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Mayer KP, Kosmac K, Wen Y, Parry SM, Dhar S, Foster S, Starck J, Montgomery-Yates AA, Dupont-Versteegden EE, Kalema AG. Construct and criterion validity of muscle ultrasonography for assessment of skeletal muscle in patients recovering from COVID-19. Front Physiol 2023; 14:1231538. [PMID: 37936579 PMCID: PMC10625915 DOI: 10.3389/fphys.2023.1231538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/10/2023] [Indexed: 11/09/2023] Open
Abstract
Background: The purpose was to investigate the content, construct, and criterion validity of muscle ultrasound in a mixed cohort of participants recovering from mild and critical COVID-19. Methods: A secondary analysis of a prospective cross-sectional study was conducted on data obtained from a battery of muscle and physical function assessments including a muscle biopsy and muscle ultrasonography (US). Rectus femoris (RF) muscle thickness (mT), quadricep complex (QC) mT, RF muscle cross-sectional area (CSA) using 2D freeform trace and estimated from Feret's diameter, and RF echo intensity (EI) were assessed with US. Muscle fiber CSA, fiber type, protein content in muscle fibers, extracellular matrix content (ECM; wheat-germ agglutin), and percent area of collagen in ECM (picrosirius red) were examined from vastus lateralis muscle biopsies. Spearman rho correlations (r) were performed to assess validity of ultrasound parameters. Results: Thirty-three individuals participated including 11 patients surviving critical COVID-19, 15 individuals recovering from mild-COVID, and 7 controls. There were several significant correlations between RF mT, QC mT, RF CSA, and RF EI with age, comorbid burden, body-mass index, and measures of muscle strength, muscle power, and physical function (range r = 0.35-0.83). RF Feret's CSA correlated to CSA of type II muscle fibers (r = 0.41, p = 0.022) and the average size of all muscle fibers (r = 0.39, p = 0.031). RF EI was correlated with collagen in muscle ECM (r = 0.53, p = 0.003) and protein content in muscle tissue (r = -0.52, p = 0.012). Conclusion: Muscle size and quality measured using US has moderate content and construct validity, and to lesser extent, fair to moderate criterion validity in a mixed cohort of individuals recovering from COVID. Muscle ultrasound quality (EI) appears to be sensitive at detecting muscle dysfunction as it is associated with strength, power, physical function, and collagen distribution in a mixed group of individuals recovering from COVID-19.
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Affiliation(s)
- Kirby P. Mayer
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, KY, United States
- Center for Muscle Biology, University of Kentucky, Lexington, KY, United States
| | - Kate Kosmac
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, KY, United States
- Center for Muscle Biology, University of Kentucky, Lexington, KY, United States
| | - Yuan Wen
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, KY, United States
| | - Selina M. Parry
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Sanjay Dhar
- Division of Pulmonary, Critical Care, and Sleep Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Sarah Foster
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, KY, United States
| | - Jonathan Starck
- Department of Biology, College of Arts and Sciences, University of Kentucky, Lexington, KY, United States
| | - Ashley A. Montgomery-Yates
- Division of Pulmonary, Critical Care, and Sleep Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Esther E. Dupont-Versteegden
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, KY, United States
- Center for Muscle Biology, University of Kentucky, Lexington, KY, United States
| | - Anna G. Kalema
- Division of Pulmonary, Critical Care, and Sleep Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States
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Jubina LE, Locke A, Fedder KR, Slone SA, Soper MK, Kalema AG, Montgomery-Yates AA, Mayer KP. Nutrition in the intensive care unit and early recovery influence functional outcomes for survivors of critical illness: A prospective cohort study. JPEN J Parenter Enteral Nutr 2023; 47:888-895. [PMID: 37345259 DOI: 10.1002/jpen.2538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 05/26/2023] [Accepted: 06/20/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Patients who are critically ill may receive suboptimal nutrition that leads to weight loss and increased risk of functional deficits. METHODS Our overarching hypothesis is that nutrition in the intensive care unit (ICU) and the early recovery phase associates with functional outcomes at short-term follow-up. We enrolled adult patients who attended the University of Kentucky ICU recovery clinic (ICU-RC) from November 2021 to June 2022. Patients participated in muscle and functional assessments. Nutrition intake and status during the ICU stay were analyzed. The Subjective Global Assessment and a nutrition questionnaire were used to identify changes in intake, ongoing gastrointestinal symptoms, and patient's access to food at the ICU-RC appointment. RESULTS Forty-one patients enrolled with a median hospital length of stay (LOS) of 23 days. Patients with 0 days of nil per os (NPO) status throughout hospitalization had a shorter LOS (P = 0.05), were able to complete the five times sit-to-stand test (P = 0.02), and were less likely to experience ICU-acquired weakness (P = 0.04) at short-term follow-up compared with patients with ≥1 day of NPO status. Twenty (48%) patients reported changes in nutrition intake in early recovery compared with before hospitalization. Eight (20%) patients reported symptoms leading to decreased intake and four (10%) reported access to food as a barrier to intake. CONCLUSION Barriers to nutrition exist during critical illness and persist after discharge, with almost half of patients reporting a change in intake. Inpatient nutrition intake is associated with functional outcomes and warrants further exploration.
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Affiliation(s)
- Lindsey E Jubina
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, Kentucky, USA
| | - Alleyna Locke
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, Kentucky, USA
| | - Kelly R Fedder
- Department of Clinical Nutrition, University of Kentucky HealthCare, Lexington, Kentucky, USA
| | - Stacey A Slone
- Dr. Bing Zhang Department of Statistics, College of Arts & Sciences, University of Kentucky, Lexington, Kentucky, USA
| | - Melissa K Soper
- Division of Pulmonary, Critical Care and Sleep Medicine, Internal Medicine, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Anna G Kalema
- Division of Pulmonary, Critical Care and Sleep Medicine, Internal Medicine, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
- Kentucky Research Alliance for Lung Disease, Office of Research, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Ashley A Montgomery-Yates
- Division of Pulmonary, Critical Care and Sleep Medicine, Internal Medicine, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
- Kentucky Research Alliance for Lung Disease, Office of Research, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Kirby P Mayer
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, Kentucky, USA
- Kentucky Research Alliance for Lung Disease, Office of Research, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
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Sturgill JL, Mayer KP, Kalema AG, Dave K, Mora S, Kalantar A, Carter DJ, Montgomery-Yates AA, Morris PE. Post-intensive care syndrome and pulmonary fibrosis in patients surviving ARDS-pneumonia of COVID-19 and non-COVID-19 etiologies. Sci Rep 2023; 13:6554. [PMID: 37085548 PMCID: PMC10119831 DOI: 10.1038/s41598-023-32699-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 03/31/2023] [Indexed: 04/23/2023] Open
Abstract
The purpose was to examine patient-centered outcomes and the occurrence of lung fibrotic changes on Chest computed tomography (CT) imaging following pneumonia-related acute respiratory distress syndrome (ARDS). We sought to investigate outpatient clinic chest CT imaging in survivors of COVID19-related ARDS and non-COVID-related ARDS, to determine group differences and explore relationships between lung fibrotic changes and functional outcomes. A retrospective practice analysis of electronic health records at an ICU Recovery Clinic in a tertiary academic medical center was performed in adult patients surviving ARDS due to COVID-19 and non-COVID etiologies. Ninety-four patients with mean age 53 ± 13 and 51% male were included (n = 64 COVID-19 and n = 30 non-COVID groups). There were no differences for age, sex, hospital length of stay, ICU length of stay, mechanical ventilation duration, or sequential organ failure assessment (SOFA) scores between the two groups. Fibrotic changes visualized on CT imaging occurred in a higher proportion of COVID-19 survivors (70%) compared to the non-COVID group (43%, p < 0.001). Across both groups, patients with fibrotic changes (n = 58) were older, had a lower BMI, longer hospital and ICU LOS, lower mean RASS scores, longer total duration of supplemental oxygen. While not statistically different, patients with fibrotic changes did have reduced respiratory function, worse performance on the six-minute walk test, and had high occurrences of anxiety, depression, emotional distress, and mild cognitive impairment regardless of initial presenting diagnosis. Patients surviving pneumonia-ARDS are at high risk of impairments in physical, emotional, and cognitive health related to Post-Intensive Care Syndrome. Of clinical importance, pulmonary fibrotic changes on chest CT occurred in a higher proportion in COVID-ARDS group; however, no functional differences were measured in spirometry or physical assessments at ICU follow-up. Whether COVID infection imparts a unique recovery is not evident from these data but suggest that long-term follow up is necessary for all survivors of ARDS.
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Affiliation(s)
- Jamie L Sturgill
- Department of Microbiology, Immunology, and Molecular Genetics College of Medicine, University of Kentucky, Lexington, KY, USA
- Kentucky Research Alliance for Lung Disease, Lexington, KY, USA
| | - Kirby P Mayer
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, KY, USA
- Kentucky Research Alliance for Lung Disease, Lexington, KY, USA
| | - Anna G Kalema
- Division of Pulmonary, Critical Care, and Sleep Medicine College of Medicine, Department of Internal Medicine, University of Kentucky, 740 South Limestone Street, Lexington, KY, L54340536, USA.
- Kentucky Research Alliance for Lung Disease, Lexington, KY, USA.
| | - Kinjal Dave
- Division of Pulmonary, Critical Care, and Sleep Medicine College of Medicine, Department of Internal Medicine, University of Kentucky, 740 South Limestone Street, Lexington, KY, L54340536, USA
- Kentucky Research Alliance for Lung Disease, Lexington, KY, USA
| | - Stephanie Mora
- College of Pharmacy, University of Kentucky, Lexington, KY, USA
- Kentucky Research Alliance for Lung Disease, Lexington, KY, USA
| | - Alborz Kalantar
- Department of Microbiology, Immunology, and Molecular Genetics College of Medicine, University of Kentucky, Lexington, KY, USA
- Kentucky Research Alliance for Lung Disease, Lexington, KY, USA
| | - David J Carter
- Division of Pulmonary, Critical Care, and Sleep Medicine College of Medicine, Department of Internal Medicine, University of Kentucky, 740 South Limestone Street, Lexington, KY, L54340536, USA
- Kentucky Research Alliance for Lung Disease, Lexington, KY, USA
| | - Ashley A Montgomery-Yates
- Division of Pulmonary, Critical Care, and Sleep Medicine College of Medicine, Department of Internal Medicine, University of Kentucky, 740 South Limestone Street, Lexington, KY, L54340536, USA
- Kentucky Research Alliance for Lung Disease, Lexington, KY, USA
| | - Peter E Morris
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama Birmingham, Birmingham, AL, USA
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Morelli N, Johnson NF, Cassity EP, Kalema AG, Morris PE, Montgomery-Yates AA, Mayer KP. Feasibility of Contrasting Brain Connectivity Patterns in Cognitive and Motor Cerebral Networks to Clinical Outcomes in Patients Surviving Acute Respiratory Failure: A Pilot Study. Cureus 2021; 13:e17785. [PMID: 34659996 PMCID: PMC8495532 DOI: 10.7759/cureus.17785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND There is a paucity of research regarding the feasibility and association of cerebral cortex function to patient outcomes after acute respiratory failure (ARF). PURPOSE To determine the feasibility of functional connectivity measures and examine the association of functional connectivity to a multifaceted battery of outcomes in survivors of ARF. METHODS Eight ARF patients (age:58±3.7, ICU days:10.4±8.6) completed functional magnetic resonance imaging (fMRI), cognitive, physical-function, anxiety, depression, and driving simulator tests at one month post-hospital discharge. Pearson's correlations assessed the relationship between functional connectivity within the default mode network (FPN), sensorimotor network (SMN), and frontoparietal network (FPN) to outcomes. RESULTS Low physical-function (r=0.75, p=0.03) and divided-attention (r=-0.86, p=0.03) during the driving simulator task correlated with low FPN connectivity. Low SMN connectivity demonstrated relationships to slower gait speed (r=0.82, p=0.01) and low short physical performance battery (SPPB) scores (r=0.81, p=0.01). CONCLUSIONS fMRI is feasible to assess ARF patients' post-ICU limitations, as low post-ARF brain connectivity may be linked to low physical function, providing potential development of therapeutic interventions.
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Affiliation(s)
- Nathan Morelli
- Department of Physical Therapy, High Point University, High Point, USA
| | - Nathan F Johnson
- Department of Physical Therapy, University of Kentucky, Lexington, USA
| | - Evan P Cassity
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky College of Medicine, Lexington, USA
| | - Anna G Kalema
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky College of Medicine, Lexington, USA
| | - Peter E Morris
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky College of Medicine, Lexington, USA
| | - Ashley A Montgomery-Yates
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky College of Medicine, Lexington, USA
| | - Kirby P Mayer
- Department of Physical Therapy, University of Kentucky, Lexington, USA
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Mayer KP, Steele AK, Soper MK, Branton JD, Lusby ML, Kalema AG, Dupont-Versteegden EE, Montgomery AA. Physical Therapy Management of an Individual With Post-COVID Syndrome: A Case Report. Phys Ther 2021; 101:6177704. [PMID: 33735380 PMCID: PMC7989151 DOI: 10.1093/ptj/pzab098] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/07/2021] [Accepted: 03/10/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this case report is to provide the clinical presentation and physical therapist management for a patient with post-COVID syndrome. Secondarily, the report highlights the importance of assessing cognitive and emotional health in patients with post-COVID syndrome. METHODS (CASE DESCRIPTION) A 37-year-old woman tested positive for SARS-CoV-2 and developed mild COVID-19 disease but did not require supplemental oxygen or hospitalization. The patient experienced persistent symptoms, including dyspnea, headaches, and cognitive fog. On day 62, they participated in an outpatient physical therapist evaluation that revealed deficits in exercise capacity, obtaining 50% of their age-predicted 6-minute walk distance. They had minor reductions in muscle strength and cognitive function. Self-reported quality of life was 50, and they scored above established cut-off scores for provisional diagnosis of posttraumatic stress disorder (PTSD). RESULTS The patient participated in biweekly physical therapist sessions for 8 weeks, which included aerobic training, strengthening exercises, diaphragmatic breathing techniques, and mindfulness training. Metabolic equivalent for task levels increased with variability over the course of the program. The patient's muscle strength, physical function, and exercise capacity improved. 6-Minute walk distance increased by 199 m, equating to 80% of their age-predicted distance. Quality of life and PTSD scores did not improve. At evaluation after physical therapy, the patient was still experiencing migraines, dyspnea, fatigue, and cognitive dysfunction. CONCLUSION This case report described the clinical presentation and physical therapist management of a person with post-COVID syndrome, a novel health condition for which little evidence exists to guide rehabilitation examination and interventions. Physical therapists should consider cognitive function and emotional health in their plan of care for patients with post-COVID syndromes. IMPACT This case alerts physical therapists to post-COVID syndrome-which can include debilitating symptoms of decreased aerobic tolerance, anxiety, PTSD, and cognitive dysfunction-and to the role that therapists can play in assessing these symptoms and managing these patients.
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Affiliation(s)
- Kirby P Mayer
- Address all correspondence to Kirby P. Mayer, DPT, Ph.D. 900 S. Limestone, CTW 204D, Lexington, KY 40536,
| | - Angela K Steele
- Pulmonary Rehabilitation, Medicine Specialties Clinic, Therapeutic Services, University of Kentucky Healthcare
| | - Melissa K Soper
- Division of Pulmonary, Critical Care and Sleep Medicine, College of Medicine, University of Kentucky
| | - Jill D Branton
- Pulmonary Rehabilitation, Medicine Specialties Clinic, Therapeutic Services, University of Kentucky Healthcare
| | - Megan L Lusby
- Pulmonary Rehabilitation, Medicine Specialties Clinic, Therapeutic Services, University of Kentucky Healthcare
| | - Anna G Kalema
- Division of Pulmonary, Critical Care and Sleep Medicine, College of Medicine, University of Kentucky
| | | | - Ashley A Montgomery
- Division of Pulmonary, Critical Care and Sleep Medicine, College of Medicine, University of Kentucky
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