Combining High Protein Intake with Early Physical Exercise During Critical Illness to Maintain Muscle Mass in Intensive Care Unit Patients: A Prospective, Randomized Controlled Study

Abstract Background: Muscle wasting and weakness are frequent findings in critically ill patients and are associated with worse short- and long-term outcomes. We aimed to assess the efficacy of combined high protein intake with early physical exercise on the rectus femoris (RF) muscle cross-sectional area (CSA) assessed by ultrasound in a patient undergoing mechanical ventilation in the intensive care unit (ICU). Patients and Methods: This randomized controlled study was carried out on 70 mechanically ventilated patients of both genders aged 18–60 years old. Patients were randomly allocated into two groups; Group Ι received protein in a dose (1.2 g/kg/day) in addition to usual ICU physical exercise intervention, and Group ΙΙ received protein in a dose of 2 g/kg/day in addition to the physical exercise intervention. Results: The measurements of CSA at day 20 and day 30 were significantly improved in Group Π compared to Group Ι ( P = 0.012 and 0.007, respectively). The measurements of muscle thickness of the RF muscle at day 20 and day 30 were significantly improved in Group Π compared to Group Ι ( P < 0.001). The CSA and muscle thickness of the RF muscle showed no significant differences at baseline, day 5, and day 10. There was a significant decrease in the length of ICU stay and the incidence of infection in Group Π as compared to Group Ι ( P = 0.030 and 0.029, respectively). Conclusions: Early protocolized physical therapy along with high protein nutritional supplementation in critically ill, mechanically ventilated patients attenuated the decrease in the CSA and thickness of the RF muscle when compared to standard medical care and standard protein supplementation.