Ultrasound guided evaluation of muscle wasting in critically ill patients

Abstract

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.