623: ASSESSING CLINICAL VARIABLES ASSOCIATED WITH FEMORAL MUSCLE DECAY IN CRITICALLY ILL CHILDREN

Abstract

Introduction: Skeletal muscle wasting is a well-described entity of critical illness and has been found to be associated with prolonged ICU and hospital stays and acquired morbidities. Recent studies have shown ultrasound measurements of the quadriceps femoris muscle are a reliable method to track muscle decay in the pediatric population. Our study aims to identify significant clinical variables that are associated with muscle decay in critically ill mechanically ventilated children. Methods: A prospective, single center analysis was performed on sixty-seven sedated and mechanically ventilated patients admitted to the pediatric ICU between February 2021-March 2022. Point of care ultrasound was used to measure the thickness of the quadriceps femoris muscle serially for up to the first 7 days of study enrollment. Average daily change in muscle thickness was calculated for each subject. Clinical variables measured included nutritional adequacy, fluid overload, sedative and paralytic use, steroid exposure, early mobilization, disease severity, mortality, and ICU and hospital length of stay (LOS). Results: Change in muscle thickness in our patient population was similar to prior studies with a mean daily change of -1.9% [IQR -0.8, -5.0]. Patients with adequate cumulative caloric intake, as defined by >60% of goal, were shown to have less muscle decay compared to those with inadequate caloric intake (-1.8% vs. -2.4%, p< 0.001). Average daily change in muscle thickness was found to correlate with both ICU and hospital LOS (r = 0.328, p = 0.007 and r = 0.393, p = 0.001). No correlation was found between daily change in muscle thickness and mortality, disease severity, and fluid balance. Similarly, early mobilization, sedative and paralytic use, and steroid exposure did not show significant associations with change in muscle thickness. Conclusions: We demonstrate quadriceps femoris muscle decay in critically ill children as measured by ultrasonography. Average daily muscle decay was associated with longer ICU and hospital length of stay. Children with adequate cumulative caloric intake were found to have less muscle decay than those with inadequate caloric intake.