Ultrasound assessment of muscle mass and correlation with clinical outcomes in critically ill patients: a prospective observational study

Guzmán-David, Cristian Arvey; Ruiz-Ávila, Héctor Andrés; Camargo-Rojas, Diana Alexandra; Gómez-Alegría, Claudio Jaime; Hernández-Álvarez, Edgar Debray

doi:10.1007/s40477-023-00823-2

Cited by 4 publications

(1 citation statement)

References 49 publications

(72 reference statements)

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“…A recent investigation in 37 critically ill subjects, 24 of whom developed ICU-acquired weakness, found that the changes in the thickness and CSA of various skeletal muscles between admission and the 10th day of ICU stay was associated with the development of weakness with areas under the ROC curves between 0.734 and 0.888 [ 92 ]. A subsequent study in 31 critically ill patients confirmed how a decrease in rectus femoris CSA > 10% during the first 72 h after ICU admission increased the risk for limb muscle weakness and handgrip weakness [ 105 ]. A recent systematic review and meta-analysis that included chronic as well as acutely ill subjects (including critically ill patients) found that muscle thickness, CSA, and echo-intensity have been shown to be correlated with functional outcomes such as muscle strength, physical function, exercise tolerance, and quality of life [ 106 ].…”

Section: Ultrasonographic Assessment Of Muscle Weaknessmentioning

confidence: 99%

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

Umbrello,

Brogi,

Formenti

et al. 2023

JCM

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Muscle wasting begins as soon as in the first week of one’s ICU stay and patients with multi-organ failure lose more muscle mass and suffer worse functional impairment as a consequence. Muscle wasting and weakness are mainly characterized by a generalized, bilateral lower limb weakness. However, the impairment of the respiratory and/or oropharyngeal muscles can also be observed with important consequences for one’s ability to swallow and cough. Muscle wasting represents the result of the disequilibrium between breakdown and synthesis, with increased protein degradation relative to protein synthesis. It is worth noting that the resulting functional disability can last up to 5 years after discharge, and it has been estimated that up to 50% of patients are not able to return to work during the first year after ICU discharge. In recent years, ultrasound has played an increasing role in the evaluation of muscle. Indeed, ultrasound allows an objective evaluation of the cross-sectional area, the thickness of the muscle, and the echogenicity of the muscle. Furthermore, ultrasound can also estimate the thickening fraction of muscle. The objective of this review is to analyze the current understanding of the pathophysiology of acute skeletal muscle wasting and to describe the ultrasonographic features of normal muscle and muscle weakness.

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Section: Ultrasonographic Assessment Of Muscle Weaknessmentioning

confidence: 99%

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

Umbrello,

Brogi,

Formenti

et al. 2023

JCM

View full text Add to dashboard Cite

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Assessing Clinical Variables Associated With Femoral Muscle Decay as Measured by Point‐of‐Care Ultrasound in Critically Ill Children

Kim,

Wai,

Pedoeim

et al. 2024

J of Ultrasound Medicine

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ObjectivesSkeletal muscle wasting is a common occurrence in critical illness, often resulting in intensive care unit (ICU)‐acquired weakness. This study aims to identify clinical factors associated with muscle decay in mechanically ventilated critically ill children. Utilizing point‐of‐care ultrasound, a noninvasive and cost‐effective tool, we assess muscle decay through ultrasound of the quadriceps femoris.MethodsA prospective observational study was conducted in a single‐center quaternary‐care pediatric intensive care unit at a children's hospital. A convenience sample of 103 sedated and mechanically ventilated patients were enrolled in this study. Ultrasound measurements of quadriceps femoris muscle thickness were taken, and daily muscle decay rates were calculated. Demographic, clinical, and outcome data were analyzed for correlations with muscle decay.ResultsAmong the enrolled patients, 67 had repeat measurements. Muscle thickness change aligned with prior studies, with a mean daily change of −1.9% [IQR −0.8, −5.0]. Adequate cumulative caloric intake (>60% of goal) correlated with less muscle decay compared with inadequate intake (−1.8 vs −2.4%, P < .001). Average daily muscle change correlated with both ICU and hospital length of stay (LOS) (r = .328, P = .007 and r = .393, P = .001). No significant correlations emerged between muscle change and mortality, disease severity, fluid balance, early mobilization, steroid exposure, or sedative and paralytic use.ConclusionThis study demonstrates early and frequent muscle decay in critically ill children, as detected by point‐of‐care ultrasound. Average daily muscle decay was associated with longer ICU and hospital LOS. Adequate cumulative caloric intake is linked to reduced muscle decay. These findings contribute to understanding muscle wasting in critically ill pediatric patients.

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Ultrasound guided evaluation of muscle wasting in critically ill patients

Ali,

Mostafa,

Hammad

et al. 2024

Egypt. J. Critical. Care. Med.

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Background Muscle wasting constitutes a frequent complication in critical illness and may be most prevalent in chronic critical illness as inpatients with prolonged ICU length of stay. Objective To evaluate the incidence and percentage of muscle wasting estimated by ultrasonography during ICU stay in patients with sepsis and receiving medications as corticosteroids, muscle relaxant, and certain antibiotics during ICU stay and hospital stay. Patients and methods We enrolled 90 patients diagnosed with sepsis who were admitted to ICU at Kasr Alainy Hospital were subdivided in to 3 groups: Group 1 consists of 30 patients receiving steroids. Group 2 consists of 30 patients receiving antibiotic causing muscle wasting in the form of aminoglycosides. Group 3 consists of 30 patients receiving neuromuscular blocking agents (muscle relaxants) for any indication in ICU. Results Our study included 90 patients, with mean age 50.44 ± 6.79 years, with male % 60%, APACHE II score 7.16 ± 3.59, SOFA score 7.16 ± 3.59, results showed there was a significant decline in QMT on both right and left sides as well as RFCSA on both right and left sides when compared with baseline starting from the 3rd day of ICU admission till the end of the study period (15th day of ICU admission) (P < 0.001). Patients who received muscle relaxant had significantly higher QMT% and RFCSA% wasting when compared to patients who received aminoglycosides (P < 0.001) and when compared to patients who received steroids (P < 0.001). Patients who received aminoglycosides had significantly higher QMT% and RFCSA% wasting compared to patients who received steroids (P < 0.001). There was a significant negative correlation between Horowitz index with right side QMT% wasting (r = − 0.557; P < 0.001), left side QMT% wasting (r = − 0.444; P < 0.001), right side RFCSA% wasting (r = − 0.638; P < 0.001), and left side RFCSA% wasting (r = − 0.621; P < 0.001). Right side QMT% wasting positively correlated with WBCs (r = 0.254; P = 0.016). There was a significant positive correlation between SOFA score with right side QMT% wasting (r = 0.308; P = 0.003) and left side QMT% wasting (r = 0.285; P = 0.006). There was a significant positive correlation between SOFA score with right side RFCSA% wasting (r = 0.210; P = 0.003) and left side RFCSA% wasting (r = 0.303; P = 0.004). Conclusion Ultrasound showed significant reduction in QMT and RFCSA from the baseline in patients with sepsis starting from the 3rd day of admission. Patients who received muscle relaxant had the highest incidence of muscle wasting (QMT% wasting and RFCSA% wasting). Patients who received steroids reported the least percentage of muscle wasting.

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Ultrasound assessment of muscle mass and correlation with clinical outcomes in critically ill patients: a prospective observational study

Cited by 4 publications

References 49 publications

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

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

Assessing Clinical Variables Associated With Femoral Muscle Decay as Measured by Point‐of‐Care Ultrasound in Critically Ill Children

Ultrasound guided evaluation of muscle wasting in critically ill patients

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