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Chandrasekaran A, Pal D, Harne R, Patel SJ, Jagadeesh KN, Pachisia AV, Tyagi P, Brar K, Pattajoshi S, Patel PB, Zatakiya R, Govil D. Comparison between Effect of Indirect Calorimetry vs Weight-based Equation (25 kcal/kg/day)-guided Nutrition on Quadriceps Muscle Thickness as Assessed by Bedside Ultrasonography in Medical Intensive Care Unit Patients: A Randomized Clinical Trial. Indian J Crit Care Med 2024; 28:587-594. [PMID: 39130394 PMCID: PMC11310671 DOI: 10.5005/jp-journals-10071-24737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 05/04/2024] [Indexed: 08/13/2024] Open
Abstract
Aim and background Sarcopenia is a substantial contributor to intensive care unit (ICU)-acquired weakness and is associated with significant short- and long-term outcomes. It can, however, be mitigated by providing appropriate nutrition. Indirect calorimetry (IC) is believed to be the gold standard in determining caloric targets in the dynamic environment of critical illness. We conducted this study to compare the effect of IC vs weight-based (25 kcal/kg/day) feeding on quadriceps muscle thickness (QMT) by ultrasound in critically ill patients. Materials and methods A prospective study was conducted on 60 mechanically ventilated patients randomized to two groups [weight-based equation (WBE) group or the IC group] in medical ICU after obtaining institutional ethics committee approval, and fed accordingly. The right QMT measurement using ultrasound and caloric targets were documented on day 1, 3 and 7 and analyzed statistically. The IC readings were obtained from the metabolic cart E-COVX ModuleTM. Results The baseline demographics, APACHE-II, NUTRIC score, and SOFA scores on day 1, 3, and 7 were comparable between the two groups. The resting energy expenditure (REE) obtained in the IC group was significantly less than the WBE energy targets and the former were fed with significantly less calories. A significantly less percent reduction of QMT in the IC group compared with the WBE group was observed from day 1 to day 3, day 3 to day 7, and day 1 to day 7. Conclusion From our study, we conclude that IC-REE-based nutrition is associated with lesser reduction in QMT and lesser calories fed in critically ill mechanically ventilated patients compared from WBE. CTRI registration-CTRI/2023/01/049119. How to cite this article Chandrasekaran A, Pal D, Harne R, Patel SJ, Jagadeesh KN, Pachisia AV, et al. Comparison between Effect of Indirect Calorimetry vs Weight-based Equation (25 kcal/kg/day)-guided Nutrition on Quadriceps Muscle Thickness as Assessed by Bedside Ultrasonography in Medical Intensive Care Unit Patients: A Randomized Clinical Trial. Indian J Crit Care Med 2024;28(6):587-594.
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Affiliation(s)
- Aravind Chandrasekaran
- Department of Critical Care Medicine, K.K. Patel Super Specialty Hospital, Bhuj, Gujarat, India
| | - Divya Pal
- Institute of Critical Care and Anaesthesia, Medanta – The Medicity, Gurugram, Haryana, India
| | - Rahul Harne
- Institute of Critical Care and Anaesthesia, Medanta – The Medicity, Gurugram, Haryana, India
| | - Sweta J Patel
- Institute of Critical Care and Anaesthesia, Medanta – The Medicity, Gurugram, Haryana, India
| | - KN Jagadeesh
- Institute of Critical Care and Anaesthesia, Medanta – The Medicity, Gurugram, Haryana, India
| | - Anant V Pachisia
- Institute of Critical Care and Anaesthesia, Medanta – The Medicity, Gurugram, Haryana, India
| | - Pooja Tyagi
- Institute of Critical Care and Anaesthesia, Medanta – The Medicity, Gurugram, Haryana, India
| | - Keerti Brar
- Institute of Critical Care and Anaesthesia, Medanta – The Medicity, Gurugram, Haryana, India
| | - Swagat Pattajoshi
- Institute of Critical Care and Anaesthesia, Medanta – The Medicity, Gurugram, Haryana, India
| | - Parimal B Patel
- Institute of Critical Care and Anaesthesia, Medanta – The Medicity, Gurugram, Haryana, India
| | - Ronak Zatakiya
- Institute of Critical Care and Anaesthesia, Medanta – The Medicity, Gurugram, Haryana, India
| | - Deepak Govil
- Institute of Critical Care and Anaesthesia, Medanta – The Medicity, Gurugram, Haryana, India
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de Gomes Figueiredo T, Frazão M, Werlang LA, Peltz M, Sobral Filho DC. Functional electrical stimulation cycling-based muscular evaluation method in mechanically ventilated patients. Artif Organs 2024; 48:254-262. [PMID: 37930042 DOI: 10.1111/aor.14677] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 09/22/2023] [Accepted: 10/11/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Intensive care acquired muscle weakness is a common feature in critically ill patients. Beyond the therapeutic uses, FES-cycling could represent a promising nonvolitional evaluation method for detecting acquired muscle weakness. OBJECTIVES To assess whether FES-cycling is able to identify muscle dysfunctions, and to evaluate the survival rate in patients with detected muscle dysfunction. METHODS A prospective observational study was carried out, with 29 critically ill patients and 20 healthy subjects. Maximum torque and power achieved were recorded, in addition to the stimulation cost, and patients were followed up for six months. RESULTS Torque (2.64 [1.53 to 4.81] vs 6.03 [4.56 to 6.73] Nm) and power (3.31 [2.33 to 6.37] vs 6.35 [5.22 to 10.70] watts) were lower and stimulation cost (22 915 [5069 to 37 750] vs 3411 [2080 to 4024] μC/W) was higher in patients compared to healthy people (p < 0.05). Surviving patients showed a nonsignificant difference in power and torque in relation to nonsurvivors (p > 0.05), but they had a lower stimulation cost (4462 [3598 to 11 788] vs 23 538 [10 164 to 39 836] μC/W) (p < 0.05). In total, 34% of all patients survived during the six months of follow-up. Furthermore, 62% of patients with a stimulation cost below 15 371 μC/W and 7% of patients with a stimulation cost above 15 371 μC/W survived. CONCLUSIONS FES-cycling has good sensitivity and specificity for detecting muscle disorders. Critical patients have low torque and power and a high stimulation cost. Stimulation cost is related to survival. A low stimulation cost was related to a 3 times greater chance of survival.
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Affiliation(s)
| | - Murillo Frazão
- Lauro Wanderley University Hospital, João Pessoa, Brazil
- CLINAR Exercise Physiology, João Pessoa, Brazil
| | | | - Maikel Peltz
- INBRAMED-Brazilian Medical Equipment Industry, Porto Alegre, Brazil
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Lima J, Foletto E, Cardoso RCB, Garbelotto C, Frenzel AP, Carneiro JU, Carpes LS, Barbosa-Silva TG, Gonzalez MC, Silva FM. Ultrasound for measurement of skeletal muscle mass quantity and muscle composition/architecture in critically ill patients: A scoping review on studies' aims, methods, and findings. Clin Nutr 2024; 43:95-110. [PMID: 38016244 DOI: 10.1016/j.clnu.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 10/24/2023] [Accepted: 11/06/2023] [Indexed: 11/30/2023]
Abstract
AIMS This scoping review aimed to identify, explore, and map the objectives, methodological aspects, and results of studies that used ultrasound (US) to assess skeletal muscle (SM) in critically ill patients. METHODS A scoping review was conducted according to the Joanna Briggs Institute's methodology. All studies that evaluated SM parameters from the US in patients admitted to the intensive care unit (ICU) were considered eligible. We categorized muscle thickness and cross-sectional area as parameters for assessing SM quantity, while echogenicity, fascicle length, and pennation angle analysis were used to evaluate muscle "quality" (composition/architecture). A literature search was conducted using four databases for articles published until December 2022. Independent reviewers selected the studies and extracted data. Descriptive statistics were calculated to present the results. RESULTS A total of 107 studies were included, the majority of which were prospective cohort studies (59.8 %) conducted in general ICUs (49.5 %). The most frequent objective of the studies was to evaluate SM quantity depletion during the ICU stay (25.2 %), followed by determining whether a specific intervention would modify SM (21.5 %). Most studies performed serial SM evaluations (76.1 %). The rectus femoris muscle thickness was evaluated in most studies (67.9 %), followed by the rectus femoris cross-sectional area (54.3 %) and the vastus intermedius muscle thickness (40.2 %). The studies demonstrated the feasibility and reproducibility of US for SM evaluation, especially related to quantitative parameters. Most studies (70.3 %) reported significant SM quantity depletion during hospitalization. However, the accuracy of the US in measuring SM varied across the studies. CONCLUSIONS The lack of detailed description and standardization in the protocols adopted by the studies included in this scoping review precludes the translation of the evidence related to US for SM assessment into clinical practice.
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Affiliation(s)
- Júlia Lima
- Nutrition Science Graduate Program, Federal University of Health Sciences of Porto Alegre, Porto Alegre Brazil
| | - Estéfani Foletto
- Nutrition Course, Department, Federal University of Health Sciences of Porto Alegre, Porto Alegre Brazil
| | - Rafaella C B Cardoso
- Nutrition Course, Department, Federal University of Health Sciences of Porto Alegre, Porto Alegre Brazil
| | - Charlles Garbelotto
- Nutrition Course, Department, Federal University of Health Sciences of Porto Alegre, Porto Alegre Brazil
| | - Aline P Frenzel
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas Brazil
| | - Juliana U Carneiro
- Multiprofessional Residency Program: Intensive Care. Federal University of Health Sciences of Porto Alegre, Porto Alegre Brazil
| | - Larissa S Carpes
- Santa Casa de Misericórdia de Porto Alegre Hospital, Porto Alegre Brazil
| | - Thiago G Barbosa-Silva
- Department of General Surgery, Faculty of Medicine, Federal University of Pelotas, Pelotas Brazil
| | | | - Flávia M Silva
- Nutrition Department and Nutrition Science Graduate Program. Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre Brazil.
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Rajagopal K, Vijayan D, Thomas SM. Association of SOFA Score with Severity of Muscle Wasting in Critically Ill Patients: A Prospective Observational Study. Indian J Crit Care Med 2023; 27:743-747. [PMID: 37908434 PMCID: PMC10613861 DOI: 10.5005/jp-journals-10071-24540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 08/21/2023] [Indexed: 11/02/2023] Open
Abstract
Background Muscle wasting is a frequent complication in critically ill patients. This study aimed to evaluate whether muscle wasting occurs in these patients and its association with the severity of the disease. Materials and methods This was a prospective, observational study including 50 patients admitted to the multidisciplinary ICU of a tertiary care hospital. Using a linear ultrasound probe, the thickness of the rectus femoris was measured on day 1 of admission and repeated at the same point on day 7. Sequential organ failure assessment (SOFA) scores were calculated daily during the study period. The highest SOFA score during this period was recorded. The mean difference in the thickness of the rectus femoris between day 1 and day 7 was used to predict the occurrence of muscle wasting and the correlation between this difference and the highest SOFA score was analyzed. Results The mean thickness of the rectus femoris on day 1 was 1.32 + 0.06 cm and on day 7 was 1.16 + 0.08 cm. The mean difference was found to be 0.16 cm (p < 0.01). There was a statistically significant difference in the thickness of the rectus femoris between day 1 and day 7. It was found to have a positive correlation with the highest SOFA score r = 0.886 (p < 0.01). Conclusion This study demonstrates that there is significant muscle wasting in critically ill patients and this positively correlates with the severity of illness. Our study also highlights the role of bedside ultrasound in detecting muscle wasting. How to cite this article Rajagopal K, Vijayan D, Thomas SM. Association of SOFA Score with Severity of Muscle Wasting in Critically Ill Patients: A Prospective Observational Study. Indian J Crit Care Med 2023;27(10):743-747.
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Affiliation(s)
- Kiran Rajagopal
- Department of Critical Care, Sree Gokulam Medical College & Research Foundation, Nellanad, Kerala, India
| | - Deepak Vijayan
- Department of Critical Care, KIMS HEALTH, Thiruvananthapuram, Kerala, India
| | - Sujith M Thomas
- Department of Critical Care, St. Gregorios Medical Mission Multi-specialty, Hospital, Parumala, Kerala, India
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Gürsoy C, Alkan A, Kaya Çubuk E, Karcı E, Yılmaz HO, Çakır T. Rectus abdominis and rectus femoris muscle thickness in determining nutritional risk in critically ill patients: a prospective cohort study in Turkey. BMJ Open 2023; 13:e071796. [PMID: 36997242 PMCID: PMC10069567 DOI: 10.1136/bmjopen-2023-071796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVES Malnutrition is a clinical condition that is frequently seen in critically ill patients in the intensive care unit (ICU). Although there are many scoring systems and tools used to determine nutritional risk, those that can be used in critically ill patients in the ICU are very few. The scoring systems used are insufficient to identify ICU patients with malnutrition or at risk.Malnutrition is generally presented with a decrease in skeletal muscle mass and muscle strength. Therefore, in many recent studies, attention has been drawn to the relationship between nutritional status and loss of muscle mass. DESIGN A cohort study. SETTING Forty-five patients hospitalised in an anaesthesia ICU in Turkey were included in the study. PARTICIPANTS Patients aged 18 years and older. INTERVENTIONS Demographic data of patients included in the study, and Nutritional Risk Screening 2002 (NRS-2002) and Modified Nutrition Risk in Critically ill (mNUTRIC) scores in the first 24 hours of ICU admission were noted. Rectus abdominis muscle (RAM) and rectus femoris muscle (RFM) thicknesses were measured by the same person (intensive care specialist) with ultrasonography (USG). OUTCOME MEASURES Finding a quantitative and practical evaluation method by determining the correlation of measurement of RAM and RFM thickness with USG with NRS-2002 and mNUTRIC score, which are scoring systems used to assess nutritional risk. RESULTS The performance of RAM and RFM thickness in determining nutritional status was evaluated by receiver operating characteristic (ROC) analysis. Area under the ROC curves were calculated as >0.7 for RFM and RAM measurements (p<0.05). Specificity and sensitivity percentages of RAM were found to be higher than RFM in determining nutritional status. CONCLUSION This study showed that RAM and RFM thickness measured by USG can be a reliable and easily applicable quantitative method that can be used to determine nutritional risk in the ICU.
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Affiliation(s)
- Canan Gürsoy
- Division of Intensive Care Medicine, Department of Anesthesiology and Reanimation, Muğla Sıtkı Koçman University, Mugla, Turkey
| | - Aslı Alkan
- Division of Intensive Care Medicine, Department of Anesthesiology and Reanimation, Muğla Sıtkı Koçman University, Mugla, Turkey
| | - Emine Kaya Çubuk
- Division of Intensive Care Medicine, Department of Anesthesiology and Reanimation, Muğla Sıtkı Koçman University, Mugla, Turkey
| | - Efsane Karcı
- Department of Anesthesiology and Reanimation, Muğla Sıtkı Koçman University, Mugla, Turkey
| | - Hüseyin Oğuz Yılmaz
- Department of Intensive Care Medicine, Muğla Training and Research Hospital, Mugla, Turkey
| | - Tümay Çakır
- Department of Intensive Care Medicine, Muğla Training and Research Hospital, Mugla, Turkey
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Hogenbirk RNM, Hentzen JEKR, van der Plas WY, Campmans-Kuijpers MJE, Kruijff S, Klaase JM. Surgery-Related Muscle Loss after Pancreatic Resection and Its Association with Postoperative Nutritional Intake. Cancers (Basel) 2023; 15:cancers15030969. [PMID: 36765926 PMCID: PMC9913550 DOI: 10.3390/cancers15030969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/28/2023] [Accepted: 02/01/2023] [Indexed: 02/05/2023] Open
Abstract
To study the occurrence of surgery-related muscle loss (SRML) and its association with in-hospital nutritional intake, we conducted a prospective observational cohort study including patients who underwent pancreatic surgery because of (suspected) malignant diseases. Muscle diameter was measured by using bedside ultrasound 1 day prior to surgery and 7 days postoperatively. Clinically relevant SRML was defined as ≥10% muscle diameter loss in minimally one arm and leg muscle within 1 week after surgery. Protein and caloric intake was measured by nutritional diaries. The primary endpoint included the number of patients with SRML. Secondary endpoints included the association between SRML and postoperative nutritional intake. Of the 63 included patients (60.3% men; age 67.1 ± 10.2 years), a total of 24 patients (38.1%) showed SRML. No differences were observed in severe complication rate or length of hospital stay between patients with and without SRML. During the first postoperative week, patients with clinically relevant SRML experienced more days without any nutritional intake compared with the non-SRML group (1 [0-4] versus 0 [0-1] days, p = 0.007). Significantly lower nutritional intake was found in the SRML group at postoperative days 2, 3 and 5 (p < 0.05). Since this study shows that SRML occurred in 38.1% of the patients and most of the patients failed to reach internationally set nutritional goals, it is suggested that more awareness concerning direct postoperative nutritional intake is needed in our surgical community.
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Affiliation(s)
- Rianne N. M. Hogenbirk
- Department of Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
- Correspondence:
| | - Judith E. K. R. Hentzen
- Department of Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Willemijn Y. van der Plas
- Department of Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
- Department of Surgery, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands
| | - Marjo J. E. Campmans-Kuijpers
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Schelto Kruijff
- Department of Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Joost M. Klaase
- Department of Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
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Fazzini B, Märkl T, Costas C, Blobner M, Schaller SJ, Prowle J, Puthucheary Z, Wackerhage H. The rate and assessment of muscle wasting during critical illness: a systematic review and meta-analysis. Crit Care 2023; 27:2. [PMID: 36597123 PMCID: PMC9808763 DOI: 10.1186/s13054-022-04253-0] [Citation(s) in RCA: 73] [Impact Index Per Article: 73.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/23/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Patients with critical illness can lose more than 15% of muscle mass in one week, and this can have long-term detrimental effects. However, there is currently no synthesis of the data of intensive care unit (ICU) muscle wasting studies, so the true mean rate of muscle loss across all studies is unknown. The aim of this project was therefore to systematically synthetise data on the rate of muscle loss and to identify the methods used to measure muscle size and to synthetise data on the prevalence of ICU-acquired weakness in critically ill patients. METHODS We conducted a systematic literature search of MEDLINE, PubMed, AMED, BNI, CINAHL, and EMCARE until January 2022 (International Prospective Register of Systematic Reviews [PROSPERO] registration: CRD420222989540. We included studies with at least 20 adult critically ill patients where the investigators measured a muscle mass-related variable at two time points during the ICU stay. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and assessed the study quality using the Newcastle-Ottawa Scale. RESULTS Fifty-two studies that included 3251 patients fulfilled the selection criteria. These studies investigated the rate of muscle wasting in 1773 (55%) patients and assessed ICU-acquired muscle weakness in 1478 (45%) patients. The methods used to assess muscle mass were ultrasound in 85% (n = 28/33) of the studies and computed tomography in the rest 15% (n = 5/33). During the first week of critical illness, patients lost every day -1.75% (95% CI -2.05, -1.45) of their rectus femoris thickness or -2.10% (95% CI -3.17, -1.02) of rectus femoris cross-sectional area. The overall prevalence of ICU-acquired weakness was 48% (95% CI 39%, 56%). CONCLUSION On average, critically ill patients lose nearly 2% of skeletal muscle per day during the first week of ICU admission.
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Affiliation(s)
- Brigitta Fazzini
- Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, London, UK.
| | - Tobias Märkl
- Exercise Biology Group, Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany
| | - Christos Costas
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Manfred Blobner
- Technical University of Munich, School of Medicine, Department of Anesthesiology and Intensive Care, Munich, Germany
- Charité - Universitätsmedizin Berlin, Department of Anesthesiology an Operative Intensive Care Medicine (CVK, CCM), Berlin, Germany
- Department of Anesthesiology and Operative Intensive Care Medicine (CVK, CCM), Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Stefan J Schaller
- Technical University of Munich, School of Medicine, Department of Anesthesiology and Intensive Care, Munich, Germany
- Charité - Universitätsmedizin Berlin, Department of Anesthesiology an Operative Intensive Care Medicine (CVK, CCM), Berlin, Germany
| | - John Prowle
- Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, London, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Zudin Puthucheary
- Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, London, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Henning Wackerhage
- Exercise Biology Group, Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany.
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Mendes JNDS, Rodrigues IG, Arcoverde GMPF, Floro CCP, Fortunato WSL, Lima RMDS, Pinho CPS. Evaluation of muscle loss by ultrasonography in critically ill patients. Nutr Clin Pract 2022; 38:664-671. [PMID: 36566358 DOI: 10.1002/ncp.10945] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/10/2022] [Accepted: 11/26/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Critically ill patients have intense muscle tissue mobilization, and attenuating protein catabolism may contribute to improved outcomes. OBJECTIVE To evaluate short-term muscle loss in critically ill patients. METHODS In this prospective observational study, we evaluated the thickness of the rectus femoris muscle by ultrasonography in young and older adults of both sexes admitted to a cardiological intensive care unit within 48 h of admission (baseline) and after 7 days. The results were compared and correlated with anthropometric, clinical, and biochemical parameters. The significance level for all statistical analyses was 0.05. RESULTS The final sample comprised 88 patients with a mean age of 66.2 ± 11.8 years. There was an average 13.5% reduction in rectus femoris muscle thickness over the study period (P < 0.001), regardless of the thigh circumference maintenance (P = 0.229). This reduction occurred even with improved clinical parameters (C-reactive protein, Simplified Acute Physiology Score) and was greater in patients receiving mechanical ventilation and sedation and in those who died. Regarding nutrition status, malnourished and eutrophic individuals showed greater muscle loss than overweight individuals. There was also an inverse correlation of muscle loss (percentage) with body mass index, arm circumference, and calf circumference (P < 0.05), demonstrating that the lower these anthropometric measurements, the higher the muscle loss obtained by ultrasound. CONCLUSION Ultrasonography assessment detected muscle mass loss in the short-term more sensitively than the anthropometric method. However, it demands caution and further studies demonstrating this analysis.
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Affiliation(s)
| | - Isa Galvão Rodrigues
- Pronto Socorro Cardiológico Universitário de Pernambuco, Departamento de Nutrição, Universidade de Pernambuco, Recife, Brazil
| | | | - Caio Cesar Pereira Floro
- Escola Superior de Educação Fìsica-ESEF, Programa de Pós Graduação, Universidade de Pernambuco, Recife, Brazil
| | - Wenize Suyane Lopes Fortunato
- Pronto Socorro Cardiológico Universitário de Pernambuco, Departamento de Nutrição, Universidade de Pernambuco, Recife, Brazil
| | - Roberta Maria da Silva Lima
- Pronto Socorro Cardiológico Universitário de Pernambuco, Departamento de Nutrição, Universidade de Pernambuco, Recife, Brazil
| | - Cláudia Porto Sabino Pinho
- Pronto Socorro Cardiológico Universitário de Pernambuco, Departamento de Nutrição, Universidade de Pernambuco, Recife, Brazil
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Hardy EJO, Inns TB, Hatt J, Doleman B, Bass JJ, Atherton PJ, Lund JN, Phillips BE. The time course of disuse muscle atrophy of the lower limb in health and disease. J Cachexia Sarcopenia Muscle 2022; 13:2616-2629. [PMID: 36104842 PMCID: PMC9745468 DOI: 10.1002/jcsm.13067] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 07/01/2022] [Accepted: 07/20/2022] [Indexed: 12/15/2022] Open
Abstract
Short, intermittent episodes of disuse muscle atrophy (DMA) may have negative impact on age related muscle loss. There is evidence of variability in rate of DMA between muscles and over the duration of immobilization. As yet, this is poorly characterized. This review aims to establish and compare the time-course of DMA in immobilized human lower limb muscles in both healthy and critically ill individuals, exploring evidence for an acute phase of DMA and differential rates of atrophy between and muscle groups. MEDLINE, Embase, CINHAL and CENTRAL databases were searched from inception to April 2021 for any study of human lower limb immobilization reporting muscle volume, cross-sectional area (CSA), architecture or lean leg mass over multiple post-immobilization timepoints. Risk of bias was assessed using ROBINS-I. Where possible meta-analysis was performed using a DerSimonian and Laird random effects model with effect sizes reported as mean differences (MD) with 95% confidence intervals (95% CI) at various time-points and a narrative review when meta-analysis was not possible. Twenty-nine studies were included, 12 in healthy volunteers (total n = 140), 18 in patients on an Intensive Therapy Unit (ITU) (total n = 516) and 3 in patients with ankle fracture (total n = 39). The majority of included studies are at moderate risk of bias. Rate of quadriceps atrophy over the first 14 days was significantly greater in the ITU patients (MD -1.01 95% CI -1.32, -0.69), than healthy cohorts (MD -0.12 95% CI -0.49, 0.24) (P < 0.001). Rates of atrophy appeared to vary between muscle groups (greatest in triceps surae (-11.2% day 28), followed by quadriceps (-9.2% day 28), then hamstrings (-6.5% day 28), then foot dorsiflexors (-3.2% day 28)). Rates of atrophy appear to decrease over time in healthy quadriceps (-6.5% day 14 vs. -9.1% day 28) and triceps surae (-7.8% day 14 vs. -11.2% day 28), and ITU quadriceps (-13.2% day 7 vs. -28.2% day 14). There appears to be variability in the rate of DMA between muscle groups, and more rapid atrophy during the earliest period of immobilization, indicating different mechanisms being dominant at different timepoints. Rates of atrophy are greater amongst critically unwell patients. Overall evidence is limited, and existing data has wide variability in the measures reported. Further work is required to fully characterize the time course of DMA in both health and disease.
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Affiliation(s)
- Edward J O Hardy
- Department of General Surgery, Royal Derby Hospital, Derby, UK.,Centre Of Metabolism, Ageing and Physiology (COMAP), School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, UK
| | - Thomas B Inns
- Centre Of Metabolism, Ageing and Physiology (COMAP), School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, UK.,MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research (CMAR) and NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Jacob Hatt
- Department of General Surgery, Royal Derby Hospital, Derby, UK.,Centre Of Metabolism, Ageing and Physiology (COMAP), School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, UK
| | - Brett Doleman
- Centre Of Metabolism, Ageing and Physiology (COMAP), School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, UK.,Department of Anaesthetics, Royal Derby Hospital, Derby, UK
| | - Joseph J Bass
- Centre Of Metabolism, Ageing and Physiology (COMAP), School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, UK.,MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research (CMAR) and NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Philip J Atherton
- Centre Of Metabolism, Ageing and Physiology (COMAP), School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, UK.,MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research (CMAR) and NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Jonathan N Lund
- Department of General Surgery, Royal Derby Hospital, Derby, UK.,Centre Of Metabolism, Ageing and Physiology (COMAP), School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, UK
| | - Bethan E Phillips
- Centre Of Metabolism, Ageing and Physiology (COMAP), School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, UK.,MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research (CMAR) and NIHR Nottingham Biomedical Research Centre, Nottingham, UK
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10
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Fuest KE, Lanz H, Schulz J, Ulm B, Bennett VA, Grunow JJ, Weiss B, Blobner M, Schaller SJ. Comparison of Different Ultrasound Methods to Assess Changes in Muscle Mass in Critically ill Patients. J Intensive Care Med 2022; 38:431-439. [PMID: 36227022 PMCID: PMC10154988 DOI: 10.1177/08850666221132246] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Muscle ultrasound represents a promising approach to aid diagnoses of neuromuscular diseases in critically ill patients. Unfortunately, standardization of ultrasound measurements in clinical research is lacking, making direct comparisons between studies difficult. Protocols are required to assess qualitative muscle changes during an ICU stay in patients at high risk for the development of neuromuscular acquired weakness (ICUAW). METHODS We conducted a retrospective, observational analysis comprised of three prospective observational studies with the aim of diagnosing muscle changes by ultrasound measurement of the quadriceps muscle. Different protocols were used in each of the three studies. In total, 62 surgical, neurocritical care and trauma intensive care patients were serially assessed by different ultrasound protocols during the first week of critical illness. The relative change in ultrasound measurements was calculated for all possible locations, methods and sides. Comparison was obtained using mixed effect models with the location, the height and the side as influencing variables and patients as fixed effect. The relationship between variables and outcomes was assessed by multivariable regression analysis. RESULTS Ultrasound methods and measurement sites of the quadriceps muscles from all protocols were equally effective in detecting muscle changes. During the first week of an ICU stay, two groups were identified: patients with decreased muscle mass on ultrasound (n = 42) and a cohort with enlargement (n = 23). Hospital mortality was significantly increased in the cohort with muscle swelling (8 (19%) versus 12 (52%), p = .013). CONCLUSIONS Different approaches of ultrasound measurement during critical-illness are equally able to detect muscle changes. While some patients have a decrease in muscle mass, others show swelling, which may result in a reduced probability of surviving the hospital stay. Causative reasons for these results still remain unclear.
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Affiliation(s)
- Kristina E Fuest
- Technical University of Munich, 9184School of Medicine, Department of Anesthesiology and Intensive Care, Munich, Germany
| | - Hugo Lanz
- Technical University of Munich, 9184School of Medicine, Department of Anesthesiology and Intensive Care, Munich, Germany
| | - Jana Schulz
- Technical University of Munich, 9184School of Medicine, Department of Anesthesiology and Intensive Care, Munich, Germany
| | - Bernhard Ulm
- Technical University of Munich, 9184School of Medicine, Department of Anesthesiology and Intensive Care, Munich, Germany
| | - Victoria A Bennett
- Adult Critical Care Unit, 112001Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Julius J Grunow
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine, Berlin, Germany
| | - Björn Weiss
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine, Berlin, Germany
| | - Manfred Blobner
- Technical University of Munich, 9184School of Medicine, Department of Anesthesiology and Intensive Care, Munich, Germany.,Adult Critical Care Unit, 112001Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Stefan J Schaller
- Technical University of Munich, 9184School of Medicine, Department of Anesthesiology and Intensive Care, Munich, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine, Berlin, Germany
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11
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Pinto-Ramos J, Costa-Santos C, Costa F, Tavares H, Cabral J, Moreira T, Brito R, Barroso J, Sousa-Pinto B. Reliability of point-of-care ultrasound for measuring quadriceps femoris muscle thickness. Eur J Phys Rehabil Med 2022; 58:767-773. [PMID: 36052891 PMCID: PMC10019477 DOI: 10.23736/s1973-9087.22.07432-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Point-of-care ultrasound can be used to assess muscle thickness. However, its reliability has not been fully evaluated. AIM This study aimed to assess the intrarater and inter-rater reliability of point-of-care ultrasound for the estimation of quadriceps and rectus femoris thickness in patients from a rehabilitation setting. DESIGN This is a cross-sectional study. SETTING This study was conducted at the Department of Physical Medicine and Rehabilitation of a tertiary care hospital. POPULATION Twenty-nine inpatients consecutively selected after admission. METHODS Four observers, two trained and two untrained, used point-of-care ultrasound to measure quadriceps femoris and rectus femoris thickness. Each observer performed two measurements followed by a second set of two measurements three hours later. Intraclass correlation coefficients (ICC) were then calculated. RESULTS Both intrarater and inter-rater ICC were higher than 0.888 for both quadriceps and rectus femoris measurements. Reliability was highest when ICC were calculated based on the average of two measurements, with the intrarater ICC being of 0.956 (95% CI: 0.937-0.970) for rectus femoris and of 0.966 (95% CI: 0.951-0.976) for quadriceps femoris; and with the inter-rater ICC being of 0.919 (95% CI: 0.863-0.957) for rectus femoris and 0.945 (95% CI: 0.907- 0.971) for quadriceps femoris. Trained and untrained observers did not have significantly different ICC values. CONCLUSIONS These results suggest that point-of-care ultrasound is a reliable option to measure muscle thickness of knee extensors by the same or different observers. CLINICAL REHABILITATION IMPACT Measuring knee extensors thickness may aid to adequately modulate treatment choices in patients with disability. This study suggests that quadriceps and rectus femoris muscle thickness measured after a short training course, by either an experienced or inexperienced clinician, presents high reliability. Reliability can be increased if the average of two measurements is used. Besides being inexpensive and portable, point-of-care ultrasound is a reliable tool for measuring knee extensors' thickness, rendering it potentially adequate to be used in clinical practice.
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Affiliation(s)
- João Pinto-Ramos
- Department of Physical Medicine and Rehabilitation, São João University Hospital Center, Porto, Portugal - .,Center for Health Technologies and Services Research - CINTESIS, University of Porto, Porto, Portugal -
| | - Cristina Costa-Santos
- Center for Health Technologies and Services Research - CINTESIS, University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences - MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Frederico Costa
- Department of Physical Medicine and Rehabilitation, São João University Hospital Center, Porto, Portugal
| | - Helena Tavares
- Department of Physical Medicine and Rehabilitation, São João University Hospital Center, Porto, Portugal
| | - João Cabral
- Department of Physical Medicine and Rehabilitation, São João University Hospital Center, Porto, Portugal
| | - Tiago Moreira
- Department of Physical Medicine and Rehabilitation, São João University Hospital Center, Porto, Portugal
| | - Rui Brito
- Department of Physical Medicine and Rehabilitation, Centro Hospitalar do Porto, Porto, Portugal
| | - Joana Barroso
- Department of Physical Medicine and Rehabilitation, São João University Hospital Center, Porto, Portugal.,Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal.,Institute for Health Research and Innovation - i3s, University of Porto, Porto, Portugal.,Feinberg School of Medicine, Departments of Neuroscience and Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Bernardo Sousa-Pinto
- Center for Health Technologies and Services Research - CINTESIS, University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences - MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
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12
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Shaaban-Ali M, Momeni M, Denault A. Clinical and Technical Limitations of Cerebral and Somatic Near-Infrared Spectroscopy as an Oxygenation Monitor. J Cardiothorac Vasc Anesth 2020; 35:763-779. [PMID: 32709385 DOI: 10.1053/j.jvca.2020.04.054] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/12/2020] [Accepted: 04/29/2020] [Indexed: 12/11/2022]
Abstract
Cerebral and somatic near-infrared spectroscopy monitors are commonly used to detect tissue oxygenation in various circumstances. This form of monitoring is based on tissue infrared absorption and can be influenced by several physiological and non-physiological factors that can induce error in the interpretation. This narrative review explores those clinical and technical limitations and proposes solutions and alternatives in order to avoid some of those pitfalls.
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Affiliation(s)
- Mohamed Shaaban-Ali
- Department of Anesthesia, College of Medicine, Assiut University, Assiut, Egypt
| | - Mona Momeni
- Department of Acute Medicine, Section Cardiothoracic and Vascular Anesthesia, Cliniques Universitaires Saint Luc, UCLouvain, Brussels, Belgium
| | - André Denault
- Department of Anesthesia and Critical Care Medicine, Montreal Heart Institute, Université de Montréal, and Centre Hospitalier de l'Université de Montréal, Montreal, Canada.
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13
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Weinel LM, Summers MJ, Chapple LA. Ultrasonography to measure quadriceps muscle in critically ill patients: A literature review of reported methodologies. Anaesth Intensive Care 2019; 47:423-434. [DOI: 10.1177/0310057x19875152] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Muscle wasting in the intensive care unit (ICU) is common and may impair functional recovery. Ultrasonography (US) presents a modern solution to quantify skeletal muscle size and monitor muscle wasting. However, no standardised methodology for the conduct of ultrasound-derived quadriceps muscle layer thickness or cross-sectional area in this population exists. The aim of this study was to compare methodologies reported for the measurement of quadriceps muscle layer thickness (MLT) and cross-sectional area (CSA) using US in critically ill patients. Databases PubMed, Ovid, Embase, and CINAHL were searched for original research publications that reported US-derived quadriceps MLT and/or CSA conducted in critically ill adult patients. Data were extracted from eligible studies on parameters relating to US measurement including anatomical location, patient positioning, operator technique and image analysis. It was identified that there was a clear lack of reported detail and substantial differences in the reported methodology used for all parameters. A standardised protocol and minimum reporting standards for US-derived measurement of quadriceps muscle size in ICU is required to allow for consistent measurement techniques and hence interpretation of results.
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Affiliation(s)
- Luke M Weinel
- Department of Critical Care Services, Royal Adelaide Hospital, Adelaide, Australia
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia
| | - Matthew J Summers
- Department of Critical Care Services, Royal Adelaide Hospital, Adelaide, Australia
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia
| | - Lee-Anne Chapple
- Department of Critical Care Services, Royal Adelaide Hospital, Adelaide, Australia
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia
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14
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Castro J, Livino de Carvalho K, Silva PE, Fachin-Martins E, Babault N, Marqueti RDC, Durigan JLQ. Intra- and inter-rater reproducibility of ultrasound imaging of patellar and quadriceps tendons in critically ill patients. PLoS One 2019; 14:e0219057. [PMID: 31247020 PMCID: PMC6597100 DOI: 10.1371/journal.pone.0219057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 06/15/2019] [Indexed: 02/06/2023] Open
Abstract
Since the outset of body image reconstruction for diagnosis purposes, ultrasound has been used to investigate structural changes located in tendons. Ultrasound has clinical applications in the intensive care unit, but its utility for tendon imaging remains unknown. Thus, we aimed to determine intra- and inter-rater reproducibility of measures obtained by images generated through morphological tendon sonographic analysis recorded from critically ill patients. We designed a cross-sectional study to assess thickness, cross-sectional area, and echogenicity of patellar and quadriceps tendons in a convenience sample formed with 20 critically ill patients. Two independent raters (experienced and novice) recorded repeated measures, checking for agreement (Kappa statistics) and reliability (Intraclass coefficient Correlation-ICC and Bland-Altman). The quality of images acquired by the two independent raters substantially agreed (k = 0.571–1.000), regardless of the region on the patellar tendon or the studied tendon (patellar or quadriceps). Regardless of how much experience the rater had, their repeated records (intra-rater reliability) always demonstrated almost complete correlation, ICC ranging from 0.89 to 0.98 for both tendons in all outcomes. At the same way, the statistically significant inter-rater ICC ranging from 0.87 to 0.97. Both repeated measures by the raters (intra-rater) and the repeated single and double measures between the raters (inter-rater) presented a minimum measurement error constituting a predominant pattern of random variability. We conclude that ultrasound imaging acquisition performed by independent raters for tendon thickness, CSA, and echogenicity monitoring of critically ill patients are acceptable and are not influenced by rater experience.
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Affiliation(s)
- Joana Castro
- Graduate Program in Rehabilitation Sciences, University of Brasília (UnB), Ceilândia, Federal District, Brazil
- Institute of Strategic Health Management of the Federal District (IGESDF), Brasília, Brazil
- * E-mail:
| | - Karina Livino de Carvalho
- Graduate Program in Rehabilitation Sciences, University of Brasília (UnB), Ceilândia, Federal District, Brazil
| | - Paulo Eugênio Silva
- Institute of Strategic Health Management of the Federal District (IGESDF), Brasília, Brazil
- Graduate Program in Science and Technology in Health, University of Brasília (UnB), Ceilândia, Federal District, Brazil
| | - Emerson Fachin-Martins
- Graduate Program in Rehabilitation Sciences, University of Brasília (UnB), Ceilândia, Federal District, Brazil
- Graduate Program in Science and Technology in Health, University of Brasília (UnB), Ceilândia, Federal District, Brazil
| | - Nicolas Babault
- INSERM UMR1093-CAPS, Université Bourgogne Franche-Comté, UFR des Sciences du Sport, Dijon, France
| | - Rita de Cássia Marqueti
- Graduate Program in Rehabilitation Sciences, University of Brasília (UnB), Ceilândia, Federal District, Brazil
- Graduate Program in Science and Technology in Health, University of Brasília (UnB), Ceilândia, Federal District, Brazil
| | - João Luiz Quagliotti Durigan
- Graduate Program in Rehabilitation Sciences, University of Brasília (UnB), Ceilândia, Federal District, Brazil
- Graduate Program in Science and Technology in Health, University of Brasília (UnB), Ceilândia, Federal District, Brazil
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