Person: González Seguel, Felipe
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González Seguel
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Felipe
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Felipe Andrés González Seguel
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Publication Which factors are associated with acquired weakness in the ICU? An overview of systematic reviews and meta-analyses(2024) Fuentes, Rocío; González Seguel, Felipe; Marzuca, Gabriel; Torres, Rodrigo; Najum, Jasim; Seron, PamelaRationale: Intensive care unit-acquired weakness (ICUAW) is common in critically ill patients, characterized by muscle weakness and physical function loss. Determining risk factors for ICUAW poses challenges due to variations in assessment methods and limited generalizability of results from specific populations, the existing literature on these risk factors lacks a clear and comprehensive synthesis. Objective: This overview aimed to synthesize risk factors for ICUAW, categorizing its modifiable and nonmodifiable factors. Methods: An overview of systematic reviews was conducted. Six relevant databases were searched for systematic reviews. Two pairs of reviewers selected reviews following predefined criteria, where bias was evaluated. Results were qualitatively summarized and an overlap analysis was performed for meta-analyses. Results: Eighteen systematic reviews were included, comprising 24 risk factors for ICUAW. Meta-analyses were performed for 15 factors, while remaining reviews provided qualitative syntheses. Twelve reviews had low risk of bias, 4 reviews were unclear, and 2 reviews exhibited high risk of bias. The extent of overlap ranged from 0 to 23% for the corrected covered area index. Nonmodifiable factors, including advanced age, female gender, and multiple organ failure, were consistently associated with ICUAW. Modifiable factors, including neuromuscular blocking agents, hyperglycemia, and corticosteroids, yielded conflicting results. Aminoglycosides, renal replacement therapy, and norepinephrine were associated with ICUAW but with high heterogeneity. Conclusions: Multiple risk factors associated with ICUAW were identified, warranting consideration in prevention and treatment strategies. Some risk factors have produced conflicting results, and several remain underexplored, emphasizing the ongoing need for personalized studies encompassing all potential contributors to ICUAW development.Publication Acute skeletal muscle wasting in patients with acute kidney injury requiring continuous kidney replacement therapy: A prospective multicenter study(2026) Mayer, Kirby; Teixeira, Pedro; González Seguel, Felipe; Tran, Vinh; Gross, Jessica; Horikawa, Arimitsu; Anil, Chaitanya; Shareef, Zan; Puffer, Hayley; Wen, Yuan; Griffin, Benjamin; Neyra, JavierPurpose: Acute kidney injury (AKI) requiring continuous kidney replacement therapy (CKRT) has been hypothesized to increase the risk of developing intensive care unit-associated weakness (ICU-AW), but prospective data are lacking. Materials and methods: This prospective observational study evaluated critically ill adults with AKI requiring CKRT at two U.S. academic hospitals. Using ultrasonography (US), we quantified changes in rectus femoris (RF) muscle mass and quality in the first week after CKRT initiation. At hospital discharge, we assessed for ICU-AW, physical function, and frailty. Results: Twenty-three patients with median age 56 [IQR 47-60] years, BMI 29 [26-36] kg/m2, and Charlson Comorbidity Index 3 [1.5-5] were enrolled. The baseline Sequential Organ Failure Assessment (SOFA) score was 9 [7.5-11.5] and CKRT duration was 4 [1-7] days. Six (26 %) patients died in the ICU and one (4 %) transitioned to comfort measures before study completion. Substantial muscle wasting occurred between Day 1 and Day 7: RF muscle thickness (mT) decreased by 10 % [3 %-20 %]; RF cross-sectional area (CSA) decreased by 19 % [12 %-22 %]; and echo intensity (EI) increased (implying worse muscle quality) by 14 % [5 %-25 %]. A significant effect of time within subjects was observed for all three ultrasound measures (CSA: F = 66.2, p < 0.001; mT: F = 27.1, p < 0.001; EI: F = 22.5, p < 0.001). At hospital discharge, 67 % of survivors (n = 10/15) met criteria for ICU-AW. Conclusions: Patients with AKI requiring CKRT experienced significant muscle wasting in the first week following CKRT initiation and had high rate of ICU-AW at hospital discharge. Trial registration: NCT05287204, Registered 20 October 2021.