Metabolic aspects of muscle wasting during critical illness

Summary

This narrative review synthesises recent advances in understanding the metabolic derangements underlying skeletal muscle wasting during critical illness. The authors identify immobilisation, inflammation, and disturbed energy and nutrient metabolism as key drivers of muscle protein catabolism, and evaluate emerging interventions—protein enhancement, targeted substrate delivery, and physical rehabilitation—whilst noting that improvements in muscle mass do not consistently translate to functional gains. The review concludes that further mechanistic research is needed to clarify how nutritional strategies might improve anabolic capacity in critically ill patients.

UK applicability

The findings are directly applicable to UK critical care practice, informing nutritional management protocols in NHS intensive care units. However, the review highlights that no proven effective interventions currently exist, suggesting that further clinical trial evidence is needed before recommendations can be widely implemented in UK hospital settings.

Key measures

Skeletal muscle mass, muscle protein loss rates, muscle function, muscle strength, effects of protein provision and substrate delivery on anabolic/catabolic balance

Outcomes reported

The review examined metabolic factors driving skeletal muscle protein loss during critical illness and evaluated the efficacy of interventions including enhanced protein provision, specific substrate delivery, and physical exercise. It assessed both acute and long-term impacts on muscle mass and function beyond ICU discharge.

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