Assessment of Muscle Wasting in Long-Stay ICU Patients Using a New Ultrasound Protocol.

Carmen Hernández-Socorro,Juan López-Fernández,Sergio Ruiz-Santana,Pedro Saavedra

doi:10.3390/nu10121849

Carmen Hernández-Socorro, Juan López-Fernández + Show 2 more

Open Access

https://doi.org/10.3390/nu10121849

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Abstract

There is currently no standardized procedure to assess sarcopenia in long-stay catabolic patients. Our aim is to analyze a novel ultrasound muscle assessment protocol in these patients versus healthy controls, by carrying out a prospective observational study. We designed a new ultrasound protocol that assesses quadriceps rectus femoris (QRF) muscle quality in real-time B-mode, color-Doppler, and M-mode ultrasound, and evaluates QRF intramuscular central tendon thickness, cross-sectional area, and muscle thickness in ultrasound B-mode. Logistic regression was performed as a multivariable analysis on 29 cases and 19 controls. The QRF muscle area and thickness were shown to significantly decrease (p ≤ 0.001), and the central tendon thickness significantly increased (p = 0.047) in cases versus controls. The QRF muscle echogenicity and angiogenic activity fasciculations, subcutaneous edema, and intramuscular fluid were also significantly different between the two groups (p < 0.001). The selected variables in the multivariate logit analysis were the muscle area (OR per cm2 = 0.07; 95% confidence interval (CI) = 0.012–0.41) and the central tendon thickness (OR per mm 1.887; 95% CI = 2.66–13.38).

Highlights

Skeletal muscle wasting is a characteristic early finding in the acute phase response, but has been linked to functional impairment in patients with prolonged weaning from mechanical ventilation and increased hospital length of stay, as well as acute and long-term functional disability.its relationship with neuromuscular acquired weakness or secondary sarcopenia has not yet been well-established
862 patients were admitted to the Intensive Care Unit (ICU), where 738 of them were mechanically ventilated and 159 had prolonged mechanical ventilation (median (IQR) for number of days: 37.5 (28.8; 61.9))
More importantly, the quadriceps rectus femoris (QRF) central tendon thickness significantly increased in the cases (p = 0.047)

Summary

Introduction

Skeletal muscle wasting is a characteristic early finding in the acute phase response, but has been linked to functional impairment in patients with prolonged weaning from mechanical ventilation and increased hospital length of stay, as well as acute and long-term functional disability.its relationship with neuromuscular acquired weakness or secondary sarcopenia has not yet been well-established. Skeletal muscle wasting is a characteristic early finding in the acute phase response, but has been linked to functional impairment in patients with prolonged weaning from mechanical ventilation and increased hospital length of stay, as well as acute and long-term functional disability. Increased energy and protein administration within the first acute-phase admission week does not seem to prevent muscle wasting or promote muscle preservation. Protein-loading and exercise, used successfully to treat frailty in older patients [1], may fail in the still not well-defined group of severely catabolic patients, if applied as a standard treatment [2,3]. The most frequently used imaging modalities to measure muscle mass are magnetic resonance (MR), ultrasonography (US), computed tomography (CT), and dual-energy X-ray absorptiometry (DXA). Bioelectrical impedance analysis (BIA) is used to assess body composition [4]

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