Evidence map›Paper›PMID 34446067›Full record

Trial reportCritical care (London, England)2021

A randomized controlled trial to determine whether beta-hydroxy-beta-methylbutyrate and/or eicosapentaenoic acid improves diaphragm and quadriceps strength in critically Ill mechanically ventilated patients.

Gerald S Supinski, Paul F Netzel, Philip M Westgate, Elizabeth A Schroder, Lin Wang, Leigh Ann Callahan

Registry-linked trialOpen access · goldAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Critical care (London, England), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01270516 (Effect of EPA and HMB on Diaphragm and Limb Muscle Strength in Mechanically Ventilated Patients), which is not on this map. Cited by 9 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed, 1 pooled it
3.4field-weighted citation impact, top 7% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01270516 nacompletednot on this map

Effect of EPA and HMB on Diaphragm and Limb Muscle Strength in Mechanically Ventilated Patients

TypeinterventionalSponsorGerald SupinskiRan2014 to 2020Enrolled73ConditionsMuscle WeaknessArmsHMB, hydroxymethylbutyrate, EPA, eicosapentaenoic acid, Saline
3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 1 synthesis or guideline pooled it, 29 citations in OpenAlex.

  1. Pooled it
  2. Trial
  3. Review
  4. Article
  5. Review
  6. Article
  7. Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 1 institution in 1 country.

Gerald S SupinskiDivision of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, College of Medicine, University of Kentucky, 740 South Limestone, L543, Lexington, KY, 40536-0284, USA.
Paul F NetzelDivision of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, College of Medicine, University of Kentucky, 740 South Limestone, L543, Lexington, KY, 40536-0284, USA.
Philip M WestgateDepartment of Biostatistics, College of Public Health, University of Kentucky, 725 Rose Street, Lexington, KY, MDS 205B40536-0082, USA.
Elizabeth A SchroderDivision of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, College of Medicine, University of Kentucky, 740 South Limestone, L543, Lexington, KY, 40536-0284, USA.
Lin WangDivision of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, College of Medicine, University of Kentucky, 740 South Limestone, L543, Lexington, KY, 40536-0284, USA.
Leigh Ann CallahanDivision of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, College of Medicine, University of Kentucky, 740 South Limestone, L543, Lexington, KY, 40536-0284, USA. lacall2@email.uky.edu.ORCID 0000-0003-3658-5226
University of Kentucky · US

Funding

Treatment of Skeletal Muscle Dysfunction in ICU PatientsR01HL113494 · NHLBI · UNIVERSITY OF KENTUCKY · PI SUPINSKI, GERALD S. · 2013 to 2016
$2.3M
Mitochondrially Targeted Therapies for Sepsis Induced Diaphragm DysfunctionR01HL141356 · NHLBI · UNIVERSITY OF KENTUCKY · PI CALLAHAN, LEIGH A, SCHRODER STUMPF, ELIZABETH A · 2018 to 2021
$2.2M
BLRD VA I01 BX002132NHLBI NIH HHS R01 HL113494NHLBI NIH HHS R01HL113494NHLBI NIH HHS R01 HL141356NHLBI NIH HHS R01HL141356
6 · The paper itself

Abstract

backgroundIntensive care unit acquired weakness is a serious problem, contributing to respiratory failure and reductions in ambulation. Currently, there is no pharmacological therapy for this condition. Studies indicate, however, that both beta-hydroxy-beta-methylbutyrate (HMB) and eicosapentaenoic acid (EPA) increase muscle function in patients with cancer and in older adults. The purpose of this study was to determine whether HMB and/or EPA administration would increase diaphragm and quadriceps strength in mechanically ventilated patients.

methodsStudies were performed on 83 mechanically ventilated patients who were recruited from the Medical Intensive Care Units at the University of Kentucky. Diaphragm strength was assessed as the trans-diaphragmatic pressure generated by supramaximal magnetic phrenic nerve stimulation (PdiTw). Quadriceps strength was assessed as leg force generated by supramaximal magnetic femoral nerve stimulation (QuadTw). Diaphragm and quadriceps thickness were assessed by ultrasound. Baseline measurements of muscle strength and size were performed, and patients were then randomized to one of four treatment groups (placebo, HMB 3 gm/day, EPA 2 gm/day and HMB plus EPA). Strength and size measurements were repeated 11 days after study entry. ANCOVA statistical testing was used to compare variables across the four experimental groups.

resultsTreatments failed to increase the strength and thickness of either the diaphragm or quadriceps when compared to placebo. In addition, treatments also failed to decrease the duration of mechanical ventilation after study entry.

conclusionsThese results indicate that a 10-day course of HMB and/or EPA does not improve skeletal muscle strength in critically ill mechanically ventilated patients. These findings also confirm previous reports that diaphragm and leg strength in these patients are profoundly low. Additional studies will be needed to examine the effects of other anabolic agents and innovative forms of physical therapy.

trial registrationClinicalTrials.gov, NCT01270516. Registered 5 January 2011, https://clinicaltrials.gov/ct2/show/NCT01270516?term=Supinski&draw=2&rank=4 .

Indexed as

AgedCritical IllnessDiaphragmEicosapentaenoic AcidFemaleHumansKentuckyMaleMiddle AgedMuscle StrengthQuadriceps MuscleRespiration, ArtificialValeratesbeta-hydroxyisovaleric acidEicosapentaenoic AcidValeratesBeta-hydroxy-beta-methylbutyrateDiaphragm weaknessEicosapentaenoic acidLimb muscle weaknessMechanical ventilationRespiratory failure

Identifiers

PMID34446067
PMCPMC8390080
OpenAlexW3194978427

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.