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

Authors
  • Wandrag, L.1, 2
  • Brett, S. J.3
  • Frost, G. S.1
  • To, M.1
  • Loubo, E. Alves1
  • Jackson, N. C.4
  • Umpleby, A. M.4
  • Bountziouka, V.5
  • Hickson, M.1, 6
  • 1 Imperial College London, Nutrition and Dietetic Research Group, Department of Investigative Medicine, London, UK , London (United Kingdom)
  • 2 Guy’s & St Thomas’ NHS Foundation Trust, Department of Nutrition & Dietetics, London, UK , London (United Kingdom)
  • 3 Imperial College Healthcare NHS Trust, Centre for Peri-operative Medicine and Critical Care Research, London, UK , London (United Kingdom)
  • 4 University of Surrey, Department of Nutritional Science, Guildford, UK , Guildford (United Kingdom)
  • 5 University College London, Statistical Support Service, Population, Policy and Practice Programme, Institute of Child Health, London, UK , London (United Kingdom)
  • 6 University of Plymouth, Institute of Health and Community, Plymouth, Devon, UK , Plymouth (United Kingdom)
Type
Published Article
Journal
Trials
Publisher
Springer (Biomed Central Ltd.)
Publication Date
Sep 11, 2019
Volume
20
Issue
1
Identifiers
DOI: 10.1186/s13063-019-3639-2
Source
Springer Nature
Keywords
License
Green

Abstract

BackgroundCritically 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.MethodsA 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.ResultsEight 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.ConclusionL-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 registrationISRCTN Registry, ISRCTN79066838. Registered on 25 July 2012.

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