Novel protocol combining physical and nutrition therapies, Intensive Goal-directed REhabilitation with Electrical muscle stimulation and Nutrition (IGREEN) care bundle

Abstract Background Although the combination of rehabilitation and nutrition may be important for the prevention of intensive care unit (ICU)-acquired weakness, a protocolized intervention of this combination has not yet been reported. We herein developed an original combined protocol and evaluated...

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Autores principales:	Hidehiko Nakano, Hiromu Naraba, Hideki Hashimoto, Masaki Mochizuki, Yuji Takahashi, Tomohiro Sonoo, Yasuhiro Ogawa, Yujiro Matsuishi, Nobutake Shimojo, Yoshiaki Inoue, Kensuke Nakamura
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	NMES EGDM Critical care nutrition Nitrogen balance ICU-AW Titin Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
Acceso en línea:	https://doaj.org/article/3507cedc599f49739fb50922512805bf
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spelling	oai:doaj.org-article:3507cedc599f49739fb50922512805bf2021-12-05T12:03:52ZNovel protocol combining physical and nutrition therapies, Intensive Goal-directed REhabilitation with Electrical muscle stimulation and Nutrition (IGREEN) care bundle10.1186/s13054-021-03827-81364-8535https://doaj.org/article/3507cedc599f49739fb50922512805bf2021-12-01T00:00:00Zhttps://doi.org/10.1186/s13054-021-03827-8https://doaj.org/toc/1364-8535Abstract Background Although the combination of rehabilitation and nutrition may be important for the prevention of intensive care unit (ICU)-acquired weakness, a protocolized intervention of this combination has not yet been reported. We herein developed an original combined protocol and evaluated its efficacy. Methods In this single-center historical control study, we enrolled adult patients admitted to the ICU. Patients in the control group received standard care, while those in the intervention group received the protocol-based intervention. The ICU mobility scale was used to set goals for early mobilization and a neuromuscular electrical stimulation was employed when patients were unable to stand. The nutritional status was assessed for nutritional therapy, and target calorie delivery was set at 20 or 30 kcal/kg/day and target protein delivery at 1.8 g/kg/day in the intervention group. The primary endpoint was a decrease in femoral muscle volume in 10 days assessed by computed tomography. Results Forty-five patients in the control group and 56 in the intervention group were included in the analysis. Femoral muscle volume loss was significantly lower in the intervention group (11.6 vs 14.5%, p = 0.03). The absolute risk difference was 2.9% (95% CI 0.1–5.6%). Early mobilization to a sitting position by day 10 was achieved earlier (p = 0.03), and mean calorie delivery (20.1 vs. 16.8 kcal/kg/day, p = 0.01) and mean protein delivery (1.4 vs. 0.8 g/kg/day, p < 0.01) were higher in the intervention group. Conclusion The protocolized intervention, combining early mobilization and high-protein nutrition, contributed to the achievement of treatment goals and prevention of femoral muscle volume loss. Trial registration number The present study is registered at the University Hospital Medical Information Network-clinical trials registry (UMIN000040290, Registration date: May 7, 2020).Hidehiko NakanoHiromu NarabaHideki HashimotoMasaki MochizukiYuji TakahashiTomohiro SonooYasuhiro OgawaYujiro MatsuishiNobutake ShimojoYoshiaki InoueKensuke NakamuraBMCarticleNMESEGDMCritical care nutritionNitrogen balanceICU-AWTitinMedical emergencies. Critical care. Intensive care. First aidRC86-88.9ENCritical Care, Vol 25, Iss 1, Pp 1-12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	NMES EGDM Critical care nutrition Nitrogen balance ICU-AW Titin Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
spellingShingle	NMES EGDM Critical care nutrition Nitrogen balance ICU-AW Titin Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 Hidehiko Nakano Hiromu Naraba Hideki Hashimoto Masaki Mochizuki Yuji Takahashi Tomohiro Sonoo Yasuhiro Ogawa Yujiro Matsuishi Nobutake Shimojo Yoshiaki Inoue Kensuke Nakamura Novel protocol combining physical and nutrition therapies, Intensive Goal-directed REhabilitation with Electrical muscle stimulation and Nutrition (IGREEN) care bundle
description	Abstract Background Although the combination of rehabilitation and nutrition may be important for the prevention of intensive care unit (ICU)-acquired weakness, a protocolized intervention of this combination has not yet been reported. We herein developed an original combined protocol and evaluated its efficacy. Methods In this single-center historical control study, we enrolled adult patients admitted to the ICU. Patients in the control group received standard care, while those in the intervention group received the protocol-based intervention. The ICU mobility scale was used to set goals for early mobilization and a neuromuscular electrical stimulation was employed when patients were unable to stand. The nutritional status was assessed for nutritional therapy, and target calorie delivery was set at 20 or 30 kcal/kg/day and target protein delivery at 1.8 g/kg/day in the intervention group. The primary endpoint was a decrease in femoral muscle volume in 10 days assessed by computed tomography. Results Forty-five patients in the control group and 56 in the intervention group were included in the analysis. Femoral muscle volume loss was significantly lower in the intervention group (11.6 vs 14.5%, p = 0.03). The absolute risk difference was 2.9% (95% CI 0.1–5.6%). Early mobilization to a sitting position by day 10 was achieved earlier (p = 0.03), and mean calorie delivery (20.1 vs. 16.8 kcal/kg/day, p = 0.01) and mean protein delivery (1.4 vs. 0.8 g/kg/day, p < 0.01) were higher in the intervention group. Conclusion The protocolized intervention, combining early mobilization and high-protein nutrition, contributed to the achievement of treatment goals and prevention of femoral muscle volume loss. Trial registration number The present study is registered at the University Hospital Medical Information Network-clinical trials registry (UMIN000040290, Registration date: May 7, 2020).
format	article
author	Hidehiko Nakano Hiromu Naraba Hideki Hashimoto Masaki Mochizuki Yuji Takahashi Tomohiro Sonoo Yasuhiro Ogawa Yujiro Matsuishi Nobutake Shimojo Yoshiaki Inoue Kensuke Nakamura
author_facet	Hidehiko Nakano Hiromu Naraba Hideki Hashimoto Masaki Mochizuki Yuji Takahashi Tomohiro Sonoo Yasuhiro Ogawa Yujiro Matsuishi Nobutake Shimojo Yoshiaki Inoue Kensuke Nakamura
author_sort	Hidehiko Nakano
title	Novel protocol combining physical and nutrition therapies, Intensive Goal-directed REhabilitation with Electrical muscle stimulation and Nutrition (IGREEN) care bundle
title_short	Novel protocol combining physical and nutrition therapies, Intensive Goal-directed REhabilitation with Electrical muscle stimulation and Nutrition (IGREEN) care bundle
title_full	Novel protocol combining physical and nutrition therapies, Intensive Goal-directed REhabilitation with Electrical muscle stimulation and Nutrition (IGREEN) care bundle
title_fullStr	Novel protocol combining physical and nutrition therapies, Intensive Goal-directed REhabilitation with Electrical muscle stimulation and Nutrition (IGREEN) care bundle
title_full_unstemmed	Novel protocol combining physical and nutrition therapies, Intensive Goal-directed REhabilitation with Electrical muscle stimulation and Nutrition (IGREEN) care bundle
title_sort	novel protocol combining physical and nutrition therapies, intensive goal-directed rehabilitation with electrical muscle stimulation and nutrition (igreen) care bundle
publisher	BMC
publishDate	2021
url	https://doaj.org/article/3507cedc599f49739fb50922512805bf
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Novel protocol combining physical and nutrition therapies, Intensive Goal-directed REhabilitation with Electrical muscle stimulation and Nutrition (IGREEN) care bundle

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