ULTRASOUND MONITORING OF MUSCLE MASS CHANGES FOR TARGETING OF NUTRITIONAL SUPPORT IN NEUROCRITICALLY ILL PATIENTS

Abstract

The main goal of this study was to identify a way to optimize nutritional support during ICU stay and obtain information about catabolic state through non-invasive and reliable methods as ultrasonography. We designed an observational case-series of 11 critically ill patients hospitalised at NEURO-ICU at IRCCS Bellaria Hospital - Bologna. The population studied shown uniform characteristics wich allowed comparison for muscle mass changes. Primary endpoint was to evaluate ultrasound sensitivity for monitoring muscle mass changes considering muscle layer thickness. Secondarly we compared ultrasonographic data and biomarkers of catabolism (sCr, nitrogen balance) in order to assess correlation between nutritional intakes (calories and protein) and changes in muscle during monitoring range of time. According to statistical index (CV<5%, ICC and Lin's Coefficient) the best reliable muscles for ultrasound monitoring resulted Rectus Femoris (RF), Vastus Intermedius (VI) and Tibialis Anterior (TA). The most statistically relevant (p<0.05) reduction of muscle layer thickness happened between Day1 and Day14 for Right VI, Right and Left TA. Significant correlation between APACHE II scored within first 24 hours of ICU admission emerged with muscle layer thickness at baseline (Day1). Muscle ultrasound resulted as a feasible method for assessing muscle changes during acute phase of critical illness. Correlation between muscle layer thickness and APACHEscore at ICU admission could represent a role of muscle mass in the prognostic response to critical illness.