Qualitative Ultrasound in Acute Critical Illness Muscle Wasting

Abstract

Myofiber necrosis and fascial inflammation can be detected noninvasively using ultrasound in the critically ill. Fasciitis precedes and frequently accompanies muscle necrosis. These findings may have functional implications for survivors of critical illness.

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

“…The validity of ultrasonography for evaluating changes in the overall quality of muscle in individuals with critical illness may need to be determined in comparison to muscle biopsy. A recent study by Puthucheary and colleagues [34] correlated ultrasound echogenicity with muscle biopsy measurement of muscle necrosis within the ICU setting, adding further support to the proposed hypothesis that echogenicity may be representative of muscle necrosis and architectural destruction at a cellular level. Echogenicity scores did not follow a consistent trend or pattern across all included participants within this study.…”

Rectus Femoris Cross-Sectional Area and Muscle Layer Thickness: Comparative Markers of Muscle Wasting and Weakness

“…DThickness also underestimated DRF CSA (a 28% bias on Bland-Altman plot being relevant, given that a 10% change in RF CSA is considered sufficient to affect function [11])-in part, perhaps, because it is a unidimensional measure when compared with (two-dimensional) muscle area or (three-dimensional) volume. The specific relationship of tissue edema to ultrasound measures remains unclear (3,8), although edema may also affect fiber CSA (12). Although these data are derived from the largest cohort available for longitudinal radiopathological correlation, our study is limited by its size.…”

ICU-Acquired Weakness

“…23 In another cohort of patients with respiratory failure, vastus lateralis ultrasound had a sensitivity of 74% for prediction of myofiber necrosis in muscle biopsy specimens; in patients without a potential iatrogenic cause for muscle necrosis, sensitivity increased to 85%. 24 Among patients with sepsis, muscle ultrasound was able to help detect neuromyopathy in 93% of patients studied, with excellent interrater reliability (intraclass correlation, 0.97). 24 Although muscle ultrasound is a potential noninvasive marker of ICUAW, we currently lack evidence demonstrating an association between ultrasound findings and clinical outcomes and therapeutic ultrasound targets, limiting routine clinical use.…”

“…24 Among patients with sepsis, muscle ultrasound was able to help detect neuromyopathy in 93% of patients studied, with excellent interrater reliability (intraclass correlation, 0.97). 24 Although muscle ultrasound is a potential noninvasive marker of ICUAW, we currently lack evidence demonstrating an association between ultrasound findings and clinical outcomes and therapeutic ultrasound targets, limiting routine clinical use.…”