ArticleJournal of cachexia, sarcopenia and muscle2022
Impact of protocol-based physiotherapy on insulin sensitivity and peripheral glucose metabolism in critically ill patients.
Article in Journal of cachexia, sarcopenia and muscle, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed, 12 citations in OpenAlex.
- Distinct diurnal temperature rhythm patterns in critical illness myopathy: secondary analysis of two prospective trials.Annals of intensive care · 2025Article
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- The flux of energy in critical illness and the obesity paradox.Physiological reviews · 2025Review
- Muscle weakness after critical illness: unravelling biological mechanisms and clinical hurdles.Critical care (London, England) · 2025Review
- Insulin signaling in skeletal muscle during inflammation and/or immobilisation.Intensive care medicine experimental · 2023Article
- Mitochondrial Dysfunction in Intensive Care Unit-Acquired Weakness and Critical Illness Myopathy: A Narrative Review.International journal of molecular sciences · 2023Review
- Attenuating Muscle Mass Loss in Critical Illness: the Role of Nutrition and Exercise.Current osteoporosis reports · 2022Review
- [54/m-Muscle weakness and prolonged weaning from mechanical ventilation after peritonitis with septic shock : Preparation course anesthesiological intensive care medicine: case 29].Die Anaesthesiologie · 2022Article
- Impact of protocol-based physiotherapy on insulin sensitivity and peripheral glucose metabolism in critically ill patients.Journal of cachexia, sarcopenia and muscle · 2022Article
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9 authors at 1 institution in 1 country.
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Abstract
backgroundThe impact of physiotherapy on insulin sensitivity and peripheral glucose metabolism in critically ill patients is not well understood.
methodsThis pooled analysis investigates the impact of different physiotherapeutic strategies on insulin sensitivity in critically ill patients. We pooled data from two previous trials in adult patients with sequential organ failure assessment score (SOFA)≥ 9 within 72 h of intensive care unit (ICU) admission, who received hyperinsulinaemic euglycaemic (HE) clamps. Patients were divided into three groups: standard physiotherapy (sPT, n = 22), protocol-based physiotherapy (pPT, n = 8), and pPT with added muscle activating measures (pPT+, n = 20). Insulin sensitivity index (ISI) was determined by HE clamp. Muscle metabolites lactate, pyruvate, and glycerol were measured in the M. vastus lateralis via microdialysis during the HE clamp. Histochemical visualization of glucose transporter-4 (GLUT4) translocation was performed in surgically extracted muscle biopsies. All data are reported as median (25th/75th percentile) (trial registry: ISRCTN77569430 and ISRCTN19392591/ethics approval: Charité-EA2/061/06 and Charité-EA2/041/10).
resultsFifty critically ill patients (admission SOFA 13) showed markedly decreased ISIs on Day 17 (interquartile range) 0.029 (0.022/0.048) (mg/min/kg)/(mU/L) compared with healthy controls 0.103 (0.087/0.111), P < 0.001. ISI correlated with muscle strength measured by medical research council (MRC) score at first awakening (r = 0.383, P = 0.026) and at ICU discharge (r = 0.503, P = 0.002). Different physiotherapeutic strategies showed no effect on the ISI [sPT 0.029 (0.019/0.053) (mg/min/kg)/(mU/L) vs. pPT 0.026 (0.023/0.041) (mg/min/kg)/(mU/L) vs. pPT+ 0.029 (0.023/0.042) (mg/min/kg)/(mU/L); P = 0.919]. Regardless of the physiotherapeutic strategy metabolic flexibility was reduced. Relative change of lactate/pyruvate ratio during HE clamp is as follows: sPT 0.09 (-0.13/0.27) vs. pPT 0.07 (-0.16/0.31) vs. pPT+ -0.06 (-0.19/0.16), P = 0.729, and relative change of glycerol concentration: sPT -0.39 (-0.8/-0.12) vs. pPT -0.21 (-0.33/0.07) vs. pPT+ -0.21 (-0.44/-0.03), P = 0.257. The majority of ICU patients showed abnormal localization of GLUT4 with membranous GLUT4 distribution in 37.5% (3 of 8) of ICU patients receiving sPT, in 42.9% (3 of 7) of ICU patients receiving pPT, and in 53.8% (7 of 13) of ICU patients receiving pPT+ (no statistical testing possible).
conclusionsOur data suggest that a higher duration of muscle activating measures had no impact on insulin sensitivity or metabolic flexibility in critically ill patients with sepsis-related multiple organ failure.
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