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Review
. 2025 Apr;41(2):299-312.
doi: 10.1016/j.ccc.2024.08.011. Epub 2024 Oct 3.

Skeletal Muscle: A Critical Organ for Survival and Recovery in Critical Illness

Matthew J Lees  1 , Carla M Prado  2 , Paul E Wischmeyer  3 , Stuart M Phillips  4
Affiliations
Review

Skeletal Muscle: A Critical Organ for Survival and Recovery in Critical Illness

Matthew J Lees et al. Crit Care Clin. 2025 Apr.

Abstract

The intensive care unit (ICU) environment is one of the most challenging for skeletal muscle health. Atrophy associated with clinical care is distinct from that seen with inactivity or immobilization in the absence of disease and is exacerbated by aging. The substantial muscle loss in the ICU is likely due to the presence of inflammation, elevated proteolysis, bedrest, and undernutrition. Skeletal muscle parameters at admission are predictive of mortality and other clinically important outcomes. Treatment goals to mitigate muscle loss are early mobilization and adequate nutrient supply, especially protein, using an individualized approach to support skeletal muscle maintenance and recovery.

Keywords: Amino acids; Atrophy; Bed rest; Immobilization; Intensive care unit; Skeletal muscle.

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Conflict of interest statement

Disclosures S.M. Phillips has received grant funding from the Canadian Institutes of Health Research, Canada, the Natural Sciences and Engineering Research Council of Canada, Canada, the US National Institutes for Health, Roquette Freres, France, Nestle Health Science, Friesland Campina, The Netherlands, The US National Dairy Council, Dairy Farmers of Canada and Myos. S.M. Phillips has received travel expenses and honoraria for speaking from Nestle Health Science. S.M. Phillips holds patents licensed to Exerkine Inc. but reports no financial gains. S.M. Phillips and C.M. Prado are supported by a Tier 1 Canada Research Chair award. M.J. Lees is supported by a Canadian Institutes of Health Research (CIHR) Postdoctoral Fellowship award (Funding Reference Number 187773). C.M. Prado has received honoraria and/or paid consultancy from Abbott Nutrition, Nutricia, Nestle Health Science, Pfizer, Amra Medical, Novo Nordisk and funding from Almased for unrelated research. Dr P.E. Wischmeyer reports receiving investigator-initiated grant funding related to this work from National Institutes of Health, United States, Department of Defense, United States, Abbott, Baxter, United States, and Fresenius. Dr P.E. Wischmeyer has served as a consultant to Abbott, Fresenius, Baxter, Cardinal Health, Mend Inc and Nutricia, for research related to this work. Dr P.E. Wischmeyer has received unrestricted gift donation for nutrition research from Musclesound and DSM. Dr P.E. Wischmeyer has received honoraria or travel expenses for CME lectures on improving nutrition care from Abbott, Baxter, Fresenius, Danone-Nutricia, and DSM.

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