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Leucine-enriched essential amino acid supplementation in mechanically ventilated trauma patients: a feasibility study

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posted on 15.05.2020, 11:47 by L Wandrag, SJ Brett, GS Frost, M To, E Alves Loubo, NC Jackson, AM Umpleby, V Bountziouka, M Hickson
Background: Critically ill patients lose up to 2% of muscle mass per day. We assessed the feasibility of administering a leucine-enriched essential amino acid (L-EAA) supplement to mechanically ventilated trauma patients with the aim of assessing the effect on skeletal muscle mass and function. Methods: A randomised feasibility study was performed over six months in intensive care (ICU). Patients received 5 g L-EAA five times per day in addition to standard feed (L-EAA group) or standard feed only (control group) for up to 14 days. C-reactive protein, albumin, IL-6, IL-10, urinary 3-MH, nitrogen balance, protein turnover ([1-13C] leucine infusion), muscle depth change (ultrasound), functional change (Katz and Barthel indices) and muscle strength Medical Research Council (MRC) sum score to assess ICU Acquired Weakness were measured sequentially. Results: Eight patients (9.5% of screened patients) were recruited over six months. L-EAA doses were provided on 91/124 (73%) occasions. Inflammatory and urinary marker data were collected; serial muscle depth measurements were lacking due to short length of stay. Protein turnover studies were performed on five occasions. MRC sum score could not be performed as patients were not able to respond to the screening questions. The Katz and Barthel indices did not change. L-EAA delivery was achievable, but meaningful functional and muscle mass outcome measures require careful consideration in the design of a future randomised controlled trial. Conclusion: L-EAA was practical to provide, but we found significant barriers to recruitment and measurement of the chosen outcomes which would need to be addressed in the design of a future, large randomised controlled trial. Trial registration: ISRCTN Registry, ISRCTN79066838. Registered on 25 July 2012.

Funding

Liesl Wandrag was funded by a National Institute for Health Research (NIHR), Clinical Doctoral Research Fellowship for this research project. This publication presents independent research funded by the National Institute for Health Research (NIHR). The research was further supported by the NIHR Comprehensive Biomedical Research Centre based at Imperial College Healthcare NHS Trust and Imperial College London. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

History

Citation

Wandrag, L., Brett, S.J., Frost, G.S. et al. Leucine-enriched essential amino acid supplementation in mechanically ventilated trauma patients: a feasibility study. Trials 20, 561 (2019). https://doi.org/10.1186/s13063-019-3639-2

Version

VoR (Version of Record)

Published in

TRIALS

Volume

20

Issue

1

Pagination

561 (6)

Publisher

BMC

issn

1745-6215

eissn

1745-6215

Acceptance date

08/08/2019

Copyright date

2019

Available date

11/09/2019

Publisher version

https://link.springer.com/article/10.1186/s13063-019-3639-2

Spatial coverage

London, England

Language

English