Abstract
IntroductionMuscle ultrasound is emerging as a promising tool in the diagnosis of neuromuscular diseases. The current observational study evaluates the usefulness of muscle ultrasound in patients with severe sepsis for assessment of critical illness polyneuropathy and myopathy (CINM) in the intensive care unit.Methods28 patients with either septic shock or severe sepsis underwent clinical neurological examinations, muscle ultrasound, and nerve conduction studies on days 4 and 14 after onset of sepsis. 26 healthy controls of comparable age underwent clinical neurological evaluation and muscle ultrasound only.Results26 of the 28 patients exhibited classic electrophysiological characteristics of CINM, and all showed typical clinical signs. Ultrasonic echogenicity of muscles was graded semiquantitatively and fasciculations were evaluated in muscles of proximal and distal arms and legs. 75% of patients showed a mean echotexture greater than 1.5, which was the maximal value found in the control group. A significant difference in mean muscle echotexture between patients and controls was found at day 4 and day 14 (both p < 0.001). In addition, from day 4 to day 14, the mean grades of muscle echotexture increased in the patient group, although the values did not reach significance levels (p = 0.085). Controls revealed the lowest number of fasciculations. In the patients group, fasciculations were detected in more muscular regions (lower and upper arm and leg) in comparison to controls (p = 0.08 at day 4 and p = 0.002 at day 14).ConclusionsMuscle ultrasound represents an easily applicable, non-invasive diagnostic tool which adds to neurophysiological testing information regarding morphological changes of muscles early in the course of sepsis. Muscle ultrasound could be useful for screening purposes prior to subjecting patients to more invasive techniques such as electromyography and/or muscle biopsy.Trial registrationGerman Clinical Trials Register, DRKS-ID: DRKS00000642.
Highlights
Muscle ultrasound is emerging as a promising tool in the diagnosis of neuromuscular diseases
There is no direct relationship between ICU-acquired weakness (ICUAW) and electrophysiological abnormalities with a high prevalence of electrophysiological abnormalities early on in critical illness
Exclusion criteria comprised a history of neuromuscular disorders, known alcohol abuse, high-dose steroid therapy before sepsis
Summary
Muscle ultrasound is emerging as a promising tool in the diagnosis of neuromuscular diseases. The current observational study evaluates the usefulness of muscle ultrasound in patients with severe sepsis for assessment of critical illness polyneuropathy and myopathy (CINM) in the intensive care unit. Critical illness polyneuropathy (CIP) and critical illness myopathy (CIM) as well as the combination of both are common sequelae in patients with severe sepsis in ICUs [1,2,3]. The common clinical feature of unclassified CIM and CIP comprises ICU-acquired weakness (ICUAW). The current gold standard for diagnosis of CIP and CIM in the ICU setting consists of a careful neurological examination together with nerve conduction studies and electromyography (EMG) [9]. Assessment of Medical Research Council scores of muscle strength and classical EMG examinations beyond the detection of spontaneous activity often cannot reliably be performed since, in the acute phase of severe sepsis, patients are as a rule unconscious and uncooperative
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