Peripheral muscular ultrasound as outcome assessment tool in critically ill patients on mechanical ventilation: An observational cohort study

Toledo, Diogo Oliveira; Freitas, Branca Jardini de; Dib, Rogério; Pfeilsticker, Flavia Julie do Amaral; Santos, Dyaiane Marques dos; Gomes, Brenno Cardoso; Silva-Jr, João Manoel

doi:10.1016/j.clnesp.2021.03.015

Cited by 26 publications

(40 citation statements)

References 28 publications

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“…However, it remains unclear whether it is the change in muscle mass from baseline or the total muscle mass at admission that is the most important factor associated with clinical outcomes 45 . In this observational study, the finding that clinical outcomes were not associated with muscle loss was unexpected, and these results conflicted with other published studies in heterogeneous critically ill patients 14,46 . Most patients (57.1%) in this study developed sepsis, which is known to directly affect clinical outcomes, so perhaps the confounding factors overwhelmed the contribution of muscle loss toward clinical outcomes.…”

Section: Discussioncontrasting

confidence: 64%

“…45 In this observational study, the finding that clinical outcomes were not associated with muscle loss was unexpected, and these results conflicted with other published studies in heterogeneous critically ill patients. 14,46 Most patients (57.1%) in this study developed sepsis, which is known to directly affect clinical outcomes, so perhaps the confounding factors overwhelmed the contribution of muscle loss toward clinical outcomes. Differences in ultrasound measurement protocol, such as patient position, tissue compression, and transducer location between studies, reduced the comparability of results.…”

Section: Discussionmentioning

confidence: 95%

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Association between skeletal muscle changes, anthropometric measurements, and clinical outcomes in critically ill trauma and surgical patients: A prospective observational study

et al. 2022

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Background: Acute skeletal muscle wasting may predict clinical outcomes in critically ill patients. This study aimed to assess acute muscle loss, changes in anthropometric measurements, and the relationship between muscle loss and clinical outcomes in critically ill trauma and surgical patients.Methods: This single-center, prospective observational study was conducted in critically ill trauma and surgical patients who were expected to stay in the intensive care unit (ICU) for at least 7 days. Rectus femoris cross-sectional area muscle measurements were performed by bedside ultrasound, and anthropometric measurements were obtained at baseline and 7 days after the first assessment. Length of mechanical ventilation, ICU and hospital stay, and mortality were recorded. Results: Thirty-five patients with a mean age of 49.6 ± 18.6 years and 74.1% male were enrolled. The rectus femoris cross-sectional area, mid-arm circumference, and calf circumference were reduced at second assessment from baseline (P < 0.05). In univariate analysis, muscle loss and changes in anthropometric measurements were not associated with 90-day mortality (P > 0.05). Conclusion:Muscle loss in critical trauma and surgical patients occurred rapidly during the first week of critical illness. Rectus femoris muscle crosssectional area assessment can be used to detect skeletal muscle changes in critically ill patients. Further investigations on the skeletal muscle changes and clinical outcomes need to be conducted.

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Section: Discussioncontrasting

confidence: 64%

Section: Discussionmentioning

confidence: 95%

Association between skeletal muscle changes, anthropometric measurements, and clinical outcomes in critically ill trauma and surgical patients: A prospective observational study

et al. 2022

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“…Twenty studies took serial measurements of the same muscle group to describe longitudinal changes in muscle mass. All 20 of these longitudinal studies found statistically significant changes in muscle measurements over time, which ranged from 15% to 30% reduction in muscle measurement between Day 0 (baseline) and Day 20 24,25,28,30,32,33,35–39,41,42,44,45,47,49,56–58 …”

Section: Resultsmentioning

confidence: 96%

“…The number of publications over the last 18 months ( n = 18 studies) was similar to that of the preceding 11 years ( n = 19 studies) highlighting the recent surge of new evidence ( Figure 2 ). Data from 26 prospective observational studies 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 (of which 6 were cohort studies, 44 , 45 , 46 , 47 , 48 , 49 7 cross‐sectional studies, 27 , 50 , 51 , 52 , 53 , 54 , 55 3 randomized control trials, 56 , 57 , 58 and 1 post hoc analysis of a negative trial) were included. 59 Five of the 37 studies involved an interventional arm [critical care nutritional intervention ( n = 4) 44 , 56 , 57 , 58 and an exercise intervention in breast cancer ( n = 1) 45 ].…”

Section: Resultsmentioning

confidence: 99%

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The current use of ultrasound to measure skeletal muscle and its ability to predict clinical outcomes: a systematic review

Casey

Alasmar

McLaughlin

et al. 2022

J cachexia sarcopenia muscle

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Quantification and monitoring of lean body mass is an important component of nutrition assessment to determine nutrition status and muscle loss. The negative impact of reduced muscle mass and muscle function is increasingly evident across acute and chronic disease states but is particularly pronounced in patients with cancer. Ultrasound is emerging as a promising tool to directly measure skeletal muscle mass and quality. Unlike other ionizing imaging techniques, ultrasound can be used repeatedly at the bedside and may compliment nutritional risk assessment. This review aims to describe the current use of skeletal muscle ultrasound (SMUS) to measure muscle mass and quality in patients with acute and chronic clinical conditions and its ability to predict functional capacity, severity of malnutrition, hospital admission, and survival. Databases were searched from their inception to August 2021 for full-text articles in English. Relevant articles were included if SMUS was investigated in acute or chronic clinical contexts and correlated with a defined clinical outcome measure. Data were synthesized for narrative review due to heterogeneity between studies. This review analysed 37 studies (3100 patients), which met the inclusion criteria. Most studies (n = 22) were conducted in critical care. The clinical outcomes investigated included functional status at discharge (intensive care unit-acquired weakness), nutritional status, and length of stay. SMUS was also utilized in chronic conditions such as chronic obstructive pulmonary disease, chronic heart failure, and chronic renal failure to predict hospital readmission and disease severity. Only two studies investigated the use of SMUS in patients with cancer. Of the 37 studies, 28 (76%) found that SMUS (crosssectional area, muscle thickness, and echointensity) showed significant associations with functional capacity, length of stay, readmission, and survival. There was significant heterogeneity in terms of ultrasound technique and outcome measurement across the included studies. This review highlights that SMUS continues to gain momentum as a potential tool for skeletal muscle assessment and predicting clinically important outcomes. Further work is required to standardize the technique in nutritionally vulnerable patients, such as those with cancer, before SMUS can be widely adopted as a bedside prognostic tool.

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Reproducibility and feasibility of a handheld ultrasound device compared to a standard ultrasound machine in muscle thickness measurements

Alfuraih

Alqarni

Alhuthaili

et al. 2023

Australas J Ultrason Med

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Objective To test the feasibility and reproducibility of a handheld ultrasound device (HUD) compared to a standard ultrasound machine for muscle thickness measurements in healthy participants. Methods A prospective cross‐sectional study was designed where two novice operators tested the thickness of the vastus lateralis, rectus femoris, and vastus intermedius muscles on recruited asymptomatic participants with no history of muscle diseases. The anterior–posterior thickness of each muscle was measured three times per operator to evaluate intra‐operator reproducibility and using two machines to evaluate inter‐system reproducibility. Scanning started using the HUD followed by the standard system. Intraclass correlation coefficients (ICC) and simple linear regression were used to test for reproducibility and proportional bias respectively. Results A total of 33 male participants volunteered to take part in this study with a mean age of 22.7 years (6.8). Intra‐operator reproducibility was almost perfect for both operators on both machines (ICC > 0.80). The measurements difference percentage between the machines ranged from 1.8% to 6.6% and inter‐system reproducibility ICC ranged from 0.815 to 0.927 showing excellent reproducibility. Inter‐operator reproducibility was poor to moderate on both machines (ICC: 0.522–0.849). Regression analysis showed no proportional bias in the measurements. All measurements were completed successfully using the HUD. Conclusion The HUD demonstrated excellent accuracy compared to the standard ultrasound machine for measuring thigh muscle thickness.

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Peripheral muscular ultrasound as outcome assessment tool in critically ill patients on mechanical ventilation: An observational cohort study

Cited by 26 publications

References 28 publications

Association between skeletal muscle changes, anthropometric measurements, and clinical outcomes in critically ill trauma and surgical patients: A prospective observational study

Association between skeletal muscle changes, anthropometric measurements, and clinical outcomes in critically ill trauma and surgical patients: A prospective observational study

The current use of ultrasound to measure skeletal muscle and its ability to predict clinical outcomes: a systematic review

Reproducibility and feasibility of a handheld ultrasound device compared to a standard ultrasound machine in muscle thickness measurements

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