Monitoring of muscle mass in critically ill patients: comparison of ultrasound and two bioelectrical impedance analysis devices

Abstract

BackgroundSkeletal muscle atrophy commonly occurs in critically ill patients, and decreased muscle mass is associated with worse clinical outcomes. Muscle mass can be assessed using various tools, including ultrasound and bioelectrical impedance analysis (BIA). However, the effectiveness of muscle mass monitoring is unclear in critically ill patients. This study was conducted to compare ultrasound and BIA for the monitoring of muscle mass in critically ill patients.MethodsWe recruited adult patients who were expected to undergo mechanical ventilation for > 48 h and to remain in the intensive care unit (ICU) for > 5 days. On days 1, 3, 5, 7, and 10, muscle mass was evaluated using an ultrasound and two BIA devices (Bioscan: Malton International, England; Physion: Nippon Shooter, Japan). The influence of fluid balance was also evaluated between each measurement day.ResultsWe analyzed 93 images in 21 patients. The age of the patients was 69 (interquartile range, IQR, 59–74) years, with 16 men and 5 women. The length of ICU stay was 11 days (IQR, 9–25 days). The muscle mass, monitored by ultrasound, decreased progressively by 9.2% (95% confidence interval (CI), 5.9–12.5%), 12.7% (95% CI, 9.3–16.1%), 18.2% (95% CI, 14.7–21.6%), and 21.8% (95% CI, 17.9–25.7%) on days 3, 5, 7, and 10 (p < 0.01), respectively, with no influence of fluid balance (r = 0.04, p = 0.74). The muscle mass did not decrease significantly in both the BIA devices (Bioscan, p = 0.14; Physion, p = 0.60), and an influence of fluid balance was observed (Bioscan, r = 0.37, p < 0.01; Physion, r = 0.51, p < 0.01). The muscle mass assessment at one point between ultrasound and BIA was moderately correlated (Bioscan, r = 0.51, p < 0.01; Physion, r = 0.37, p < 0.01), but the change of muscle mass in the same patient did not correlate between these two devices (Bioscan, r = − 0.05, p = 0.69; Physion, r = 0.23, p = 0.07).ConclusionsUltrasound is suitable for sequential monitoring of muscle atrophy in critically ill patients. Monitoring by BIA should be carefully interpreted owing to the influence of fluid change.Trial registrationUMIN000031316. Retrospectively registered on 15 February 2018.

Upper limb muscle atrophy associated with in-hospital mortality and physical function impairments in mechanically ventilated critically ill adults: a two-center prospective observational study

“…Atrophy assessment will be clinically useful for functional impairment assessment because functional tests can be performed only in conscious patients despite its clinical utility [ 29 – 31 ]. In a previous report, ICU-AW can be assessed in less than half of critically ill patients [ 32 ], but ultrasonographic assessment is applicable in almost all patients [ 15 , 33 ].…”

“…Generous amounts of contact gel were applied to avoid muscle compression by the transducer. As described elsewhere [ 7 , 15 ], the transducer was placed perpendicular to the long axis of the limbs. We evaluated the cross-sectional area, which was measured by outlining the muscle area shown in the transverse plane ( Fig.…”

Early Initiation of Awake Veno-Venous Extracorporeal Membrane Oxygenation Can Attenuate Muscle Atrophy and Weakness in Acute Respiratory Distress Syndrome

“…conducted the measurement with previously reported intra- and inter-observer reproducibilities [ 8 , 9 ]. The Rectus femoris cross-sectional area was measured between the anterosuperior iliac spine and the proximal end of the patella [ 9 ]. Diaphragm thickness was also measured by the ultrasound from the zone of apposition [ 8 ].…”

Ultrasound Imaging as a Diagnostic Tool to Assess the Functional Status of Muscles after a Spinal Cord Injury

“…Modalities such as magnetic resonance imaging (Gorgey and Dudley 2007) and dual-energy X-ray absorptiometry (Giangregorio and McCartney 2006) have been reported to provide measurements of the changes that occur in muscles as the result of atrophy; however, because of cost and accessibility, these techniques are limited to research and are not often used in a clinical setting. Measurements of bioelectrical impedance can also be used to monitor muscle mass; however, these results should be interpreted with caution as they are influenced by fluid retention (Nakanishi et al 2019).…”