• Paul Twose, Una Jones, and Matt P Wise.
• Physiotherapy Department, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK; School of Healthcare Sciences, Cardiff University, Cardiff CF14 4XN, UK. Electronic address: Paul.Twose@wales.nhs.uk.
• J Crit Care. 2018 Jun 1; 45: 105-109.

IntroductionCritical illness has profound effects on muscle strength and long-term physical morbidity. However, there remains a paucity of evidence for the aetiology of critical illness related weakness. Recent animal model research identified that hypercapnia may reduce the rate of muscle loss. The aim of this study was to determine the effect of hypercapnia on respiratory and peripheral skeletal muscle in patients with critical illness.MethodsA pilot observational study of mechanically ventilated critically ill patients at a tertiary critical care unit who were retrospectively categorised as: 1) Respiratory failure with normocapnia; 2) Respiratory failure with hypercapnia; and 3) brain injury. Diaphragm thickness and quadriceps rectus femoris cross-sectional area (RFCSA) were measured using ultrasound imaging at baseline and at days 3, 5, 7 and 10 of mechanical ventilation.ResultsSignificant reductions in RFCSA muscle loss were observed for all time-points when compared to baseline [day 10: -14.9%±8.2 p< 0.001], and in diaphragm thickness between baseline and day 7 [day 7: -5.8%±9.5 p=0.029). No correlation was identified between the rate of muscle mass loss in the diaphragm and RFCSA.ConclusionIn this pilot study, peripheral skeletal muscle weakness occurred early and rapidly within the critical care population, irrespective of carbon dioxide levels.Copyright © 2018 Elsevier Inc. All rights reserved.

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