{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T03:11:09Z","timestamp":1760238669178,"version":"build-2065373602"},"reference-count":157,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2022,7,6]],"date-time":"2022-07-06T00:00:00Z","timestamp":1657065600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","award":["PB-PG-0815-20029"],"award-info":[{"award-number":["PB-PG-0815-20029"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Intensive Care Foundation New Investigator Award","award":["PB-PG-0815-20029"],"award-info":[{"award-number":["PB-PG-0815-20029"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Muscle wasting is implicated in the pathogenesis of intensive care unit acquired weakness (ICU-AW), affecting 40% of patients and causing long-term physical disability. A repetitive vascular occlusion stimulus (RVOS) limits muscle atrophy in healthy and orthopaedic subjects, thus, we explored its application to ICU patients. Adult multi-organ failure patients received standard care +\/\u2212 twice daily RVOS {4 cycles of 5 min tourniquet inflation to 50 mmHg supra-systolic blood pressure, and 5 min complete deflation} for 10 days. Serious adverse events (SAEs), tolerability, feasibility, acceptability, and exploratory outcomes of the rectus femoris cross-sectional area (RFCSA), echogenicity, clinical outcomes, and blood biomarkers were assessed. Only 12 of the intended 32 participants were recruited. RVOS sessions (76.1%) were delivered to five participants and two could not tolerate it. No SAEs occurred; 75% of participants and 82% of clinical staff strongly agreed or agreed that RVOS is an acceptable treatment. RFCSA fell significantly and echogenicity increased in controls (n = 5) and intervention subjects (n = 4). The intervention group was associated with less frequent acute kidney injury (AKI), a greater decrease in the total sequential organ failure assessment score (SOFA) score, and increased insulin-like growth factor-1 (IGF-1), and reduced syndecan-1, interleukin-4 (IL-4) and Tumor necrosis factor receptor type II (TNF-RII) levels. RVOS application appears safe and acceptable, but protocol modifications are required to improve tolerability and recruitment. There were signals of possible clinical benefit relating to RVOS application.<\/jats:p>","DOI":"10.3390\/jcm11143938","type":"journal-article","created":{"date-parts":[[2022,7,6]],"date-time":"2022-07-06T09:41:10Z","timestamp":1657100470000},"page":"3938","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Safety and Feasibility Assessment of Repetitive Vascular Occlusion Stimulus (RVOS) Application to Multi-Organ Failure Critically Ill Patients: A Pilot Randomised Controlled Trial"],"prefix":"10.3390","volume":"11","author":[{"given":"Ismita","family":"Chhetri","sequence":"first","affiliation":[{"name":"Intensive Care Unit, Royal Surrey County Hospital, NHS Foundation Trust, Guildford GU2 7XX, UK"},{"name":"Faculty of Health and Medical Sciences, School of Biosciences & Medicine, University of Surrey, Guildford GU2 7XH, UK"},{"name":"Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London SW7 2BX, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julie E. A.","family":"Hunt","sequence":"additional","affiliation":[{"name":"Faculty of Health and Medical Sciences, School of Biosciences & Medicine, University of Surrey, Guildford GU2 7XH, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeewaka R.","family":"Mendis","sequence":"additional","affiliation":[{"name":"Faculty of Health and Medical Sciences, School of Biosciences & Medicine, University of Surrey, Guildford GU2 7XH, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lui G.","family":"Forni","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Royal Surrey County Hospital, NHS Foundation Trust, Guildford GU2 7XX, UK"},{"name":"Faculty of Health and Medical Sciences, School of Biosciences & Medicine, University of Surrey, Guildford GU2 7XH, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9493-045X","authenticated-orcid":false,"given":"Justin","family":"Kirk-Bayley","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Royal Surrey County Hospital, NHS Foundation Trust, Guildford GU2 7XX, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ian","family":"White","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Ashford and St Peter\u2019s Hospitals NHS Foundation Trust, Chertsey KT16 0PZ, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Cooper","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Ashford and St Peter\u2019s Hospitals NHS Foundation Trust, Chertsey KT16 0PZ, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karthik","family":"Somasundaram","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Ashford and St Peter\u2019s Hospitals NHS Foundation Trust, Chertsey KT16 0PZ, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nikunj","family":"Shah","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Ashford and St Peter\u2019s Hospitals NHS Foundation Trust, Chertsey KT16 0PZ, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4667-9939","authenticated-orcid":false,"given":"Stephen D.","family":"Patterson","sequence":"additional","affiliation":[{"name":"Faculty of Sport, Allied Health & Performance Sciences, St Mary\u2019s University, London TW1 4SX, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zudin A.","family":"Puthucheary","sequence":"additional","affiliation":[{"name":"William Harvey Research Institute, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London E1 4NS, UK"},{"name":"Institute for Sport, Exercise and Health, University College London, London W1T 7HA, UK"},{"name":"Centre for Human Health and Performance, Department of Medicine, University College London, London W1T 7HA, UK"},{"name":"Intensive Care Unit, Royal Free London NHS Foundation Trust, London NW3 2QG, UK"},{"name":"Centre for Human and Applied Physiological Sciences, King\u2019s College London, London WC2R 2LS, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8797-5019","authenticated-orcid":false,"given":"Hugh E.","family":"Montgomery","sequence":"additional","affiliation":[{"name":"Centre for Human Health and Performance, Department of Medicine, University College London, London W1T 7HA, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4397-1232","authenticated-orcid":false,"given":"Benedict C.","family":"Creagh-Brown","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Royal Surrey County Hospital, NHS Foundation Trust, Guildford GU2 7XX, UK"},{"name":"Faculty of Health and Medical Sciences, School of Biosciences & Medicine, University of Surrey, Guildford GU2 7XH, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,7,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"b4353","DOI":"10.1136\/bmj.b4353","article-title":"Evaluation of modernisation of adult critical care services in England: Time series and cost effectiveness analysis","volume":"339","author":"Hutchings","year":"2009","journal-title":"BMJ"},{"key":"ref_2","first-page":"112","article-title":"Rising use of intensive care unit services in Medicare","volume":"9","author":"Milbrandt","year":"2005","journal-title":"Crit. 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