Abstract
Background and aims: Critically ill patients with acute kidney injury (AKI) undergo major muscle wasting in the first few days of ICU stay. An important concern in this clinical setting is the lack of adequate tools for routine bedside evaluation of the skeletal muscle mass, both for the determination of nutritional status at admission, and for monitoring. In this regard, the present study aims to ascertain if ultrasound (US) is able to detect changes in quadriceps muscle thickness of critically ill patients with acute kidney injury (AKI) over short periods of time.Methods: This is a prospective observational study with a follow-up at 5 days. All adult patients with AKI hospitalized at the Renal ICU of the Parma University Hospital over 12 months, with a hospital stay before ICU admission no longer than 72 h, and with a planned ICU stay of at least 5 days, were eligible for the study. An experienced investigator assessed quadriceps rectus femoris and vastus intermedius thickness (QRFT and QVIT) at baseline and after 5 days of ICU stay.Results: We enrolled 30 patients with 74 ± 11 years of age and APACHE II score of 22 ± 5. Muscle thickness decreased by 15 ± 13% within the first 5 days of ICU stay (P < 0.001 for all sites as compared to ICU admission). Patients with more severe muscle loss had lower probability of being discharged home (OR: 0.04, 95%CI: 0.00–0.74; P = 0.031).Conclusions: In critically ill patients with AKI, bedside muscle US identifies patients with accelerated muscle wasting.
Highlights
Ill patients undergo major muscle wasting in the first few days of their ICU stay [1]
All adult patients with Acute Kidney Injury (AKI) hospitalized in the Renal ICU from 15/03/2017 to 15/03/2018, with a hospital stay before ICU admission no longer than 72 hours, and with a predictable ICU stay of at least 5 days were eligible for the study
Quadriceps rectus femoris thickness (QRFT) and quadriceps vastus intermedius thickness (QVIT) were measured at the midpoint (RF Prox; VI Prox) and at the border between the lower third and upper two-thirds (RF Dist; Prox Dist) between the anterior superior iliac spine (ASIS) and the upper pole of the patella
Summary
Ill patients undergo major muscle wasting in the first few days of their ICU stay [1]. Clinical consequences are represented by delayed functional recovery, difficult weaning from mechanical ventilation and increased mortality risk [1] In this clinical setting an important cause of concern is the lack of adequate tools for routine bedside evaluation of the skeletal muscle mass [2]. An important concern in this clinical setting is the lack of adequate tools for routine bedside evaluation of the skeletal muscle mass, both for the determination of nutritional status at admission, and for monitoring In this regard, the present study aims to ascertain if ultrasound (US) is able to detect changes in quadriceps muscle thickness of critically ill patients with acute kidney injury (AKI) over short periods of time
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