Ultrasonography: New Insights in its Applicability to Explore Muscle Mass and Musculoskeletal Inflammation in Critically ill Patients

Abstract

Objective: The main aim of the study was to explore muscle mass changes and to investigate musculoskeletal inflammation in critically ill patients.Methods: A pure observational study that comprised two musculoskeletal analyses was conducted. Ultrasonography was used to determine the inflammatory process and muscle mass modifications. We assessed the presence of musculoskeletal inflammation and muscles area reduction. We recruited 26 patients and we performed both imaging investigations (shoulder and hip joints, biceps brachii and rectus femoris areas) and anthropometric measurements (mid-upper arm circumference).Results: More than 70% of patients were classified with low muscle mass, over one half of sarcopenic patients being over-weight and 17% being obese. The relationship between the length of stay in intensive care unit, mechanical ventilation and presence of low mid-upper arm circumference, highlighted a significant difference when comparing sarcopenic and non-sarcopenic groups. Musculoskeletal inflammation expressed by step-down lesions, calcifications and osteophytes, is common in these patients. Statistically significant results were obtained when comparing the dimensions of the investigated muscles. Good inter-observer variability in day 3 of assessment for biceps brachii and rectus femoris was noticed.Conclusions: More than 1/3 of critically ill patients included in the present study was classified with low muscle mass. The length of stay in intensive care unit and the length of mechanical ventilation had an important impact on sarcopenic patients. Musculoskeletal impairment was frequent, reflected by presence of enthesitis lesions in joints and by dynamic reduction of muscle area.

Assessment of the Diaphragm Thickness Decrease in Critically Ill COVID-19 Patients: Could Computed Tomography Be of Aid Regarding Diaphragm Muscle Mass?

“…Measurement of muscle wasting was found to add data regarding the evolution of patients' diseases, either assessed by ultrasound in the ICU [26] or by CT investigations in critical and noncritical settings [27,28]. Even if various studies evaluated patients diagnosed with common respiratory disorders and their associated risks [29], with reference to COVID-19 patients, Parlak et al evaluated the association of diaphragm thickness and density measured with chest CT with disease severity [12], and Branea et al investigated diaphragm alterations on CTs of critically ill patients [30].…”

“…Albumin (g/dL, <3.2 g/dL low serum level); Glucose (g/dL, ≥180 g/dL high serum glucose); Creatinine (mg/dL, normal range 0.7-1.20 mg/dL); GFR, glomerular filtration rate (mL/min, reference value >60 mL/min); Fibrinogen (mg/dL, normal range 150-400 mg/dL), §missing26 laboratory values; Ferritin (ng/mL, normal range 15-150 ng/mL), § §missing 10 laboratory values; *Mann-Whitney U test; ** Student t-test. The laboratory results for all patients identified WBC values of 10.21 (2.27-56.5) 10 3 /μL, and they confirmed a clinical evolution of neutrophilia 8.84 (1.56-52.32) 10 3 /μL and lymphopenia 0.78 (0.19-3.64) 10 3 /μL, with increased CRP values of 91.36 (4.20-480.0) mg/L and increased IL-6 values of 50.1 (1.5-1,768.0).…”

Urinary Titin N-Fragment as a Biomarker of Muscle Atrophy, Intensive Care Unit-Acquired Weakness, and Possible Application for Post-Intensive Care Syndrome

“…Computed tomography is accurate, but exposes patients to radiation, whereas bioelectrical impedance analysis is influenced by fluid changes in critically ill patients [ 32 ]. Ultrasound can be used to monitor muscle atrophy at the bedside, but it requires a skilled and experienced operator [ 33 , 34 ]. Thus, a biomarker to assess muscle atrophy is urgently needed.…”

Urinary Titin N-fragment as a Biomarker of Muscle Atrophy, Intensive Care Unit-Acquired Weakness, and Possible Application for Post-Intensive Care Syndrome

“…Computed tomography is accurate, but exposes patients to radiation, while the bioelectrical impedance analysis is influenced by fluid changes in critically ill patients [23]. Ultrasound can be used for the bed-side monitoring of muscle atrophy, but it requires a skilled and experienced operator [24,25]. Thus, a biomarker to assess muscle atrophy is urgently needed.…”