Abstract
BackgroundMuscle wasting in critically ill patients is associated with negative clinical outcomes. Ultrasound quadriceps femoris muscle assessment may constitute a convenient tool to evaluate muscle wasting. Nevertheless, its reliability remains uncertain. Our primary aim was to study the intra- and inter-observer reliability of this technique. Our secondary aim was to assess the evolution of the quadriceps muscle during the first 3 weeks after ICU admission and its possible association with nutritional intake.MethodsThis observational study included patients expected to stay more than 7 days in the ICU. Ultrasound quadriceps muscle thickness was measured with a 12 MHz linear transducer, by two trained physicians, on D1, D3, D5, D7 and D21. Two measurements sites were evaluated: on the midpoint or on the two-thirds of the length between the anterior superior iliac spine and the upper border of the patella. Intra and inter-observer reliability was assessed by calculating the intra-class correlation coefficient (ICC).ResultsA total of 280 ultrasound quadriceps thickness measurements were performed on 29 critically ill patients. Intra-observer reliability’s ICC was 0.74 [95% CI 0.63; 0.84] at the “midpoint” site and 0.83 [95% CI 0.75; 0.9] at the “two-thirds” site. Inter-observer reliability’s ICC was 0.76 [95% CI, 0.66; 0.86] at the “midpoint” site and 0.81 [95% CI, 0.7; 0.9] at the “two-thirds” site. Quadriceps femoris muscle thickness decreased over 16% within the first week after ICU admission. No correlation was found between muscle loss and caloric (p = 0.96) or protein (p = 0.80) debt over the first week.ConclusionThe assessment by ultrasonography of the quadriceps muscle thickness reveals good intra- and inter-observer reliability and may constitute a promising tool to evaluate the effect of nutritional-based interventions on muscle wasting in critically ill patients.Trial registration“Committee for the Protection of Human Subjects in Biomedical Research” - Paris Ile de France VI Pitié-Salpêtrière – 10/07/2014.French Data Protection Committee (“Commission Nationale Informatique et Libertés”) - #1771144.
Highlights
Muscle wasting in critically ill patients is associated with negative clinical outcomes
The ultrasound probe was placed perpendicular to the long axis of the thigh on its anterior surface, at the two-thirds (“two-thirds” site) and the midpoint (“midpoint” site) of the length between the anterior superior iliac spine (ASIS) and the upper border of the patella
Median age was 64 years old [95% CI, 60–69] and median SAPS Simplified acute physiology score II (II) score was 49 which corresponds to an expected mortality of 44%
Summary
Muscle wasting in critically ill patients is associated with negative clinical outcomes. Pardo et al BMC Anesthesiology (2018) 18:205 challenging in this setting: different methods have been described and validated, but none of them can be applied in the ICU setting [6] Anthropometric measurements such as tricipital skin-fold thickness and mid-arm muscle circumference may underestimate sarcopenia in critically ill patients considering the high incidence of subcutaneous edema [7]. Computed tomography [5], dual-energy X-ray absorptiometry [9] and magnetic resonance imaging [10] offer accurate estimations of muscle mass by analyzing a cross-section usually going through the third lumbar vertebrae These imaging techniques are not compatible with bedside evaluation and require unnecessary radiations and perilous transports
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