Low skeletal muscle area is a risk factor for mortality in mechanically ventilated critically ill patients

Weijs, P.J.M.; Looijaard, W.G.; Dekker, Ingeborg M.; Stapel, Sandra N.; Girbes, Armand R. J.; Straaten, Heleen M. Oudemans–van; Beishuizen, Albertus

doi:10.1186/cc13189

Cited by 328 publications

(352 citation statements)

References 31 publications

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“…Wasting was evidenced by a reduction in rectus femoris cross-sectional area measured by ultrasonography and decreased muscle protein synthesis and increased muscle protein breakdown measured by muscle biopsy. Low skeletal muscle mass, estimated by the crosssectional area of muscle on abdominal CT scan, a previously validated measure of sarcopenia in older adults (77), is independently associated with in-hospital mortality in older trauma ICU patients and adults receiving mechanical ventilation (78,79). These findings are consistent with prior studies in community-dwelling older adults showing low muscle mass increases the risk for subsequent disability and mortality (80)(81)(82).…”

Section: Biological Correlates Of Frailty In Critically Ill Adultssupporting

confidence: 82%

Frailty in Pulmonary and Critical Care Medicine

Singer

Lederer²,

Baldwin

2016

Annals ATS

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Conceptualized first in the field of geriatrics, frailty is a syndrome characterized by a generalized vulnerability to stressors resulting from an accumulation of physiologic deficits across multiple interrelated systems. This accumulation of deficits results in poorer functional status and disability. Frailty is a "state of risk" for subsequent disproportionate declines in health status following new exposure to a physiologic stressor. Two predominant models have emerged to operationalize the measurement of frailty. The phenotype model defines frailty as a distinct clinical syndrome that includes conceptual domains such as strength, activity, wasting, and mobility. The cumulative deficit model defines frailty by enumerating the number of age-related things wrong with a person. The biological pathways driving frailty include chronic systemic inflammation, sarcopenia, and neuroendocrine dysregulation, among others. In adults with chronic lung disease, frailty is independently associated with more frequent exacerbations of lung disease, all-cause hospitalization, declines in functional status, and all-cause mortality. In addition, frail adults who become critically ill are more likely develop chronic critical illness or severe disability and have higher in-hospital and long-term mortality rates. The evaluation of frailty appears to provide important prognostic information above and beyond routinely collected measures in adults with chronic lung disease and the critically ill. The study of frailty in these populations, however, requires multipronged efforts aimed at refining clinical assessments, understanding the mechanisms, and developing therapeutic interventions.Keywords: frailty; body composition; disability; health-related quality of life; mortality Correspondence and requests for reprints should be addressed to Jonathan P. Singer, M.D., M.S.,

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Section: Biological Correlates Of Frailty In Critically Ill Adultssupporting

confidence: 82%

Frailty in Pulmonary and Critical Care Medicine

Singer

Lederer²,

Baldwin

2016

Annals ATS

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“…Diminished contractility and loss in muscle mass may occur independently; and thus, ICU-AW and muscle atrophy should not be construed to be synonymous or interchangeable [27]. A recent retrospective study demonstrated that muscle mass at ICU admission was an independent predictor of mortality [28]. Lower admission muscle mass was also associated with increased disability and higher frequency of discharge to a nursing home [28].…”

Section: Discussionmentioning

confidence: 97%

Ultrasonography in the intensive care setting can be used to detect changes in the quality and quantity of muscle and is related to muscle strength and function

Parry¹,

El-Ansary²,

Cartwright³

et al. 2015

Journal of Critical Care

303

324

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“…Our study provides further support for this "obesity paradox," with greater BMI increasing the likelihood of functional recovery among older adults after a critical illness. Notably, a recent study found that when muscle area was accounted for, BMI was no longer associated with mortality, whereas low skeletal muscle mass was a strong independent predictor of mortality (51). This suggests that skeletal muscle mass may be the factor that is truly responsible for functional recovery after a critical illness.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Functional Recovery among Older Intensive Care Unit Survivors

Ferrante

Pisani

Murphy

et al. 2016

Am J Respir Crit Care Med

118

113

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Rationale: Most of the 1.4 million older adults who survive the intensive care unit (ICU) annually in the United States face increased disability, but little is known about those who achieve functional recovery.Objectives: Our objectives were twofold: to evaluate the incidence and time to recovery of premorbid function within 6 months of a critical illness and to identify independent predictors of functional recovery among older ICU survivors.Methods: Potential participants included 754 persons aged 70 years or older who were evaluated monthly in 13 functional activities (1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012). The analytic sample included 218 ICU admissions from 186 ICU survivors. Functional recovery was defined as returning to a disability count less than or equal to the pre-ICU disability count within 6 months. Twenty-one potential predictors were evaluated for their associations with recovery.Measurements and Main Results: Functional recovery was observed for 114 (52.3%) of the 218 admissions. In multivariable analysis, higher body mass index (hazard ratio [HR], 1.07; 95% confidence interval [CI], 1.03-1.12) and greater functional selfefficacy (HR, 1.05; 95% CI, 1.02-1.08), a measure of confidence in performing various activities, were associated with recovery, whereas pre-ICU impairment in hearing (HR, 0.38; 95% CI, 0.22-0.66) and vision (HR, 0.59; 95% CI, 0.37-0.95) were associated with a lack of recovery.Conclusions: Among older adults who survived an ICU admission with increased disability, pre-ICU hearing and vision impairment were strongly associated with poor functional recovery within 6 months, whereas higher body mass index and functional selfefficacy were associated with recovery. Future research is needed to evaluate whether interventions targeting these factors improve functional outcomes among older ICU survivors. The organizations funding this study had no role in the design or conduct of the study; in the collection, management, analysis, or interpretation of the data; or in the preparation, review, or approval of the manuscript.Author Contributions: Study concept and design: L.E.F. and T.M.G.; acquisition, analysis, or interpretation of data: all authors; drafting of the manuscript: L.E.F., T.E.M., and E.A.G.; critical revision of the manuscript for important intellectual content: L.E.F., T.M.G., M.A.P., and T.E.M.; statistical analysis: T.E.M. and E

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Low skeletal muscle area is a risk factor for mortality in mechanically ventilated critically ill patients

Cited by 328 publications

References 31 publications

Frailty in Pulmonary and Critical Care Medicine

Frailty in Pulmonary and Critical Care Medicine

Ultrasonography in the intensive care setting can be used to detect changes in the quality and quantity of muscle and is related to muscle strength and function

Factors Associated with Functional Recovery among Older Intensive Care Unit Survivors

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