Abstract
Novel ultrasound (US) methods are required to assess qualitative changes in the quadriceps rectus femoris (QRF) muscle when evaluating mechanically ventilated, long-stay ICU patients with suspected neuromuscular acquired weakness (ICUAW). Our aim was to analyze novel US muscle assessment methods in these patients versus healthy controls by carrying out a prospective observational study. Shear wave elastography (SWE) showed, with a receiver operating characteristic (ROC) curve of 0.972 (95% confidence interval (CI) = 0.916–1.000), that patients increased muscle stiffness associated with muscle fibrosis when diagnosed with ICUAW. We also performed, for the first time, superb microvascular imaging (SMI), which is an innovative US technique designed for imaging microvascularization unseen with color Doppler US, and observed that 53.8% of cases had significantly lower QRF muscle microvascular angiogenic activity than controls (p < 0.001). Finally, we used contrast-enhanced ultrasound (CEUS) to analyze maximum and minimum QRF muscle perfusion and obtained a ROC curve of 0.8, but when used as markers for SMI, their diagnostic capacity increased to 0.988 (CI = 0.965–1) and 0.932 (CI = 0.858–1), respectively. These findings show, for the first time, that these novel sonographic muscle methods should be used for their diagnostic capacity when assessing sarcopenic processes associated with this group of critically ill patients.
Highlights
We have recently described a new, reliable, structured ultrasound (US) protocol to assess secondary sarcopenia in long-stay ICU catabolic patients with ICU-acquired weakness (ICUAW) that allows clinicians to assess quantitative and qualitative changes in the quadriceps rectus femoris (QRF) muscle in severely ill, mechanically ventilated patients with clinically suspected
Most of the studied patients were septic, had a multiorgan failure and received corticosteroids or neuromuscular blocking agents, which are wellrecognized risk factors for ICUAW [14,15]. They were at risk of developing secondary sarcopenia, which eventually leads to musculoskeletal weakness and physical damage that can persist for years in those who survive a prolonged ICU stay
On applying the researched novel high-quality US tools in these patients, we found that QRF muscle Shear wave elastography (SWE) showed a significant increase in muscle stiffness, measured in kPa, in patients compared to the control group (p < 0.001), with an outstanding area under the receiver operating characteristic (ROC) curve of 0.97
Summary
A long ICU stay is usually defined as the requirement for mechanical ventilation and ICU therapy for more than 1 week and up to 3 weeks [1,2]. Chronic critical illness (CCI) has been defined as an ICU length of stay of at least 8 days combined with at least one eligible diagnosis during hospitalization among the following: prolonged acute mechanical ventilation, sepsis, severe wounds, stroke and traumatic brain injury, and tracheotomy [3]. We have recently described a new, reliable, structured ultrasound (US) protocol to assess secondary sarcopenia in long-stay ICU catabolic patients with ICUAW that allows clinicians to assess quantitative and qualitative changes in the quadriceps rectus femoris (QRF) muscle in severely ill, mechanically ventilated patients with clinically suspected
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