Abstracts of the 11 th International Conference on Cachexia, Sarcopenia and Muscle Wasting, Maastricht, The Netherlands, 7–9 December 2018 (Part 2)

s of the 11th International Conference on Cachexia, Sarcopenia and Muscle Wasting, Maastricht, The Netherlands, 7–9 December 2018 (Part 2) 1-07 Skeletal muscle bioenergetics in critically ill: effect of early rehabilitation on mitochondrial function and insulin resistance during and 6 months after critical illness Tomáš Urban, Adéla Krajčová, Petr Waldauf, Barbora Blahutová, Jan Gojda, František Duška OXYLAB – Department of Anaesthesia and Intensive Care Medicine, 3rd Faculty of Medicine, Kralovské Vinohrady University Hospital, Prague, Czech Republic Introduction: The hallmark of metabolic changes in skeletal muscle during critical illness is impaired aerobic phosphorylation in mitochondria and reduced insulin-stimulated glucose disposal. We asked whether these parameters can be influenced by very early (started <48 h) rehabilitation using functional-electrical stimulation assisted supine cycling (FESCE). Methods: In a nested subgroup of patients in a prospective randomized clinical trial of early rehabilitation (NCT 02864745), we performed serial vastus lateralis muscle biopsies and euglycemic hyperinsulinaemic (120 mIU.m 2 BSA.min ) clamps at Days 0, 7, and 180. Mitochondrial function was assessed by high resolution respirometry from native skeletal muscle homogenates as described, with a cohort (n = 8) of metabolically healthy age-matched elective hip surgery patient serving as the control group. Electron flux through mitochondrial respiratory complexes was measured by addition of specific substrates and inhibitors described in. Results and Discussion: In the control group, the mean rehabilitation dose was 22 min a day, whilst interventional group was receiving 77 min/day (P < 0.01). Insulin resistance: Glucose disposal was lowest in the acute phase of critical illness (1.53 ± 0.99 vs. 1.21 ± 0.92 mmol/min) and improved a little after 7 days in both groups (to 2.23 ± 1.01 vs. 2.05 ± 0.82 mmol/min) and after 6 months (3.32 ± 0.59 vs. 2.72 ± 0.90 mmol/min). Bioenergetic function: In keeping with previous studies, critical illness led to a mild impairment of aerobic phosphorylation, with major defect being in respiratory Complex I and II, whilst fatty acid oxidation was upregulated. In standard rehabilitation group, this pattern persisted up until 6 months after the critical illness, whilst in the early rehabilitation group, it seems to normalize or even overshoot to supranormal values. The major limitation indeed is the low number of subjects accumulated so far in this ongoing study. This is the reason why these data are to be considered preliminary and have not been formally statistically processed. In conclusion, our preliminary data show that critical illness leads to profound changes in skeletal muscle bioenergetics, which seem to persist in survivors at least 6months but could be influenced by early rehabilitation. Table: Mitochondrial functional indices expressed as % of values in the control group. Note: ATP, aerobic phosphorylation.