Reliability of bedside ultrasound of limb and diaphragm muscle thickness in critically ill children

Ng, Kim Tien; Dietz, Alexander R.; Johnson, Ryan; Shoykhet, Michael; Zaidman, Craig M.

doi:10.1002/mus.26327

Cited by 22 publications

(14 citation statements)

References 22 publications

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“…Measurements were obtained in triplicate and averaged for analyses. Intra-rater reproducibility coefficient ( κ ) was 0.99 for biceps, quadriceps and tibialis, and 0.8 for diaphragm, supporting recent suggestions by our group and others that serial US may reliably assess muscle properties in children[2, 27, 28].…”

Section: Methodssupporting

confidence: 76%

Muscle atrophy in mechanically-ventilated critically ill children

Johnson

Dietz

et al. 2018

PLoS ONE

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ImportanceICU-acquired muscle atrophy occurs commonly and worsens outcomes in adults. The incidence and severity of muscle atrophy in critically ill children are poorly characterized.ObjectiveTo determine incidence, severity and risk factors for muscle atrophy in critically ill children.Design, setting and participantsA single-center, prospective cohort study of 34 children receiving invasive mechanical ventilation for ≥48 hours. Patients 1 week– 18 years old with respiratory failure and without preexisting neuromuscular disease or skeletal trauma were recruited from a tertiary Pediatric Intensive Care Unit (PICU) between June 2015 and May 2016. We used serial bedside ultrasound to assess thickness of the diaphragm, biceps brachii/brachialis, quadriceps femoris and tibialis anterior. Serial electrical impedance myography (EIM) was assessed in children >1 year old. Medical records were abstracted from an electronic database.ExposuresRespiratory failure requiring endotracheal intubation for ≥48 hours.Main outcome and measuresThe primary outcome was percent change in muscle thickness. Secondary outcomes were changes in EIM-derived fat percentage and “quality”.ResultsOf 34 enrolled patients, 30 completed ≥2 ultrasound assessments with a median interval of 6 (IQR 6–7) days. Mean age was 5.42 years, with 12 infants <1 year (40%) and 18 children >1 year old (60%). In the entire cohort, diaphragm thickness decreased 11.1% (95%CI, -19.7% to -2.52%) between the first two assessments or 2.2%/day. Quadriceps thickness decreased 8.62% (95%CI, -15.7% to -1.54%) or 1.5%/day. Biceps (-1.71%; 95%CI, -8.15% to 4.73%) and tibialis (0.52%; 95%CI, -5.81% to 3.40%) thicknesses did not change. Among the entire cohort, 47% (14/30) experienced diaphragm atrophy (defined a priori as ≥10% decrease in thickness). Eighty three percent of patients (25/30) experienced atrophy in ≥1 muscle group, and 47% (14/30)—in ≥2 muscle groups. On multivariate linear regression, increasing age and traumatic brain injury (TBI) were associated with greater muscle loss. EIM revealed increased fat percentage and decreased muscle “quality”.Conclusions and relevanceIn children receiving invasive mechanical ventilation, diaphragm and other skeletal muscle atrophy is common and rapid. Increasing age and TBI may increase severity of limb muscle atrophy. Prospective studies are required to link muscle atrophy to functional outcomes in critically ill children.

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Section: Methodssupporting

confidence: 76%

Muscle atrophy in mechanically-ventilated critically ill children

Johnson

Dietz

et al. 2018

PLoS ONE

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“…We demonstrate high intra- and interrater ICCs for all SWLs and spectrally unmixed parameters except lipid, with good feasibility also for a less experienced examiner. This correlation is in the range of or even better than comparable handheld ultrasound systems [ [24] , [25] , [26] ], especially for muscle imaging applications [ [27] , [28] , [29] ]. The lower ICC values for lipid might be explainable by generally low lipid levels in healthy muscles, especially in comparable lean individuals [ 30 ], so that little variations in probe positioning may have high impact on signal quantifications.…”

Section: Discussionmentioning

confidence: 96%

Precision of handheld multispectral optoacoustic tomography for muscle imaging

et al. 2021

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“…As we performed an ultrasound on the only right side for a superior ultrasound window, unilateral pathologies like diaphragmatic eventration or palsy could be missed (left‐sided) or interfere with measurements (right‐sided). The need for special training and the interrater difference in ultrasound measurements are other limitations of ultrasound‐based diaphragmatic evaluation 26 . Also, diaphragmatic atrophy measured by ultrasound may not always translate into proportionate weakness; we did not perform any tests measuring the strength of diaphragmatic contraction.…”

Section: Discussionmentioning

confidence: 99%

Diaphragmatic atrophy and dysfunction in critically ill mechanically ventilated children

Mistri

Dhochak

Jana

et al. 2020

Pediatric Pulmonology

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Rationale The extent of diaphragmatic atrophy and dysfunction in critically ill children from developing countries is not established. Objectives To estimate changes in ultrasound measurements of diaphragmatic thickness over the first week of mechanical ventilation. To assess magnitude and risk factors of diaphragmatic atrophy. Methods In an observational cohort study, children aged 1–18 years, requiring mechanical ventilation were included. Ultrasound measurements of diaphragmatic thickness at end‐expiration (DTe) and end‐inspiration (DTi), and diaphragmatic thickening fraction (DTF) were performed daily during the first week of admission, and pre‐ and post‐extubation. Diaphragmatic atrophy (%) and atrophy rate (rate of decline in DTe, % per day) were calculated. Measurements and Main Results Of 55 children (74.6% boys) enrolled, 20 (36.4%) died. Of 35 children with planned extubation, 5 (14.3%) required reintubation. Baseline median (interquartile range [IQR]) DTe, DTi, and DTF were 1.27 mm (1, 1.6), 1.76 mm (1.35, 2.10), and 33.75% (26.90, 44.60), respectively. There was a significant reduction in DTe over the first week of mechanical ventilation (p < .001), median (IQR) diaphragmatic atrophy and atrophy rate of 9.91% (5.26, 17.35) and 2.01% (1.08, 3.04) per day, respectively. Diaphragmatic atrophy rate was lower in pressure targeted ventilation (n = 44; 1.79% [1.03, 2.87]) than volume targeted ventilation (n = 11; 3.10% [1.31, 5.49]), p = .038. There was no difference in diaphragmatic parameters (atrophy rate, and peri‐extubation DTe and DTF) in extubation success versus failure. Conclusions The diaphragm undergoes progressive atrophy during the first week of mechanical ventilation in critically ill children. Future studies should evaluate ventilation strategies to reduce the diaphragmatic atrophy.

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Reliability of bedside ultrasound of limb and diaphragm muscle thickness in critically ill children

Cited by 22 publications

References 22 publications

Muscle atrophy in mechanically-ventilated critically ill children

Muscle atrophy in mechanically-ventilated critically ill children

Precision of handheld multispectral optoacoustic tomography for muscle imaging

Diaphragmatic atrophy and dysfunction in critically ill mechanically ventilated children

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