Monitoring muscle mass using ultrasound: a key role in critical care

Ruijven, Isabel M. van; Stapel, Sandra N.; Molinger, Jeroen; Weijs, P.J.M.

doi:10.1097/mcc.0000000000000846

Cited by 15 publications

(13 citation statements)

References 22 publications

(24 reference statements)

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“…Moreover, this effect was independent of the type and severity of the disease and of the therapeutic measures taken in the intensive care unit in our cohort. While the number of patients is similar in both studies, the APACHE II Score 23.5 (95% CI, 21.9-25.2) was higher than in our analysis 17 [10][11][12][13][14][15][16][17][18][19][20]. Annetta et al observed a significant 45% decrease in rectus femoris cross-sectional area over a 20-day ICU stay in a cohort of 38 young trauma patients, meanwhile tibialis anterior CSA reduction of 22% was nonsignificant.…”

Section: Discussioncontrasting

confidence: 51%

“… 9 – 11 Assessment of the quadriceps muscle has been used extensively to assess muscle wasting with ultrasound in the critically ill. 12 The rectus femoris muscle is often used to evaluate muscle cross-sectional area as a surrogate for whole-body skeletal muscle. 13 , 14 Either the rectus femoris or quadriceps (sum of rectus femoris and vastus intermedius muscle thickness) is frequently measured for muscle thickness. Both CSA and thickness measurements have been shown to decline early during the course of critical illness and have been inconsistently associated with impairment of strength and physical function.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Different Ultrasound Methods to Assess Changes in Muscle Mass in Critically ill Patients

Fuest

Lanz

Schulz

et al. 2022

J Intensive Care Med

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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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Section: Discussioncontrasting

confidence: 51%

Section: Introductionmentioning

confidence: 99%

Comparison of Different Ultrasound Methods to Assess Changes in Muscle Mass in Critically ill Patients

Fuest

Lanz

Schulz

et al. 2022

J Intensive Care Med

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“…A recent meta-analysis suggests that a daily loss of about 2% can be estimated, whereby ultrasound is the most frequent used method to detect and monitor muscle degradation [ 66 ]. Hereby, surrogate parameters for the quantification of muscle mass are the muscle layer thickness (MLT) and the muscle CSA [ 67 ]. The MLT is usually determined in sonographic short axis as the maximum vertical diameter of muscle tissue within the muscle fascia.…”

Section: Current State Of Nmus In Icuawmentioning

confidence: 99%

Neuromuscular Ultrasound in Intensive Care Unit-Acquired Weakness: Current State and Future Directions

et al. 2023

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Intensive care unit-acquired weakness (ICUAW) is one of the most common causes of muscle atrophy and functional disability in critically ill intensive care patients. Clinical examination, manual muscle strength testing and monitoring are frequently hampered by sedation, delirium and cognitive impairment. Many different attempts have been made to evaluate alternative compliance-independent methods, such as muscle biopsies, nerve conduction studies, electromyography and serum biomarkers. However, they are invasive, time-consuming and often require special expertise to perform, making them vastly impractical for daily intensive care medicine. Ultrasound is a broadly accepted, non-invasive, bedside-accessible diagnostic tool and well established in various clinical applications. Hereby, neuromuscular ultrasound (NMUS), in particular, has been proven to be of significant diagnostic value in many different neuromuscular diseases. In ICUAW, NMUS has been shown to detect and monitor alterations of muscles and nerves, and might help to predict patient outcome. This narrative review is focused on the recent scientific literature investigating NMUS in ICUAW and highlights the current state and future opportunities of this promising diagnostic tool.

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“…Furthermore, there is a strong correlation between muscle strength and the CSA of the rectus femoris (RF) muscle. Studies conducted in ICU have shown that muscle mass can decrease rapidly, with a 10% decline in the RF' CSA within 7 days [ 80 ].…”

Section: Imagingmentioning

confidence: 99%

Early detection and assessment of intensive care unit-acquired weakness: a comprehensive review

Elkalawy,

Sekhar,

Abosena

2023

ACC

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Intensive care unit-acquired weakness (ICU-AW) is a serious complication in critically ill patients. Therefore, timely and accurate diagnosis and monitoring of ICU-AW are crucial for effectively preventing its associated morbidity and mortality. This article provides a comprehensive review of ICU-AW, focusing on the different methods used for its diagnosis and monitoring. Additionally, it highlights the role of bedside ultrasound in muscle assessment and early detection of ICU-AW. Furthermore, the article explores potential strategies for preventing ICU-AW. Healthcare providers who manage critically ill patients utilize diagnostic approaches such as physical exams, imaging, and assessment tools to identify ICU-AW. However, each method has its own limitations. The diagnosis of ICU-AW needs improvement due to the lack of a consensus on the appropriate approach for its detection. Nevertheless, bedside ultrasound has proven to be the most reliable and cost-effective tool for muscle assessment in the ICU. Combining the Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation (APACHE) II score assessment, and ultrasound can be a convenient approach for the early detection of ICU-AW. This approach can facilitate timely intervention and prevent catastrophic consequences. However, further studies are needed to strengthen the evidence.

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Monitoring muscle mass using ultrasound: a key role in critical care

Cited by 15 publications

References 22 publications

Comparison of Different Ultrasound Methods to Assess Changes in Muscle Mass in Critically ill Patients

Comparison of Different Ultrasound Methods to Assess Changes in Muscle Mass in Critically ill Patients

Neuromuscular Ultrasound in Intensive Care Unit-Acquired Weakness: Current State and Future Directions

Early detection and assessment of intensive care unit-acquired weakness: a comprehensive review

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