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Immobility and ICU-Acquired Weakness
(Cambridge University Press, 2026-01-22)
Sabrina Eggmann
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GONZALEZ SEGUEL, FELIPE ANDRES
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Owen Gustafson
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Kirby P. Mayer
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Selina M. Parry
1
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Physical Rehabilitation in the ICU and Hospital
(Cambridge University Press, 2026-01-22)
GONZALEZ SEGUEL, FELIPE ANDRES
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Sabrina Eggmann
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Owen Gustafson
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Kirby P. Mayer
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Selina M. Parry
1
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Respiratory muscle dysfunction in mechanical ventilation: a systematic review and meta-analysis of biological mechanisms
(American Physiological Society, 2026-04-01)
Owen Gustafson
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GONZALEZ SEGUEL, FELIPE ANDRES
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Cayla M. Robinson
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Cecilia Villablanca
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Catalina Olave
<jats:p> Revealing biological mechanisms leading to respiratory muscle dysfunction is essential to improve clinical outcomes in patients with critical illness. The purpose was to identify biological mechanisms associated with respiratory muscle dysfunction in patients with critical illness during mechanical ventilation or sepsis. Six databases were electronically searched from inception to January 2025, examining studies with muscle biopsies. Screening, data collection, and risk-of-bias were conducted in duplicate by two independent assessors. Meta-analysis was performed to determine differences in muscle biological parameters of patients with critical illness requiring mechanical ventilation compared with controls. From 22,036 titles screened, eight studies ( n = 187 patients and n = 161 controls) published between 2000 and 2024 met eligibility criteria. Muscle biopsies were taken between days 1 and 7 in the intensive care unit from the diaphragm ( n = 110; 3 studies), rectus abdominis ( n = 68; 5 studies), external intercostal ( n = 10; 1 study), and latissimus dorsi ( n = 3; 1 study). Diaphragmatic fiber cross-sectional area was 30% smaller (mean difference [95% confidence interval] = −629 [−876, −382] μm <jats:sup>2</jats:sup> ), with lower proportion of type II fibers (−1.94 [−3.40, −0.49]%) compared with controls. Diaphragmatic fiber force of patients was more than two standard deviations lower (standardized mean difference = −2.49 [−3.84, −1.14]), and ubiquitinated protein levels were higher (2.09 [−0.14, 4.32]) than controls. Extramyocellular, mitochondrial, and gene expression parameters were assessed in some studies, but low sample size and high heterogeneity prevented meta-analyses. In conclusion, muscle biopsies from ventilated patients revealed atrophy, contractile weakness, and proteolysis markers. Standardized methodologies assessing respiratory muscles are needed to clarify biological mechanisms leading to muscle dysfunction and to guide respiratory muscle interventions. </jats:p>
1
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Community-Based Rehabilitation and Patient-Centered Outcomes in Survivors of Critical COVID-19 Attending an Intensive Care Recovery Clinic
(Elsevier BV, 2025-09)
GONZALEZ SEGUEL, FELIPE ANDRES
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Evan Haezebrouck
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Lindsey E. Fresenko
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Carla M. Sevin
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Stacey Slone
1
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Acute skeletal muscle wasting in patients with acute kidney injury requiring continuous kidney replacement therapy: A prospective multicenter study
(Elsevier BV, 2025-10)
Kirby P. Mayer
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J. Pedro Teixeira
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GONZALEZ SEGUEL, FELIPE ANDRES
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Vinh Q. Tran
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Jessica M. Gross
Scopus© Citations 9 2
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Development of an artificial intelligence powered software for automated analysis of skeletal muscle ultrasonography
(Springer Science and Business Media LLC, 2025-04-29)
Zoe Calulo Rivera
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GONZALEZ SEGUEL, FELIPE ANDRES
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Arimitsu Horikawa-Strakovsky
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Catherine Granger
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Aarti Sarwal
1Scopus© Citations 11
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Concurrent nutrition and physical rehabilitation interventions for patients with critical illness
(Ovid Technologies (Wolters Kluwer Health), 2024-12-16)
GONZALEZ SEGUEL, FELIPE ANDRES
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Kirby P. Mayer
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Renee D. Stapleton
The effects of either physical rehabilitation or nutrition on outcomes in patients with critical illness are variable and remain unclear. The potential for the combination of exercise and nutritional delivered concurrently to provide benefit is provocative, but data are only emerging. Herein, we provide a summary of evidence from 2023 and 2024 on combined physical rehabilitation and nutrition during and following critical illness. Recent findings While latest trials on physical rehabilitation alone reported conflicting findings, recent nutrition trials found no difference between higher and lower protein delivery and even suggested harm in patients with acute kidney injury. In 2023 and 2024, we identified four studies (one randomized controlled trial) combining physical rehabilitation and nutrition (mainly protein supplementation) within the ICU setting. Overall, these suggested benefits, including reduction of muscle size loss, ICU acquired weakness, delirium, and improved mobility levels, although these benefits did not extend to mortality and hospital length of stay. No recent trials combining physical rehabilitation and nutrition for patients after ICU were identified.</jats:p>
Scopus© Citations 6 1
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Muscle Dysfunction and Physical Recovery After Critical Illness
(SAGE Publications, 2025-02-04)
Matthew F. Mart
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Joshua I. Gordon
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GONZALEZ SEGUEL, FELIPE ANDRES
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Kirby P. Mayer
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Nathan Brummel
During critical illness, patients experience significant and rapid onsets of muscle wasting and dysfunction with loss of strength, mass, and power. These deficits often persist long after the ICU, leading to impairments in physical function including reduced exercise capacity and increased frailty and disability. While there are numerous studies describing the epidemiology of impaired muscle and physical function in the ICU, there are significantly fewer data investigating mechanisms of prolonged and persistent impairments in ICU survivors. Additionally, while several potential clinical risk factors associated with poor physical recovery have been identified, there remains a dearth of interventions that have effectively improved outcomes long-term among survivors. In this article, we aim to provide a thorough, evidence-based review of the current state of knowledge regarding muscle dysfunction and physical function after critical illness with a focus on post-ICU and post-hospitalization phase of recovery.
Scopus© Citations 14 2
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Evaluating a Muscle Ultrasound Education Program: Theoretical Knowledge, Hands-on Skills, Reliability, and Satisfaction of Critical Care Physiotherapists
(2021)
GONZALEZ SEGUEL, FELIPE ANDRES
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Juan José Pinto-Concha
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Francisco Ríos-Castro
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Alexis Silva-Gutiérrez
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Agustín Camus-Molina
13
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Uninterrupted Actigraphy Recording to Quantify Physical Activity and Sedentary Behaviors in Mechanically Ventilated Adults
(2022)
Felipe González-Seguel
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Agustín Camus-Molina
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Macarena Leiva-Corvalán
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Kirby P. Mayer
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LEPPE ZAMORA, JAIME ESTEBAN
<jats:sec> <jats:title>Purpose:</jats:title> <jats:p>We evaluated the feasibility of quantification of physical activity (PA) and sedentary behaviors (SB) using actigraphy during an entire intensive care unit (ICU) length of stay.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods:</jats:title> <jats:p>A prospective study was performed in a 12-bed ICU. Triaxial accelerometers were fitted on the right ankle of mechanically ventilated adults. Twenty accelerometers were available to guarantee uninterrupted actigraphy recording 24 hours/day. Data were analyzed: (1) between awakening and ICU discharge to quantify daytime PA/SB and (2) between admission and ICU discharge to quantify day/nighttime inactivity. Secondarily, we assessed the relationship between inactivity/SB and clinical variables.</jats:p> </jats:sec> <jats:sec> <jats:title>Results:</jats:title> <jats:p>Thirty patients were enrolled, obtaining 5477 recording hours. No patient reported discomfort or injury. The median (min-max) delay time between admission and accelerometer installation was 2.1 (0.0-11.9) hours. Actigraphy recording duration was 5.4 (2.2-34.4) days. The time spent in SB and PA (percentage of minutes per hour) was 94.7% and 5.3%, respectively. PA was stratified by light, moderate, and vigorous levels equating to 91.8%, 7.7%, and 0.5%, respectively. Inactivity time (<jats:italic toggle="yes">r</jats:italic> = 0.991, <jats:italic toggle="yes">P</jats:italic> ≤ .001) and SB (<jats:italic toggle="yes">r</jats:italic> = 0.859, <jats:italic toggle="yes">P</jats:italic> ≤ .001) were strongly correlated with ICU length of stay.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions:</jats:title> <jats:p>Quantifying PA levels with continuous monitoring through actigraphy is feasible, demonstrating prolonged periods of inactivity/SB. This study highlights that uninterrupted actigraphy could contribute to pursuing the optimal dose and the intervention fidelity of the ICU mobilization in the subsequent clinical trials.</jats:p> </jats:sec>
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