The role of maximum compressed thickness of the quadriceps femoris muscle measured by ultrasonography in assessing nutritional risk in critically-ill patients with different volume statuses

Abstract

SUMMARY PURPOSE In this prospective observational study, we aimed to investigate the role of the maximum compressed (MC) and uncompressed (UC) thickness of the quadriceps femoris muscle (QFMT) measured by ultrasonography (USG) in the detection of nutritional risk in intensive care patients (ICPs) with different volume status. METHODS 55 patients were included. Right, left, and total ucQFMT and mcQFMT measurements were obtained by a standard USG device within the first 48 hours after ICU admission. Clinical examination and the USG device were used to determine the volume status of the patients. SOFA, APACHE II, modified NUTRIC scores, and demographic data were collected. RESULTS There was a significant difference between the nutritional risk of patients in terms of left, right, and total mcQFMT measurements (p=0.025, p=0.039; p=0.028, respectively), mechanical ventilation requirement (p=0.014), presence of infection (p=0.019), and sepsis (p=0.006). There was no significant difference between different volume statuses in terms of mcQFMT measurements. In the multi-variance analysis, mcQFMT measurements were found to be independently associated with high nutritional risk (p=0.019, Exp(B)=0.256, 95%CI=0.082-0.800 for modified NUTRIC score ≥ 5), and higher nutritional risk (p=0.009, Exp(B)=0.144, 95%CI=0.033-0.620 for modified NUTRIC score ≥ 6). a Total mcQFMT value below 1.36 cm was a predictor for higher nutritional risk with 79% sensitivity and 70% specificity (AUC=0.749, p=0.002, likelihood ratio=2.04). CONCLUSION Ultrasonographic measurement of total mcQFMT can be used as a novel nutritional risk assessment parameter in medical ICPs with different volume statuses. Thus, patients who could benefit from aggressive nutritional therapy can be easily identified in these patient groups.

Evaluation of muscle loss by ultrasonography in critically ill patients

“…Authors point out that a reduction in these anthropometric parameters is directly associated with muscle hypotrophy, frailty, decreased physical performance, immobility, and sedentarism. 25,26 We also found that the percentage loss of TC, along with AC and CC, was considerably lower than the RFMT loss by the US, a result similarly verified by Rodrigues et al (2019). It reveals the low sensitivity of these anthropometric parameters in detecting muscle loss in the short-term compared with the ultrasound method, which can be used more successfully for this purpose.…”

“…27 Regarding nutrition status, patients with low weight and eutrophic diagnoses showed significant reductions in RFMT, which confirms recent studies demonstrating that nutrition status also influences muscle loss in the US. 13,26 This finding further suggests that being overweight may be considered a protective factor for muscle loss, as it was lower in this group. Even though the pathophysiology of oxidative stress in the patient with critical obesity is not quite understood, it is believed that endogenous fats become the main energy source and deflate more intensely than protein support, which is more insufficient in these 30 individuals.…”

The thickness of erector spinae muscles can be easily measured by computed tomography for the assessment of physical activity: An observational study

“…According to a past report, the thickness of the quadriceps femoris muscle measured by ultrasonography relates to nutritional risk measurements, such as the Modified Nutrition Risk in Critically Ill score, in intensive care. [ 33 ] The Modified Nutrition Risk in Critically Ill score is associated with mortality in critically ill patients. [ 39 ] Therefore, ESM T might be useful for severity evaluations in patients with several diseases, including NTM pulmonary diseases.…”

“…Conversely, ESM T can be simply measured in a short time for all patients who undergo chest CT scans. While ultrasound can also easily evaluate the CSAs and the thicknesses of various muscles, [10][11][12][13][32][33][34] pulmonary diseases are not usually examined with an ultrasound evaluation of the muscles; thus, ultrasound would be an additional examination. [17] Chest CT scans that include the erector spinae muscles are usually performed to aid in the diagnosis, evaluation, and/or exclusion of pulmonary diseases.…”

Point-of-Care Ultrasound (POCUS) in the Field of Diabetology

“…The probe is positioned at half of the distance between the greater trochanter and the interarticular line of the knee, transversally to the muscle for measuring the thickness and cross-sectional area, and longitudinally for measuring the pennation angle (PA) in patients in prone position. Chiaramonte et al [65] have shown the accuracy, precision, and repeatability of US in assessing the muscle architecture between physiatrists, radiologists, and general internists, and the quadriceps femoris muscle thickness assessed by US is already used as a parameter for assessing the nutritional risk that is more accurate than serum levels of prealbumin, albumin, or transferrin that may vary with the intravascular volume excess, infection, and inflammation [66].…”