• Jeffrey Bierbrauer, Susanne Koch, Claudio Olbricht, Jida Hamati, Dörte Lodka, Joanna Schneider, Anja Luther-Schröder, Christian Kleber, Katharina Faust, Solveigh Wiesener, Claudia D Spies, Joachim Spranger, Simone Spuler, Jens Fielitz, and Steffen Weber-Carstens.
• Department of Anesthesiology and Operative Intensive Care Medicine, Campus Virchow-Klinikum & Campus Mitte, Charité University Medicine, Berlin, Germany.
• Crit. Care Med.. 2012 Feb 1;40(2):647-50.

ObjectiveIntensive care unit-acquired weakness indicates increased morbidity and mortality. Nonexcitable muscle membrane after direct muscle stimulation develops early and predicts intensive care unit-acquired weakness in sedated, mechanically ventilated patients. A comparison of muscle histology at an early stage in intensive care unit-acquired weakness has not been done. We investigated whether nonexcitable muscle membrane indicates fast-twitch myofiber atrophy during the early course of critical illness.DesignProspective observational study.SettingTwo intensive care units at Charité University Medicine, Berlin.PatientsPatients at increased risk for development of intensive care unit-acquired weakness, indicated by Sepsis-related Organ Failure Assessment scores ≥8 on 3 of 5 consecutive days within their first week in the intensive care unit.InterventionsNone.Measurements And Main ResultsElectrophysiological compound muscle action potentials after direct muscle stimulation and muscle biopsies were obtained at median days 7 and 5, respectively. Patients with nonexcitable muscle membranes (n = 15) showed smaller median type II cross-sectional areas (p < .05), whereas type I muscle fibers did not compared with patients with preserved muscle membrane excitability (compound muscle action potentials after direct muscle stimulation ≥3.0 mV; n = 9). We also observed decreased mRNA transcription levels of myosin heavy chain isoform IIa and a lower densitometric ratio of fast-to-slow myosin heavy chain protein content.ConclusionWe suggest that electrophysiological nonexcitable muscle membrane predicts preferential type II fiber atrophy in intensive care unit patients during early critical illness.

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