Letter of Intent for Transformational Research Funding
Metabolic, energy and nutritional status in ER and ICU patients. An overhaul in care
and monitoring to personalized nutrition and treatment as well as post ICU
rehabilitation.
Through a novel methodology that we developed to measure skeletal muscle glycogen in a noninvasive way through high frequency ultrasound (Hill, J. C., & San Millán, I, 2014. The Physician and
sportsmedicine) we were able to assess for the first time glycogen content in ICU patients and
showed that these patients have little or no glycogen available for energy purposes (San Millán, I.,
Hill, J., & Wischmeyer, P. (2015). Measurement of skeletal muscle glycogen status in critically ill patients: a
new approach in critical care monitoring. Critical Care) which can be an important burden for survival
and may explain cachexia and ICU-acquired weakness. In light of our findings, a re-evaluation
and development of new nutritional and personalized protocols as well as potential anabolic/anticatabolic therapy is necessary at the ICU, which could have an important positive impact on
survival. Moreover and since glycogen storage is ~400-500g we believe that many patients at the
ER and due to their hypermetabolism condition and increased glucose oxidation, deplete
glycogen storages in a matter of hours and upon ICU admittance their nutritional and energy
status is very low, incurring in muscle catabolism, ICU-acquired weakness and decreased
chances of survival. Therefore we believe it is important to start glycogen monitoring as well as
new nutritional and therapeutic protocols at the ER already. Moreover, critical illness elicits a
variety of genetic and epigenetic responses correlated to the metabolic and physiological
response of critical illness. It should be possible to develop novel diagnostic and monitoring
testing blending metabolomics and genetics (“metabologenetics”) which can allow a more
comprehensive and effective monitoring of these patients as well as to develop personalized care
in the form of nutrition and therapeutics. Furthermore, the number of patients being sent to
rehabilitation settings has tripled in the past 10 years where 50-70% of ICU “survivors” will suffer
cognitive impairment and 60-80% them will suffer functional impairment or ICU-acquired
weakness (ICU-AW) post ICU. In the next issue of Critical Care journal we are proposing new
thinking and novel approaches for post-ICU patients (Wischmeyer, P and San Millán, I. (2015). Winning
The War Against ICU-Acquired Weakness: New Innovations in Nutrition and Exercise Physiology. Critical Care.
Accepted). We believe that our project could also significantly decrease the morbidity of ICU
patients as well as personalize further rehabilitation, nutritional and therapeutic approaches for
survivors.
Proposed Faculty involved:
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PI- Inigo San Millan, PhD- Assistant Professor, Department of Physical Medicine &
Rehabilitation. Director, Sports Performance Program, CU Sports Medicine and
Performance Center
Paul Wischmeyer, MD- Professor, Department of Anesthesiology. Associate Chair of
Clinical and Translational Research Director, Translational PharmacoNutrition Laboratory
Director, Nutrition Therapy Services, UCH
Ben Honigman, MD- Professor, Department of Surgery. Associate Dean, Clinical
Outreach
Adit Ginde, MD, MPH- Associate Professor and Director of Research. Department of
Emergency Medicine
John Hill, DO. Professor, Department of Family Medicine. Director, Sports Medicine
Fellowship.
Gordon Linberg, MD, PhD- Associate Professor, Surgery-GI Tumor & Endocrine
Surgery. Department of Surgery
David Swartz, MD. Professor, Department of Medicine. Chair, Department of Medicine
Kathleen Barnes, PhD. Professor of Medicine, Department of Medicine. Director, Division
of Biomedical Informatics and Personalized Medicine
Coleen Julian, PhD. Assistant Professor, Department of Medicine.
Dennis Matthews, MD- Chair and Professor of Physical Medicine and Rehabilitation.
Medical Director, The Children’s Hospital Rehabilitation Center
Venu Akuthota, MD-Professor and Vice-Chair, Department of Physical Medicine and
Rehabilitation.
Lisa Brenner, PhD, ABPP-Professor of Psychiatry, Neurology & Physical Medicine and
Rehabilitation . Director of Research, PM&R
Tim Wimbish- Director Rehabilitation Services, UCH
Bryan Bergman, PhD-Associate Professor, Department of Medicine, Division of
Endocrinology