Time course of the Bioelectrical Impedance Vector Analysis and muscular ultrasound in critically ill patients

Formenti, Paolo; Coppola, Silvia; Umbrello, Michele; Froio, Sara; Cacioppola, Alessio; Giorgis, Valentina De; Galanti, Valentina; Lusardi, Andrea Clarissa; Ferrari, Erica; Noè, Donatella; Carnier, Simone; Folli, Franco; Chiumello, Davide

doi:10.1016/j.jcrc.2021.11.014

Cited by 16 publications

(9 citation statements)

References 45 publications

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“…In our study, a decreased in diaphragm thickness was observed independently of the septic status of the patients [ 38 ] while a more important decrease in diaphragm thickness would have been expected in the septic patients because of inflammation-mediated mechanisms [ 9 ]. For instance, Jung et al found that both psoas and diaphragm volumes decreased in 23 critically ill patients with a predominant decrease among the 14 septic patients [ 9 ].…”

Section: Discussionmentioning

confidence: 97%

Severe but reversible impaired diaphragm function in septic mechanically ventilated patients

Lecronier

Jung

Molinari

et al. 2022

Ann. Intensive Care

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Background Whether sepsis-associated diaphragm dysfunction may improve despite the exposure of mechanical ventilation in critically ill patients is unclear. This study aims at describing the diaphragm function time course of septic and non-septic mechanically ventilated patients. Methods Secondary analysis of two prospective observational studies of mechanically ventilated patients in whom diaphragm function was assessed twice: within the 24 h after intubation and when patients were switched to pressure support mode, by measuring the endotracheal pressure in response to bilateral anterior magnetic phrenic nerve stimulation (Ptr,stim). Change in diaphragm function was expressed as the difference between Ptr,stim measured under pressure support mode and Ptr,stim measured within the 24 h after intubation. Sepsis was defined according to the Sepsis-3 international guidelines upon inclusion. In a sub-group of patients, the right hemidiaphragm thickness was measured by ultrasound. Results Ninety-two patients were enrolled in the study. Sepsis upon intubation was present in 51 (55%) patients. In septic patients, primary reason for ventilation was acute respiratory failure related to pneumonia (37/51; 73%). In non-septic patients, main reasons for ventilation were acute respiratory failure not related to pneumonia (16/41; 39%), coma (13/41; 32%) and cardiac arrest (6/41; 15%). Ptr,stim within 24 h after intubation was lower in septic patients as compared to non-septic patients: 6.3 (4.9–8.7) cmH2O vs. 9.8 (7.0–14.2) cmH2O (p = 0.004), respectively. The median (interquartile) duration of mechanical ventilation between first and second diaphragm evaluation was 4 (2–6) days in septic patients and 3 (2–4) days in non-septic patients (p = 0.073). Between first and second measurements, the change in Ptr,stim was + 19% (− 13–61) in septic patients and − 7% (− 40–12) in non-septic patients (p = 0.005). In the sub-group of patients with ultrasound measurements, end-expiratory diaphragm thickness decreased in both, septic and non-septic patients. The 28-day mortality was higher in patients with decrease or no change in diaphragm function. Conclusion Septic patients were associated with a more severe but reversible impaired diaphragm function as compared to non-septic patients. Increase in diaphragm function was associated with a better survival.

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Section: Discussionmentioning

confidence: 97%

Severe but reversible impaired diaphragm function in septic mechanically ventilated patients

Lecronier

Jung

Molinari

et al. 2022

Ann. Intensive Care

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“…Formenti et al assessed the diaphragm, the parasternal muscles, and the rectus femoris muscle among subjects with COVID-related ARDS using USG. Authors reported that the muscle quality (assessed by echogenicity) was significantly poorer among survivors as compared to non-survivors [16] . Lower diaphragm thickness among non-survivors was also reported by Corradi and colleagues [17] .…”

Section: Discussionmentioning

confidence: 99%

“…Our study has further substantiated this belief by demonstrating a decline in the diaphragm thickness measured by bedside USG during the hospital stay for COVID-19. It should be noted that all the aforementioned studies [ 5 , [16] , [17] , [18] ] were conducted among critically ill subjects who either had ARDS or succumbed to severe COVID-19. In contrast, our study included COVID-19 subjects who were relatively less severely ill (median APACHE score of 3.5 and median SOFA score of 2).…”

Section: Discussionmentioning

confidence: 99%

Temporal evolution of diaphragm thickness and diaphragm excursion among subjects hospitalized with COVID-19: A prospective observational study

Hadda

Raja

Suri

et al. 2023

Respiratory Medicine and Research

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“…The main drawback of such a method is that it assumes static ratios between the compartments, most notably a fixed hydration of tissues, which often does not apply to critically ill patients, making the data less reliable [ 45 ]. A recent investigation showed how in critically ill patients BIA-assessed body composition is significantly modified after one week of ICU stay, and how BIA may be useful to define the hydration state, while it does not seem to track muscle mass [ 46 ]. Moreover, in critically ill patients, the nutritional status assessed by ultrasonography, but not by BIA, was shown to predict 28-day mortality [ 47 ].…”

Section: Discussionmentioning

confidence: 99%

Nutrition support for critically ill patients during the COVID-19 pandemic: the Italian SIAARTI survey

Tetamo

Fittipaldi

Buono

et al. 2022

J Anesth Analg Crit Care

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Background Critically ill, COVID-19 patients are characterized by a hypermetabolic state and a reduced food intake and are at high risk of malnutrition and lean body mass loss. An appropriate metabolic-nutritional intervention aims to reduce complications and improve the clinical outcomes. We conducted a cross-sectional, multicenter, observational, nationwide online survey involving Italian Intensivists to assess the nutritional practices in critically ill patients with COVID-19. Results A group of experts in nutrition of the Italian Society of Anaesthesia Analgesia Resuscitation and Intensive Care (SIAARTI) developed a 24-item questionnaire; the 9000 members of the Society were invited to participate through emails and social networks. Data was collected from June 1 to August 1, 2021. A total of 545 responses were collected: 56% in northern, 25% in central, and 20% in southern Italy. Artificial nutrition support is directly handled by intensivists in > 90 of the cases; the nutritional status is assessed as suggested by the guidelines in more than 70% of the cases, and a form of nutrition support is started within the first 48 h from ICU admission by > 90% of the respondents. Nutritional targets are reached in 4–7 days in > 75% of the cases, mainly by the enteral route. Indirect calorimetry, muscle ultrasound, and bioimpedance analysis are used by a limited part of the interviewees. Only about a half of the respondents reported the nutritional issues in the ICU discharge summary. Conclusions This survey among Italian Intensivists during the COVID-19 epidemic showed how the beginning, progression, and route of nutritional support adhere to international recommendations, while recommendations on the tools to set the target and monitor the efficacy of the metabolic support are less followed.

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Time course of the Bioelectrical Impedance Vector Analysis and muscular ultrasound in critically ill patients

Cited by 16 publications

References 45 publications

Severe but reversible impaired diaphragm function in septic mechanically ventilated patients

Severe but reversible impaired diaphragm function in septic mechanically ventilated patients

Temporal evolution of diaphragm thickness and diaphragm excursion among subjects hospitalized with COVID-19: A prospective observational study

Nutrition support for critically ill patients during the COVID-19 pandemic: the Italian SIAARTI survey

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