الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Critically ill patients particularly those requiring mechanical ventilation, are at high risk for skeletal muscle wasting and loss of physical function resulting from prolonged bed rest. This debilitated state can further result in a prolonged ICU stay along with increased mortality. The mechanisms for this muscle wasting are multifactorial and include endotoxin mediated inflammation, nutritional inadequacy and altered substrate metabolism. Nutritional supplementation, specifically dietary protein intake, has received increasing attention as a strategy to preserve skeletal muscle health when combined with standardized ICU rehabilitation. Providing the prescribed nutritional intake without the incorporation of effective exercise while bedbound will reduce the ability of muscle to effectively utilize amino acids as metabolic substrates needed to sustain an anabolic state and maintain skeletal muscle structure, mass and function. Thus, the combination of high protein diets and rehabilitation interventions may be an ideal strategy for mitigating the loss of muscle mass and preserving its function, thereby shortening the duration of MV and ICU length of stay in critically ill patients, as compared with either nutrition or rehabilitation alone. Our prospective randomized controlled study aimed to assess the efficacy of combined high protein intake with early protocolized physical exercise on rectus femoris muscle cross-sectional area (CSA) assessed by ultrasound in ICU mechanically-ventilated patients as a primary outcome. The secondary outcomes were the thickness of the rectus femoris muscle, duration of mechanical ventilation, length of surgical ICU stay, 30 days mortality rate and incidence of infection in surgical ICU. This prospective randomized controlled study was performed on all mechanically ventilated patients aged 18-60 years, with an expected ICU stay ≥4days admitted to the surgical ICU, Tanta university Hospitals, Egypt, after approval of the Institutional Ethical Committee for one year (from July 2021 to June 2022). Every patient received an explanation to the purpose of the study after approval of the institutional ethical committee. Patients were allocated into two groups to receive either protein in a dose of 1.2 g/kg/day besides usual ICU physical exercise intervention (group I) or protein in a dose of 2 g/kg/day along with the physical exercise intervention that was protocolized (group II).