Alterations in Respiratory and Limb Muscle Strength and Size in Patients With Sepsis Who Are Mechanically Ventilated

Abstract

When measured at bedside, survivors of sepsis and a period of mechanical ventilation may have respiratory muscle weakness without remarkable diaphragm wasting. Furthermore, deficits in peripheral muscle strength and size may exceed those in the diaphragm.

Ultrasonography in the intensive care setting can be used to detect changes in the quality and quantity of muscle and is related to muscle strength and function

“…Ultrasonography is both a feasible and timeefficient tool for use in the clinical setting. At baseline, levels of muscle thickness and CSA were similar to those previously reported in studies examining healthy individuals [12,25,26]. Muscle wasting occurred in this study despite usual care rehabilitation being provided.…”

Ultrasound for the Assessment of Peripheral Skeletal Muscle Architecture in Critical Illness

“…Significantly, the majority of included studies were published between 2012 and 2013 (32,34,35,37), indicating the emerging research interest in ultrasound as a technique for evaluating peripheral skeletal muscle architecture during critical illness. Five studies were European (33,(35)(36)(37)39), with one conducted in Australia (32) and one in North America (34). Patient characteristics of included studies are reported in Table 4.…”

“…None of the seven included studies (32)(33)(34)(35)(36)(37)(38) were RCTs. Six were primarily single group studies, classified as case series (33)(34)(35)(36)(37)(38).…”

“…One of these studies involved comparison with an unmatched control group (35). The final study adopted a case-control design (32). All studies were level 4 evidence grade (29).…”

“…Sample sizes ranged between 9 (33) and 118 (36) patients. Eligible patient populations in studies were characterized according to clinical diagnostic descriptors (e.g., multiple organ failure and sepsis) (33)(34)(35), ICU admission-related descriptors (e.g., duration of mechanical ventilation and length of stay) (36,37), or a combination of both (32,38). Only four studies reported actual illness severity of their patient cohorts using standard critical care scoring systems (Acute Physiology and Chronic Health Evaluation) (32,35,37,38), of which three further reported actual duration of mechanical ventilation for their patient cohorts (32,35,37).…”