Sonographic muscle mass assessment in patients after cardiac surgery

Abstract

BACKGROUND Patients undergoing cardiac surgery particularly those with comorbidities and frailty, experience frequently higher rates of post-operative morbidity, mortality and prolonged hospital length of stay. Muscle mass wasting seems to play important role in prolonged mechanical ventilation (MV) and consequently in intensive care unit (ICU) and hospital stay. AIM To investigate the clinical value of skeletal muscle mass assessed by ultrasound early after cardiac surgery in terms of duration of MV and ICU length of stay. METHODS In this observational study, we enrolled consecutively all patients, following their admission in the Cardiac Surgery ICU within 24 h of cardiac surgery. Bedside ultrasound scans, for the assessment of quadriceps muscle thickness, were performed at baseline and every 48 h for seven days or until ICU discharge. Muscle strength was also evaluated in parallel, using the Medical Research Council (MRC) scale. RESULTS Of the total 221 patients enrolled, ultrasound scans and muscle strength assessment were finally performed in 165 patients (patients excluded if ICU stay < 24 h). The muscle thickness of rectus femoris (RF), was slightly decreased by 2.2% [(95% confidence interval (CI): - 0.21 to 0.15), n = 9; P = 0.729] and the combined muscle thickness of the vastus intermedius (VI) and RF decreased by 3.5% [(95%CI: - 0.4 to 0.22), n = 9; P = 0.530]. Patients whose combined VI and RF muscle thickness was below the recorded median values (2.5 cm) on day 1 ( n = 80), stayed longer in the ICU (47 ± 74 h vs 28 ± 45 h, P = 0.02) and remained mechanically ventilated more (17 ± 9 h vs 14 ± 9 h, P = 0.05). Moreover, patients with MRC score ≤ 48 on day 3 ( n = 7), required prolonged MV support compared to patients with MRC score ≥ 49 ( n = 33), (44 ± 14 h vs 19 ± 9 h, P = 0.006) and had a longer duration of extracorporeal circulation was (159 ± 91 min vs 112 ± 71 min, P = 0.025). CONCLUSION Skeletal quadriceps muscle thickness assessed by ultrasound shows a trend to a decrease in patients after cardiac surgery post-ICU admission and is associated with prolonged duration of MV and ICU length of stay.

The current use of ultrasound to measure skeletal muscle and its ability to predict clinical outcomes: a systematic review

“…Twenty studies took serial measurements of the same muscle group to describe longitudinal changes in muscle mass. All 20 of these longitudinal studies found statistically significant changes in muscle measurements over time, which ranged from 15% to 30% reduction in muscle measurement between Day 0 (baseline) and Day 20 24,25,28,30,32,33,35–39,41,42,44,45,47,49,56–58 …”

“…The number of publications over the last 18 months ( n = 18 studies) was similar to that of the preceding 11 years ( n = 19 studies) highlighting the recent surge of new evidence ( Figure 2 ). Data from 26 prospective observational studies 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 (of which 6 were cohort studies, 44 , 45 , 46 , 47 , 48 , 49 7 cross‐sectional studies, 27 , 50 , 51 , 52 , 53 , 54 , 55 3 randomized control trials, 56 , 57 , 58 and 1 post hoc analysis of a negative trial) were included. 59 Five of the 37 studies involved an interventional arm [critical care nutritional intervention ( n = 4) 44 , 56 , 57 , 58 and an exercise intervention in breast cancer ( n = 1) 45 ].…”

“…All 20 of these longitudinal studies found statistically significant changes in muscle measurements over time, which ranged from 15% to 30% reduction in muscle measurement between Day 0 (baseline) and Day 20. 24 , 25 , 28 , 30 , 32 , 33 , 35 , 36 , 37 , 38 , 39 , 41 , 42 , 44 , 45 , 47 , 49 , 56 , 57 , 58 …”

Early mobilization is associated with decreased mechanical ventilation and ICU length of stay following cardiac surgery

“…22 In another recent study, we have shown that skeletal quadriceps muscle mass presented with a trend to a decrease in patients after cardiac surgery post-ICU admission and was associated with prolonged duration of MV and ICU length of stay. 23 Neuromuscular electrical stimulation (NMES) as an alternative form of exercise seems beneficial for preserving muscle mass and strength, 24,25 local and systemic microcirculation 26,27 in critically ill patients and also might reduce the duration of mechanical ventilation and ICU stay. 25,28 NMES has the advantage that can be applied even in sedated patients, an action that might enhance early mobilization, particularly in critically ill patients.…”

Clinical instruments for bedside functional assessment: Convergent validity among the AM‐PAC ‘6‐Clicks’ and BMAT

“…The perils of immobility during hospitalisation have been well described in the literature, and immobility has been associated with muscle weakness (Dimopoulos et al, 2020), reduced bone mineral density (Parry & Puthucheary, 2015), increased incidence of pressure ulcers, deconditioning, increased injuries from falls and increased length of hospital stay (Miller et al, 2016;Peiris et al, 2013).…”