Abstract
Background: Intensive care patients commonly develop muscle wasting and functional impairment. However, the role of severe COVID-19 in the magnitude of muscle wasting and functionality in the acute critical disease is unknown.Objective: To perform a prospective characterization to evaluate the skeletal muscle mass and functional performance in intensive care patients with severe COVID-19.Methods: Thirty-two critically ill patients (93.8% male; age: 64.1 ± 12.6 years) with the diagnosis of the severe COVID-19 were prospectively recruited within 24 to 72 h following intensive care unit (ICU) admission, from April 2020 to October 2020, at Hospital Sírio-Libanês in Brazil. Patients were recruited if older than 18 years old, diagnosis of severe COVID-19 confirmed by RT-PCR, ICU stay and absence of limb amputation. Muscle wasting was determined through an ultrasound measurement of the rectus femoris cross-sectional area, the thickness of the anterior compartment of the quadriceps muscle (rectus femoris and vastus intermedius), and echogenicity. The peripheral muscle strength was assessed with a handgrip test. The functionality parameter was determined through the ICU mobility scale (IMS) and the International Classification of Functioning, Disability and Health (ICF). All evaluations were performed on days 1 and 10.Results: There were significant reductions in the rectus femoris cross-section area (−30.1% [95% IC, −26.0% to −34.1%]; P < 0.05), thickness of the anterior compartment of the quadriceps muscle (−18.6% [95% IC, −14.6% to 22.5%]; P < 0.05) and handgrip strength (−22.3% [95% IC, 4.7% to 39.9%]; P < 0.05) from days 1 to 10. Patients showed increased mobility (0 [0–5] vs 4.5 [0–8]; P < 0.05), improvement in respiratory function (3 [3–3] vs 2 [1–3]; P < 0.05) and structure respiratory system (3 [3–3] vs 2 [1–3]; P < 0.05), but none of the patients returned to normal levels.Conclusion: In intensive care patients with severe COVID-19, muscle wasting and decreased muscle strength occurred early and rapidly during 10 days of ICU stay with improved mobility and respiratory functions, although they remained below normal levels. These findings may provide insights into skeletal muscle wasting and function in patients with severe COVID-19.
Highlights
The current outbreak of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) originated in the Hubei Province of the People’s Republic of China (World Health Organization [WHO], 2020)
Muscle loss may cause impairment of respiratory muscle strength, delaying of weaning from mechanical ventilation, prolonged intensive care unit (ICU) and hospital stay associated with reduced functional status, and eventually lead to a loss of independence and quality of life (Batt et al, 2017)
The intubation and invasive mechanical ventilation are indicated for patients with a need for FiO2 > 70%, tidal volume (TV) ≥ 9 mL/kg, dependence on ventilatory support and organ dysfunction
Summary
The current outbreak of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) originated in the Hubei Province of the People’s Republic of China (World Health Organization [WHO], 2020). Survivors among critically ill ICU patients commonly develop severe muscle wasting and impaired muscle function (Iwashyna et al, 2010; Herridge et al, 2011, 2016). Muscle loss may cause impairment of respiratory muscle strength, delaying of weaning from mechanical ventilation, prolonged ICU and hospital stay associated with reduced functional status, and eventually lead to a loss of independence and quality of life (Batt et al, 2017). We sought to prospectively characterize and evaluate the time course and magnitude of acute muscle loss in critical illness and determine the role of those alterations in the functional capacity. Intensive care patients commonly develop muscle wasting and functional impairment. The role of severe COVID-19 in the magnitude of muscle wasting and functionality in the acute critical disease is unknown
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