Muscle ultrasonographic changes in critically ill COVID-19 patients

Abstract

Background: Patients with severe forms of COVID-19 (coronavirus disease 2019) present a systemic inflammatory response and hypermetabolism. The objective of this study was to identify the change in rectus femoris and vastus medialis muscle mass in patients with severe COVID-19 who required invasive mechanical ventilation, and to establish the correlation between the change in muscle size and the amount of calories and proteins administered. Materials & methods: This prospective observational longitudinal study was conducted in the adult intensive care unit in a tertiary care clinic. Muscle mass was measured with ultrasound from admission, at seven-day intervals, until discharge from the unit. Anthropometric and biochemical data as well as the amount of calories and proteins administered were taken into account. Results: A total of 39 patients were included (59.6 ± 11.3 years; 79.5% men) with a median BMI of 27.7 kg/m2 (IQR 24.2–29.7). The size of the rectus femoris and vastus medialis muscles had diminished significantly at seven days of hospitalization: right middle third 0.38 cm (IQR 0.16-0.47), left middle third 0. 29 cm (IQR 0.08-0.54) and right middle third 0.37 cm (IQR 0.11-0.71) left middle third 0.25 cm (IQR 0.09-0.52), respectively. The changes in both muscles were directly correlated with caloric and protein intake during nutritional support. Conclusions: Critically ill patients with COVID-19 were found to lose muscle mass progressively as a result of lower coverage of caloric and protein requirements.