Abstract
To test diagnostic accuracy of changes in thickness (TH) and cross-sectional area (CSA) of muscle ultrasound for diagnosis of intensive care unit acquired weakness (ICU-AW). Fully conscious patients were subjected to muscle ultrasonography including measuring the changes in TH and CSA of biceps brachii (BB) muscle, vastus intermedius (VI) muscle, and rectus femoris (RF) muscles over time. 37 patients underwent muscle ultrasonography on admission day, day 4, day 7, and day 10 after ICU admission, Among them, 24 were found to have ICW-AW. Changes in muscle TH and CSA of RF muscle on the right side showed remarkably higher ROC-AUC and the range was from 0.734 to 0.888. Changes in the TH of VI muscle had fair ROC-AUC values which were 0.785 on the left side and 0.779 on the right side on the 10th day after ICU admission. Additionally, Sequential Organ Failure Assessment (SOFA), Acute Physiology, and Chronic Health Evaluation II (APACHE II) scores also showed good discriminative power on the day of admission (ROC-AUC 0.886 and 0.767, respectively). Ultrasonography of changes in muscles, especially in the TH of VI muscle on both sides and CSA of RF muscle on the right side, presented good diagnostic accuracy. However, SOFA and APACHE II scores are better options for early ICU-AW prediction due to their simplicity and time efficiency.
Highlights
To test diagnostic accuracy of changes in thickness (TH) and cross-sectional area (CSA) of muscle ultrasound for diagnosis of intensive care unit acquired weakness (ICU-AW)
The Medical Research Council (MRC) score is extensively utilized for diagnosing the ICU-AW and its good interobserver reliability in critical settings has been confirmed in a previously published study[12].For the patients mechanically ventilated with sedatives, if the RASS (Richmond Agitation Sedation Scale) fell anywhere between − 1 and 127 and they showed a positive reaction to 5 verbal commands with facial muscles, we considered them feasible for muscle strength a ssessment[12]
37 patients went through all 4 times muscle ultrasonography measurement successfully, of whom 24 had ICU-AW
Summary
To test diagnostic accuracy of changes in thickness (TH) and cross-sectional area (CSA) of muscle ultrasound for diagnosis of intensive care unit acquired weakness (ICU-AW). Loss of muscle mass is the clinical manifestation of critical illness neuromyopathy and usually involves bilateral symmetrical limb weakness[1] It is defined as an intensive care unit acquired weakness (ICU-AW) and presents as flaccid quadriparesis with hyporeflexia or areflexia[2]. The hypothesis of the present study is the changes in muscle ultrasound over time may show better diagnostic efficiency in the occurrence of ICU-AW. We carried out the present study at a single center to test the diagnostic accuracy of the changes of muscle ultrasound over time in differentiating patients with and without ICU-AW
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