Assessment of Muscle Wasting in Long-Stay ICU Patients Using a New Ultrasound Protocol

Abstract

There is currently no standardized procedure to assess sarcopenia in long-stay catabolic patients. Our aim is to analyze a novel ultrasound muscle assessment protocol in these patients versus healthy controls, by carrying out a prospective observational study. We designed a new ultrasound protocol that assesses quadriceps rectus femoris (QRF) muscle quality in real-time B-mode, color-Doppler, and M-mode ultrasound, and evaluates QRF intramuscular central tendon thickness, cross-sectional area, and muscle thickness in ultrasound B-mode. Logistic regression was performed as a multivariable analysis on 29 cases and 19 controls. The QRF muscle area and thickness were shown to significantly decrease (p ≤ 0.001), and the central tendon thickness significantly increased (p = 0.047) in cases versus controls. The QRF muscle echogenicity and angiogenic activity fasciculations, subcutaneous edema, and intramuscular fluid were also significantly different between the two groups (p < 0.001). The selected variables in the multivariate logit analysis were the muscle area (OR per cm2 = 0.07; 95% confidence interval (CI) = 0.012–0.41) and the central tendon thickness (OR per mm 1.887; 95% CI = 2.66–13.38).

Case report presentation of emerging seconder sarcopenia after sepsis attacks in intensive care unit

“…If patients with sarcopenia are orientated and cooperated enough related to age and disease status, muscle strength and physical performance can be evaluated. As in our patient, central nervous system disease and prolonged respiratory support without sedation and weakness can be considered as indicators of low muscle strength and low physical performance (5,13). Imaging methods used to measure muscle mass are ultrasound (US), MRI, CT, DXA, and BIA.…”

“…In addition, it may not be possible to prevent muscle loss due to increased catabolism in the first period. Although proper protein intake and exercise have been used successfully to treat weakness in older patients (primary sarcopenia), it is possible to fail in severe catabolic status as in our patient, even if standard treatment is applied in sarcopenia due to secondary conditions (5,13). Studies on sarcopenia in patients admitted to the ICU are lacking.…”

“…Therefore, secondary sarcopenia should be kept in mind for the patients who are cared in the ICU for a long-term period (11). If sarcopenia is overlooked, and not diagnosed and treated early in time, it is associated with increased morbidity and mortality (5,13).…”

“…Ultrasonography, DXA and BIA are easy techniques to use for the diagnosis (13). However, the CT and MRI, which are the gold standard methods to evaluate muscle mass ofpatients in ICU, are difficult to perform and expensive (5).However, it is thought that the patient should be evaluated with CT for a more accurate diagnosis of muscle mass (13). It has been shown that cross sectional muscle surface at the third L3 best reflects total skeletal muscle mass determined by CT or MRI.…”

Biomarkers in critical care nutrition

“…These include imaging modalities that can be performed at the bedside using portable technologies and include ultrasound evaluation of skeletal muscle thickness [100] or fat-free mass [101] and CT evaluation of paravertebral or limb fat to muscle ratio [56]. For instance, a well-designed ultrasound protocol allows clinicians to assess quantitative and qualitative changes in the skeletal muscle in mechanically ventilated patients [102]. The results of ongoing clinical trials evaluating the effect of protein nutrition and/or exercise on functional recovery in the critically ill are pending (e.g., EFFORT sub-study, NEXIS [27,103]).…”