Association of nutritional status, frailty, and rectus femoris muscle thickness measured by ultrasound and weaning in critically ill elderly patients

Abstract

Association of nutritional status, frailty, and rectus femoris muscle thickness measured by ultrasound and weaning in critically ill elderly patients Introduction Sarcopenia and frailty are critical factors linked with poor clinical outcomes among elderly individuals. This study aims to investigate the association between nutritional assessment tests and frailty with muscle thickness measured by ultrasound and their relationship with weaning among crtically ill elderly patients. Materials and Methods Patients who were over 65 years old and required invasive ventilation were assessed for nutritional status and clinical frailty scale upon admission to the intensive care unit. Additionally, the thickness of their rectus femoris and vastus intermedius muscles were measured by ultrasound within 48 hours of intubation. Correlation analysis was conducted to examine the relationship between screening tests, frailty, and ultrasound results. The association between these parameters and weaning success was also evaluated. Results Between May and August 2022, 32 consecutive patients were enrolled in the study. The mean age was 79.3 ∓ 7.9, and 18 (56.3%) of them were female. Median APACHE-II- and first-day SOFA scores were 22.5 (16.2-29.7) and 7 (5-10.75), respectively. There was a moderate negative correlation between the thickness of the rectus femoris and frailty (r= -0.41, p= 0.036), and there was a moderate positive correlation between the rectus femoris and geriatric nutritional risk index (r= 0.45, p= 0.017). Of them, 18 (56.3%) patients were classified as weaning failure in which the mean frailty score was higher (7.6 ∓ 0.9 vs 6.5 ∓ 1.7, p= 0.035), sepsis (18 vs 7, p< 0.001) and use of vasopressor (17 vs 6, p= 0.004) more common, and in-hospital mortality were higher (18 vs 5, p< 0.001). Conclusion Bedside ultrasound could be beneficial for detecting nutritional high-risk patients. Frailty was associated with muscle thickness, and it was also associated with weaning failure.

Ultrasonographic Features of Muscular Weakness and Muscle Wasting in Critically Ill Patients

“…If muscle wasting is determined to be related to malnutrition, a tailored nutritional plan, possibly including protein supplementation, may be initiated. A recent pilot study [ 97 ] showed how muscle thickness assessed by ultrasonography independently predicts one’s nutritional status, similarly to previous studies in which the authors showed a moderate positive correlation between the rectus femoris and geriatric nutritional risk index [ 98 ]. The early detection of muscle wasting through ultrasound allows for timely intervention [ 78 ].…”

O uso do ultrassom na avaliação de massa magra e previsão de desfechos clínicos em pacientes críticos

“…Destes, 7 não avaliaram associação com desfechos clínicos, 4 foram realizados com pacientes não críticos e 2 avaliaram apenas o músculo do diafragma. Dessa forma, a amostra foi composta por 15 artigos (ER et al, 2021(ER et al, , 2023GRUTHER et al, 2008;HRDY et al, 2023;LEE et al, 2021;MAGALHÃES et al, 2020;MAYER et al, 2020;MENDES et al, 2023;PARRY et al, 2015;PASSOS;MACEDO;DE-SOUZA, 2021;PUTHUCHEARY et al, 2013;TANAKA;YAMADA, 2021;TOLEDO et al, 2021;UMBRELLO et al, 2021;YANAGI et al, 2021).…”

The mode and timing of administrating nutritional treatment of critically ill elderly patients in intensive care units: a multicenter prospective study

“…Old age and nutritional status are key factors associated with adverse clinical outcomes ( 18 ). Therefore, it is important to clarify the status of nutrition treatment in elderly patients who are critically ill. ESPEN guideline detailed that critically ill elderly patients should initiate early EN (within 48 h) rather than delaying it ( 19 ).…”