Muscle wasting in intensive care patients: Ultrasound observation of the M. quadriceps femoris muscle layer

Gruther, Wolfgang; Benesch, Thomas; Zorn, Carina; Paternostro-Sluga, Tatjana; Quittan, Michael; Fialka‐Moser, Veronika; Spiss, Christian K.; Kainberger, Franz; Crevenna, Richard

doi:10.2340/16501977-0139

Cited by 317 publications

(310 citation statements)

References 29 publications

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“…We demonstrated that a previously developed four‐site protocol14 provided stronger correlations with lean tissue mass when using minimal compression ( R 2 = 0.82), compared with maximal compression ( R 2 = 0.66), at the same site‐specific landmarks using DXA. While the four‐site protocol is strongly associated with appendicular lean tissue mass ( R 2 = 0.72), we observed wide limits of agreement (−5.67, 5.67 kg).…”

Section: Discussionmentioning

confidence: 88%

“…Participants underwent anthropometric measures, a whole‐body DXA scan and ultrasound assessments, in a supine or prone position, using the previously established nine‐site 12 and four‐site 14 protocols. A subset ( n = 16) of participants had inter‐rater reliability performed by using the four‐site protocol for a single leg (alternating between dominant and non‐dominant legs).…”

Section: Participants and Methodsmentioning

confidence: 99%

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Development of a bedside viable ultrasound protocol to quantify appendicular lean tissue mass

Paris

Lafleur

Dubin

et al. 2017

J cachexia sarcopenia muscle

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BackgroundUltrasound is a non‐invasive and readily available tool that can be prospectively applied at the bedside to assess muscle mass in clinical settings. The four‐site protocol, which images two anatomical sites on each quadriceps, may be a viable bedside method, but its ability to predict musculature has not been compared against whole‐body reference methods. Our primary objectives were to (i) compare the four‐site protocol's ability to predict appendicular lean tissue mass from dual‐energy X‐ray absorptiometry; (ii) optimize the predictability of the four‐site protocol with additional anatomical muscle thicknesses and easily obtained covariates; and (iii) assess the ability of the optimized protocol to identify individuals with low lean tissue mass.MethodsThis observational cross‐sectional study recruited 96 university and community dwelling adults. Participants underwent ultrasound scans for assessment of muscle thickness and whole‐body dual‐energy X‐ray absorptiometry scans for assessment of appendicular lean tissue. Ultrasound protocols included (i) the nine‐site protocol, which images nine anterior and posterior muscle groups in supine and prone positions, and (ii) the four‐site protocol, which images two anterior sites on each quadriceps muscle group in a supine position.ResultsThe four‐site protocol was strongly associated (R 2 = 0.72) with appendicular lean tissue mass, but Bland–Altman analysis displayed wide limits of agreement (−5.67, 5.67 kg). Incorporating the anterior upper arm muscle thickness, and covariates age and sex, alongside the four‐site protocol, improved the association (R 2 = 0.91) with appendicular lean tissue and displayed narrower limits of agreement (−3.18, 3.18 kg). The optimized protocol demonstrated a strong ability to identify low lean tissue mass (area under the curve = 0.89).ConclusionsThe four‐site protocol can be improved with the addition of the anterior upper arm muscle thickness, sex, and age when predicting appendicular lean tissue mass. This optimized protocol can accurately identify low lean tissue mass, while still being easily applied at the bedside.

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Section: Discussionmentioning

confidence: 88%

Section: Participants and Methodsmentioning

confidence: 99%

Development of a bedside viable ultrasound protocol to quantify appendicular lean tissue mass

Paris

Lafleur

Dubin

et al. 2017

J cachexia sarcopenia muscle

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“…This negative effect on muscle mass has been reported previously [31,34]. Adequate muscle strength in the lower limbs, primarily in the abductor muscle, is required for satisfactory rehabilitation [35].…”

Section: Discussionmentioning

confidence: 94%

Rehabilitation following total hip arthroplasty evaluation over short follow-up time: Randomized clinical trial

Umpierres¹,

Ribeiro²,

Marchisio³

et al. 2014

J Rehabil Res Dev

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Abstract-Hip osteoarthritis (OA) is a degenerative disease, and total hip arthroplasty (THA) is one of the surgical procedures of choice to improve the OA patient's quality of life. Without a rehabilitation program, THA patients will develop functional limitations. A randomized double-blind trial was performed between July 2009 and October 2011 to compare over a short follow-up time two groups of patients who underwent THA for OA. The THA protocol (THAP) group received verbal instructions and physiotherapy exercise demonstrations, and the THA physiotherapy care protocol (THAPCP) group received the same verbal instructions and demonstrations associated with daily exercise practice guided by a physiotherapist. The outcomes that were assessed preoperatively and 15 d postoperatively in 106 patients were muscle strength force, goniometry, Medical Outcomes Study 36-Item Short Form Health Survey, and Merle d'Aubigné and Postel score. Higher muscle strength force scores and degrees in range of motion were found in the THAPCP group. Greater improvements were also observed for the THAPCP group than the THAP group in the Merle d'Aubigné and Postel score. At the end of the follow-up period, the intervention in the THAPCP group improved functional capacity, quality of life, mobility, muscle strength, goniometry, and pain. It appears to be a safe tool for accelerating recovery in THA patients.Clinical Trial Registration: ClinicalTrials.gov; NCT01491048, "Evaluation of functional rehabilitation in patients undergoing physiotherapy after total hip arthroplasty (arthrosis)"; https://clinicaltrials.gov/ct2/show/NCT01491048

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“…However, large improvements in GFR from baseline after critical illness would seem implausible, whereas large and sustained falls in creatinine generation have been shown in animal models of sepsis (14), patients with advanced CKD (15), and critically ill humans (16)(17)(18), with greatest decrease occurring in the sickest patients (16). Skeletal muscle is the major source of creatinine production, and critical illness is associated with profound loss of skeletal muscle protein (10,19,20), with muscle thickness steadily decreasing over time after ICU admission (10,21,22). Loss of muscle mass can persist long after hospital discharge (23).…”

Section: Study Findingsmentioning

confidence: 99%

Serum Creatinine Changes Associated with Critical Illness and Detection of Persistent Renal Dysfunction after AKI

Prowle

Kolic²,

Purdell-Lewis³

et al. 2014

Clinical Journal of the American Society of Nephrology

137

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Background and objectives AKI is a risk factor for development or worsening of CKD. However, diagnosis of renal dysfunction by serum creatinine could be confounded by loss of muscle mass and creatinine generation after critical illness.Design, setting, participants, & measurements A retrospective, single center analysis of serum in patients surviving to hospital discharge with an intensive care unit admission of 5 or more days between 2009 and 2011 was performed.Results In total, 700 cases were identified, with a 66% incidence of AKI. In 241 patients without AKI, creatinine was significantly lower (P,0.001) at hospital discharge than admission (median, 0.61 versus 0.88 mg/dl; median decrease, 33%). In 160 patients with known baseline, discharge creatinine was significantly lower than baseline in all patients except those patients with severe AKI (Kidney Disease Improving Global Outcomes category 3), who had no significant difference. In a multivariable regression model, median duration of hospitalization was associated with a predicted 30% decrease (95% confidence interval, 8% to 45%) in creatinine from baseline in the absence of AKI; after allowing for this effect, AKI was associated with a 29% (95% confidence interval, 10% to 51%) increase in predicted hospital discharge creatinine. Using a similar model to exclude the confounding effect of prolonged major illness on creatinine, 148 of 700 patients (95% confidence interval, 143 to 161) would have eGFR,60 ml/min per 1.73 m 2 at hospital discharge compared with only 63 of 700 patients using eGFR based on unadjusted hospital creatinine (a 135% increase in potential CKD diagnoses; P,0.001).Conclusion Critical illness is associated with significant falls in serum creatinine that persist to hospital discharge, potentially causing inaccurate assessment of renal function at discharge, particularly in survivors of AKI. Prospective measurements of GFR and creatinine generation are required to confirm the significance of these findings.

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Muscle wasting in intensive care patients: Ultrasound observation of the M. quadriceps femoris muscle layer

Cited by 317 publications

References 29 publications

Development of a bedside viable ultrasound protocol to quantify appendicular lean tissue mass

Development of a bedside viable ultrasound protocol to quantify appendicular lean tissue mass

Rehabilitation following total hip arthroplasty evaluation over short follow-up time: Randomized clinical trial

Serum Creatinine Changes Associated with Critical Illness and Detection of Persistent Renal Dysfunction after AKI

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