Monitoring and evaluation of muscle atrophy: a much needed step in critically ill COVID-19 patients

INTRODUCTION: Elderly COVID-19 patients admitted to the intensive care unit (ICU) are at high risk of an inflammatory syndrome, hypercatabolic reaction, malnutrition, and physical immobilization. This may result in loss of muscle mass and pulmonary infection leading to prolonged ventilatory support. Factors responsible for muscle mass loss in ICU are (1) microcirculatory disturbances, (2) presence of systemic inflammatory response syndrome (SIRS), (3) sepsis (4) drugs (corticoids, neuromuscular blockers) having inhibitory activity on the nervous system, neuromuscular junction and muscle itself. Mechanism of muscle atrophy in critically ill elderly patients include an imbalance between protein synthesis and degradation. Interventions to manage muscle atrophy for the patients admitted to ICU is also extrapolated to mechanically ventilated COVID-ARDS patients. PURPOSE: Early recognition of factors contributing to intensive care unit acquired weakness (ICUAW) in COVID-19 patients, inflammation, high catabolic phase, steroid use, and paralysis. The potential interventions to target these specific mechanisms and ameliorate muscle dysfunction in COVID-19 patients. CONCLUSIONS:Intensive care unit acquired weakness (ICUAW) in critically ill COVID-19 patients is due to severity of illness, co-morbidities, muscle unloading, or ICU treatments, a systemic reaction circulating within the body, or combinations therein. Furthermore, the availability of a culture model of ICUAW could facilitate in expediting the diagnosis of ICUAW and fast track the discovery of putative treatments. We recommend NIV or HFNC ventilation or early weaning from invasive mechanical ventilation in critically ill COVID-19 elderly patients.