Quantitative neuromuscular ultrasound in the intensive care unit

Abstract

Ultrasound is an informative technique for assessing muscles of patients in the ICU, and lower extremity muscles demonstrated increased homogeneity during ICU stays. This technique should be examined further for diagnosing and tracking those with ICU-AW.

Sarcopenia in critically ill patients

“…They found that tibialis anterior and rectus femoris muscles had significant decreases in gray-scale standard deviation but no muscles showed significant changes in thickness. Consequently, they suggested that this technique should be examined further for diagnosing and tracking those with ICU-AW [29]. Bioelectrical impedance analysis (BIA) is not suitable in patients with electrolyte abnormalities and hypervolemia in ICUs.…”

Ultrasound for the Assessment of Peripheral Skeletal Muscle Architecture in Critical Illness

“…None of the seven included studies (32)(33)(34)(35)(36)(37)(38) were RCTs. Six were primarily single group studies, classified as case series (33)(34)(35)(36)(37)(38). One of these studies involved comparison with an unmatched control group (35).…”

“…Significantly, the majority of included studies were published between 2012 and 2013 (32,34,35,37), indicating the emerging research interest in ultrasound as a technique for evaluating peripheral skeletal muscle architecture during critical illness. Five studies were European (33,(35)(36)(37)39), with one conducted in Australia (32) and one in North America (34). Patient characteristics of included studies are reported in Table 4.…”

“…Sample sizes ranged between 9 (33) and 118 (36) patients. Eligible patient populations in studies were characterized according to clinical diagnostic descriptors (e.g., multiple organ failure and sepsis) (33)(34)(35), ICU admission-related descriptors (e.g., duration of mechanical ventilation and length of stay) (36,37), or a combination of both (32,38). Only four studies reported actual illness severity of their patient cohorts using standard critical care scoring systems (Acute Physiology and Chronic Health Evaluation) (32,35,37,38), of which three further reported actual duration of mechanical ventilation for their patient cohorts (32,35,37).…”

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

“…However, these measures are invasive, are expensive, and require significant expertise; and they are not always readily available in the clinical setting. To date, there are no proven relationships of these invasive tests to ICU patient strength and function [8]. The ability for a testing modality to differentiate potential ICU-AW patients early in their course may prove especially important because the majority of muscle changes occur within the first 10 days [9].…”