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ICU Acquired WeaknessNCT05919940

Improved Muscle Metabolism by Combination of Muscle Activation and Protein Substitution ( IMEMPRO )

A study testing Dietary Supplement: additional substitution of protein, Neuromuscular electrical stimulation and Early Mobilization in people with ICU Acquired Weakness and Muscle Atrophy, run by Technical University of Munich at 4 sites in 2 countries.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

Intensive Care Unit Acquired Weakness (ICUAW) describes muscle weakness that occurs in around 40% of patients during an intensive care stay. The morbidity and mortality of these patients is significantly increased over a 5-year period. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Dietary Supplement: additional substitution of protein, Neuromuscular electrical stimulation and Early Mobilization
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
40 participants
Where
4 sitesin 2 countries
Study dates
27 Jun 2023to 31 Jan 2027
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • critically ill adults (≥ 18 years of age)
  • newly admitted to the ICU (<48h)
  • mechanically ventilated, expected to remain for at least 72h
  • enteral nutrition is feasible

Who cannot join

  • a BMI > 30
  • expected death or withdrawal of life-sustaining treatments
  • prior neuromuscular disease (e.g. paresis, myopathies, neuropathies)
  • injury or disease preventing neuromuscular electrical stimulation or early mobilization (e.g., elevated intracranial pressure, unstable spine)
  • a pacemaker or other electronic implant
  • allergy to components of NMES adhesive
  • have been dependent during activities of daily living prior to the hospital admission
  • a language barrier

Trial locations and contacts

4 sites in 2 countries. Contact the study team or a site near you to ask about taking part.

Stefan J Schaller, MD contact

+498941409635

s.schaller@tum.de

Marian Demitsch contact

aai-research@muv.ac.at

4 sites in 2 countries

Germany3 sites, 1 recruiting
  • Charité - Universitätsmedizin Berlin

    Berlin, State of Berlin, 10117

    Active, not recruiting
  • Klinikum rechts der Isar, School of Medicine, Technical Universtity of Munich

    Munich, Bavaria, 81675

    Active, not recruiting
  • Universitätsklinikum Ulm

    Ulm, 89070

    Flora Scheffenbichler, MD, flora.scheffenbichler@uni-ulm.de

    Bettina Jungwirth, MD, ains@uniklinik- ulm.de

    Recruiting

Other trials in Germany

Austria1 site, 1 recruiting
  • Medical University of Vienna

    Vienna, State of Vienna, 1090

    Stefan J Schaller, MD, +4314040041020, stefan.schaller@meduniwien.ac.at

    Study Coordinator, +4314040041020, aai-research@meduniwien.ac.at

    Recruiting

Other trials in Austria

About this study

Official title: Improved Muscle Metabolism by Combination of Muscle Activation and Protein Substitution: a Randomized, Outcome-assessor Blinded, Proof-of-concept Study (IMEMPRO)

Intensive Care Unit Acquired Weakness (ICUAW) describes muscle weakness that occurs in around 40% of patients during an intensive care stay. The morbidity and mortality of these patients is significantly increased over a 5-year period. The aim of this study is to investigate the combined effect of early enteral high-protein nutrition and early muscle activation on muscle atrophy in critically ill patients.

The study will include 40 patients (20 intervention, 20 observation) with requirement for enteral nutrition at time of inclusion. In the intervention group the maximum possible level of mobilization is carried out and muscles are activated twice a day using neuromuscular electrical stimulation (NMES). The nutrition plan of the intervention group is based on the applicable guidelines for intensive care medicine with exception of increased protein intake. The control group receives therapy without deviating from the standard according of the DGEM guideline.

The study aims to show that the decrease in muscle mass is significantly less than in the control group (primary hypothesis) via ultrasound of the rectus femoris muscle and in case of given consent muscle biopsy. As secondary hypothesis it is examined whether the combination of early high protein intake and muscle activation improves muscle strength and endurance.

Read the detailed description

Intensive Care Unit Acquired Weakness (ICUAW) describes the clinically diagnosed manifestation of a neuromuscular organ dysfunction. It develops in approximately 40% of all intensive care unit patients amounting to at least 1.2 million patients annually in Germany. All these patients face a broad range of sequeleae and an increased mortality up to 5 years after ICU discharge. A characteristic pathophysiological phenomenon is an early severe muscle atrophy reaching 10% during the first days after ICU admission.

The current preventative and therapeutic approach for ICUAW is a combination of targeted risk factor management as well as early activation of muscles, i.e. neuromuscular electrical stimulation (NMES) and early mobilization as they have been shown to counteract the muscle atrophy and mediate different outcome benefits such as shorter ICU stay.

Nutrition is a key element of our daily life. Protein intake has been shown to affect lean mass and muscle mass. Research into specific nutritional strategies to treat or prevent ICUAW are scarce and the combination with early muscle activation has not been adequately explored.

The study will include 40 patients (20 intervention, 20 observation) who were admitted to an intensive care unit within the last 48 hours. A basic requirement for inclusion is an indication for enteral (via the gastrointestinal tract) nutrition at time of inclusion. In the intervention group, the ability to mobilize is assessed daily and the maximum possible level of mobilization is carried out and additional muscles are activated twice a day using neuromuscular electrical stimulation (NMES). The nutrition plan of the intervention group is based on the applicable guidelines for intensive care medicine. In this study, protein intake is increased in the interventional group. The control group receives therapy without deviating from the standard according to the SOP and DGEM guideline: "Clinical nutrition in intensive care medicine" 2018.

The study aims to show that the decrease in muscle mass is significantly less than in the control group (primary hypothesis) via ultrasound of the rectus femoris muscle and muscle biopsy. As a second hypothesis it is examined whether the combination of early high protein intake and muscle activation improves muscle strength and endurance compared to the control group.

Further exploratory analyses will investigate changes in the skeletal muscle glycogen content, skeletal muscle histology, skeletal muscle gene expression, skeletal muscle protein level, as well as metabolomic changes in blood and urine.

An additional blood sample will be taken after 90 days as part of a follow-up.

Being tested
Dietary Supplement: additional substitution of protein, Neuromuscular electrical stimulation, Early Mobilization
Keywords
Early Mobilization and high-protein nutrition
Medical subject headings
Muscular Atrophy, Protein-Energy Malnutrition, Morphological and Microscopic Findings

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Dietary Supplement: additional substitution of proteinDietary supplement

    Day one (admission) no nutrition is applied.

    Protein target is increased as follows:

    • to a level of 1,2g/kg/d on day 1 after ICU admission
    • to a level of 1,4g/kg/d on day 2 after ICU admission
    • to a level of 1,6g/kg/d on day 3 after ICU admission
    • to a level of 1,8g/kg/d on day 4 after ICU admission
    • to a level of 2,0g/kg/d from day 5 onwoards

    Additional protein is given within 2 hours after mobilization respectively:

    • to 0,125g/kg/d on day 1 after ICU admission
    • to 0,2g/kg/d on day 2 after ICU admission
    • to 0,25g/kg/d on day 3 after ICU admission
    • to 0,3g/kg/d from day 4 after ICU admission onwoards
  • Neuromuscular electrical stimulationDevice

    twice daily 60 minutes till day 28 or ICU discharge

  • Early MobilizationOther

    at least 20 minutes a day following the SOMS concept. Duration: till 28 day or ICU discharge

Study groups in NCT05919940
Study groupRoleWhat they receive
InterventionExperimentalHigh protein substitution plus NMES and EM
Receives: Dietary Supplement: Dietary Supplement: additional substitution of protein; Device: Neuromuscular electrical stimulation; Other: Early Mobilization
Control GroupNo interventionNutrition and mobilization are carried out according to standard of care.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change in cross sectional area (ΔCSA) of the rectus femoris

    Change in muscle mass between study inclusion and study day 14; measured as change of the cross sectional area (ΔCSA) of the rectus femoris muscle via ultrasound.

    Measured: day 1 (study inclusion) and 14 days

Secondary outcomes (14)
  1. change in muscle thickness of the rectus femoris

    change in muscle thickness from study inclusion until 90-day follow-up, measured via ultrasound.

    Measured: day 1 (study inclusion) until 90-day Follow-up

  2. change in echogenicity of the rectus femoris

    change in echogenicity from study inclusion until 90-day follow-up, measured via ultrasound.

    Measured: day 1 (study inclusion) until 90-day Follow-up

  3. change of the pennation angle of the rectus femoris

    change of the pennation angle from study inclusion until 90-day follow-up, measured via ultrasound.

    Measured: day 1 (study inclusion) until 90-day Follow-up

  4. change of the muscle strength, measured by the Medical Research Council score (MRC-score)

    change of the muscle strength, measured by the Medical Research Council score (MRC-score) from study inclusion until 90-day follow-up

    Measured: day 1 (study inclusion) until 90-day Follow-up

  5. change of the muscle strength, measured by handgrip dynamometry

    change of the muscle strength, measured by handgrip dynamometry from study inclusion until 90-day follow-up

    Measured: day 1 (study inclusion) until 90-day Follow-up

  6. change in muscle endurance

    change in muscle endurance, measured by the 6-minute walking test up to 90-day follow-up

    Measured: up to 90 day follow up

  7. change in physical physical function

    change in physical physical function, measured by the Short Physical Performance Battery up to 90-day follow-up

    Measured: up to 90-day follow-up

  8. development of quality of life

    development of quality of life, measured by the Short Form-36 up to 90-day follow-up

    Measured: up to 90-day follow-up

  9. change in Skeletal muscle mass

    change in Skeletal muscle mass, measured with bioelectrical impedance analysis up to 90-day follow-up.

    Measured: day 1 (study inclusion) until 90-day Follow-up

  10. change in extracellular volume

    change in extracellular volume, measured by the Body impedance analysis

    Measured: day 1 (study inclusion) until 90-day Follow-up

  11. change in the REE (Resting Energy Expenditure)

    change in the REE (Resting Energy Expenditure), measured by indirect calorimetry

    Measured: day 1 (study inclusion) until 90-day Follow-up

  12. urea-to-creatinine ratio

    urea-to-creatinine ratio from blood sample

    Measured: day 1 (study inclusion) until 90-day Follow-up

  13. Identify possible predictors of muscle wasting in urine metabolomics at ICU admission

    Among the urine metabolomics that will be measured, identify metabolites or combinations of metabolites whose high or low concentration(s) at ICU admission associate(s) with the amount of muscle loss. These metabolites are candidate biomarkers that could be used to identify individuals at risk of large muscle wasting and may give further insights into the mechanisms of muscle wasting.

    Measured: day 1 (study inclusion) until 90-day Follow-up

  14. Identify possible predictors of muscle wasting in the blood metabolome at ICU admission

    Among the blood metabolome that will be measured, identify metabolites or combinations of metabolites whose high or low concentration(s) at ICU admission associate(s) with the amount of muscle loss. These metabolites are candidate biomarkers that could be used to identify individuals at risk of large muscle wasting and may give further insights into the mechanisms of muscle wasting.

    Measured: day 1 (study inclusion) until 90-day Follow-up

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted27 Jun 2023
  2. Study start27 Jun 2023
  3. Primary completion31 Dec 2026 (estimated)
  4. Study completion31 Jan 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
40 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05919940
Sponsor's protocol ID
IMEMPRO
Status last verified
Feb 2026
First submitted
6 Jun 2023
Last updated
3 Mar 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: Deidentified data can be requested on reasonable scientific request and data sharing contract, if necessary.

Questions about this trial

What is this clinical trial studying?

A study testing Dietary Supplement: additional substitution of protein, Neuromuscular electrical stimulation and Early Mobilization in people with ICU Acquired Weakness and Muscle Atrophy, run by Technical University of Munich at 4 sites in 2 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 3 Mar 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 4 sites in Germany, Austria. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Stefan J Schaller, MD (+498941409635, s.schaller@tum.de), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in cross sectional area (ΔCSA) of the rectus femoris (time frame: day 1 (study inclusion) and 14 days). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 3 Mar 2026.

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