes in skeletal muscle: molecular regulators and genetic influences. J Musculoskelet Neuronal Interact. 2006; 6(1):73-86.
• [82]Glover EI et al.. Immobilization induces anabolic resistance in human myofibrillar protein synthesis with low and high dose amino acid infusion. J Physiol. 2008; 586(Pt 24):6049-6061.
• [83]Caron AZ et al.. A novel hindlimb immobilization procedure for studying skeletal muscle atrophy and recovery in mouse. J Appl Physiol. 2009; 106(6):2049-2059.
• [84]Sacheck JM et al.. Rapid disuse and denervation atrophy involve transcriptional changes similar to those of muscle wasting during systemic diseases. Faseb J. 2007; 21(1):140-155.
• [85]Duchateau J, Hainaut K. Electrical and mechanical changes in immobilized human muscle. J Appl Physiol. 1987; 62(6):2168-2173.
• [86]Hamburg NM et al.. Physical inactivity rapidly induces insulin resistance and microvascular dysfunction in healthy volunteers. Arterioscler Thromb Vasc Biol. 2007; 27(12):2650-2656.
• [87]Tomanek RJ, Lund DD. Degeneration of different types of skeletal muscle fibres. II. Immobilization. J Anat. 1974; 118(Pt 3):531-541.
• [88]Rennie MJ. Anabolic resistance in critically ill patients. Crit Care Med. 2009; 37(10 Suppl):S398-S399.
• [89]Parry S et al.. Ultrasonography in the intensive care setting can be used to detect changes in the quality and quantity of muscle and is related to muscle strength and function. J Crit Care. 2015.
• [90]Puthucheary Z et al.. Qualitative ultrasound in acute critical illness muscle wasting. Crit Care Med. 2015; 43(8):1603-1611.
• [91]Derde S et al.. Muscle atrophy and preferential loss of myosin in prolonged critically ill patients. Crit Care Med. 2012; 40:79-89.
• [92]Klaude M et al.. Protein metabolism and gene expression in skeletal muscle of critically ill patients with sepsis. Clin Sci. 2012; 122(3):133-142.
• [93]Borina E et al.. Myosin and actin content of human skeletal muscle fibers following 35 days bed rest. Scand J Med Sci Sports. 2010; 20(1):65-73.
• [94]Llano-Diez M et al.. Mechanisms underlying intensive care unit muscle wasting and effects of passive mechanical loading. Crit Care. 2012; 16(5):R209.
• [95]Jones S et al.. Disuse atrophy and exercise rehabilitation in humans profoundly affects the expression of genes associated with the regulation of skeletal muscle mass. FASEB J. 2004; 18(9):1025-1027.
• [96]Murton A, Constantin D, Greenhaff P. The involvement of the ubiquitin proteasome system in human skeletal muscle remodelling and atrophy. Biochim Biophs Acta. 2008; 1782(12):730-743.
• [97]Sacheck J et al.. Rapid disuse and denervation atrophy involving transcriptional changes similar to those of muscle wasting during systemic diseases. FASEB J. 2007; 21(1):140-155.
• [98]Bloch S et al.. Molecular mechanisms of intensive care unit-acquired weakness. Eur Respir J. 2012; 39:1000-1011.
• [99]Khan J, Harrison T, Rich M. Mechanisms of neuromuscular dysfunction in critical illness. Crit Care Clin. 2008; 24(1):165-177, x.
• [100]Shang F, Gong Z, Taylor A. Activity of ubiquitin-dependent pathway in response to oxidative stress. Ubiquitin-activating enzyme is transiently upregulated. J Biol Chem. 1997; 272:23086-23093.
• [101]Z’Graggen W et al.. Muscle membrane dysfunction in critical illness myopathy assessed by velocity recovery cycles. Clin Neurophysiol. 2011; 122(4):834-841.
• [102]Z’Graggen W et al.. Nerve excitability changes in critical illness polyneuropathy. Brain. 2006; 129(Pt 9):2461-2470.
• [103]Lutwak L, Whedon G. The effect of physical conditioning on glucose tolerance. Clin Res. 1959; 7:143-144.
• [104]Bergouignan A et al.. Effect of physical inactivity on the oxidation of saturated and monounsaturated dietary fatty acids: results of a randomised trial. PLoS Clin Trials. 2006; 1(5):e27.
• [105]Cree M et al.. Insulin resistance, secretion and breakdown are increased 9 months following severe burn injury. Burns. 2009; 35(1):63-69.
• [106]Weber-Carstens S et al.. Critical illness myopathy and GLUT4 significance of insulin and muscle contraction. Am J Respir Crit Care Med. 2013; 187(4):387-396.
• [107]Tabata I et al.. Resistance training affects GLUT-4 content in skeletal muscle of humans after 19 days of head-down bed rest. J Appl Physiol. 1999; 86(3):909-914.
• [108]Files D, Sanchez M, Morris P. A conceptual framework: the early and late phases of skeletal muscle dysfunction in the acute respiratory distress syndrome. Crit Care. 2015; 19:266.
• [109]Puthucheary Z, Hart N. Intensive care unit acquired muscle weakness: when should we consider rehabilitation? Crit Care. 2009; 13(4):167.
• [110]Berney S et al.. Intensive care unit mobility practices in Australia and New Zealand: a point prevalence study . Crit Care Resusc. 2013; 15(4):260-265.
• [111]Nydahl P et al.. Early mobilization of mechanically ventilated patients: a 1-day point-prevalence study in Germany. Crit Care Med. 2014; 42(5):1178-1186.
• [112]Early mobilization and recovery in mechanically ventilated patients in the ICU: a bi-national, multi-centre prospective cohort study. Crit Care. 2015; 19:81.
• [113]Leditschke I et al.. Whats are the barriers to mobilizing intensive care patients? Cardiopulm Phys Ther J. 2012; 23(1):26-29.
• [114]Berney S et al.. Prospective observation of physical activity in critically ill patients who were intubated for more than 48 hours. J Crit Care. 2015; 30(4):658-663.
• [115]Beach L, et al. Low physical activity levels and poorer muscle strength are associated with reduced physical function at intensive care unit discharge: an observational study. Am J Respir Crit Care Med. 2014;A543.
• [116]Sricharoenchai T et al.. Safety of physical therapy interventions in critically ill patients: a single-center prospective evaluation of 1110 intensive care unit admissions. J Crit Care. 2014; 29(3):395-400.
• [117]Adler J, Malone D. Early mobilization in the intensive care unit: a systematic review. Cardiopulm Phys Ther J. 2012; 23(1):5-13.
• [118]Hodgson C et al.. Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults. Crit Care. 2014; 18(5):658.
• [119]Needham DM, Truong AD, Fan E. Technology to enhance physical rehabilitation of critically ill patients. Crit Care Med. 2009; 37(SUPPL. 10):S436-S441.
• [120]Burtin C et al.. Early exercise in critically ill patients enhances short-term functional recovery. Crit Care Med. 2009; 37(9):2499-2505.
• [121]Maffiuletti N. Physiological and methodological considerations for the use of neuromuscular electrical stimulation. Eur J Appl Physiol. 2010; 110(2):223-234.
• [122]Parry S et al.. Electrical muscle stimulation in the intensive care setting: a systematic review. Crit Care Med. 2013; 41(10):2406-2418.
• [123]Parry S et al.. Functional electrical stimulation with cycling in the critically ill: a pilot case-matched control study. J Crit Care. 2014; 29(4):695.e1-695.e7.
• [124]Morandi A, Brummel N, Ely E. Sedation, delirium and mechanical ventilation: the ‘ABCDE’ approach. Curr Opin Crit Care. 2011; 17(1):43-49.
• [125]Barr J, Pandharipande PP. The pain, agitation, and delirium care bundle: synergistic benefits of implementing the 2013 pain, agitation, and delirium guidelines in an integrated and interdisciplinary fashion. Crit Care Med. 2013; 41(9 Suppl 1):S99-S115.
• [126]Puthucheary ZA, Denehy L. Exercise interventions in critical illness survivors: understanding inclusion and stratification criteria. Am J Respir Crit Care Med. 2015; 191(12):1464-1467.
• [127]Kayambu G, Boots R, Paratz J. Physical therapy for the critically ill in the ICU: a systematic review and meta-analysis. Crit Care Med. 2013; 41(6):1543-1554.