Reliability and feasibility of skeletal muscle ultrasound in the acute burn setting

Schieffelers, David R.; Dombrecht, Dorien; Lafaire, Cynthia; Cuyper, Lieve De; Rose, Thomas; Meirte, Jill; Gebruers, Nick; Breda, Eric van; Daele, Ulrike Van

doi:10.1016/j.burns.2022.03.003

Cited by 2 publications

(5 citation statements)

References 66 publications

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“…The present study currently forms the first and largest clinical trial to date incorporating resistance and aerobic training in severely burned adults commenced during the acute phase of burns. Another strength of this study pertains to the use of ultrasound to quantify muscle size—a tool with good clinical applicability to monitor postburn muscle wasting at all stages of burn recovery [ 61 ], which is particularly relevant given that muscle wasting is not commonly measured in burn care and intervention trials [ 21 , 103 ].…”

Section: Discussionmentioning

confidence: 99%

“…QMLT comprises the combined thickness of the rectus femoris and intermedius muscle, measured between the superior fascial layer of the rectus femoris and the femoral periosteum [ 54 ] ( Figure 2 ). Quadriceps ultrasound provides a valid and reliable measure to track muscle wasting and has been studied in various populations [ 55–60 ], including acute burn injuries [ 61 ]. To derive the QMLT, a multifrequency linear probe was aligned perpendicular to the longitudinal axis of the anterior thigh at the halfway and two-thirds point between the anterior superior iliac spine and the superior patellar pole [ 56 ] ( Figure 3 ).…”

Section: Methodsmentioning

confidence: 99%

“…The ultrasound procedure was sterile in case the wound surface at the measurement points was not intact. Averages of triplicate bilateral measurements were calculated for both QMLT and RF-CSA, as this has been shown to reduce test–retest variability [ 61 ] and better reflect whole-body muscle mass [ 58 , 62 ]. Further details of the employed methods of quadriceps ultrasound have been described elsewhere [ 61 ].…”

Section: Methodsmentioning

confidence: 99%

“…Averages of triplicate bilateral measurements were calculated for both QMLT and RF-CSA, as this has been shown to reduce test–retest variability [ 61 ] and better reflect whole-body muscle mass [ 58 , 62 ]. Further details of the employed methods of quadriceps ultrasound have been described elsewhere [ 61 ]. Ultrasound data was exported and analyzed using DICOM reader software (Horos™ viewer v3.3.6, Horos Project).…”

Section: Methodsmentioning

confidence: 99%

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Effects of early exercise training following severe burn injury: a randomized controlled trial

Schieffelers,

Ru,

Dai

et al. 2024

Burns &Amp; Trauma

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Background Despite being a stable component of burn rehabilitation at later stages of recovery, exercise training is not commonly provided during the acute phase of burns. A lack of evidence surrounding its efficacy and safety in severely burned adults has hampered its implementation in acute burn care. The aim of this study was to investigate the capacity of early exercise training to modulate parameters of postburn muscle wasting and quality of life. Methods Adults <65 years of age with burns ≥40% total burn surface area (TBSA) were randomly allocated to either receive early exercise (n = 29) in addition to standard care or standard care alone (n = 29). Early exercise involved resistance and aerobic training, which commenced as early as possible and lasted for a duration of 6 to 12 weeks, in line with burn center length of stay. Ultrasound-derived quadriceps muscle layer thickness (QMLT) and rectus femoris cross-sectional area (RF-CSA), lower limb muscle force, Eurocol Quality of Life-5 Dimensions and Burn Specific Health Scale Brief (BSHS-B) were assessed 6 and 12 weeks after baseline. Mixed models were fitted to compare between-group changes over time. Results A total of 58 adults [42 (95% confidence interval 40–45) years old; 40–94% TBSA range, 86% previously mechanically ventilated] participated in this study. Exercise commenced 7 days [IQR (interquartile range) 5–9] after burn center admission with an attendance rate of 93%. Allocation to the exercise group had a protective effect on the loss of muscle size from baseline to 6 weeks of follow-up (QMLT: β-coefficient: 0.05 cm, p = 0.010; RF-CSA: β-coefficient: 0.05 cm2, p = 0.045), and resulted in an improved recovery from 6 to 12 weeks (QMLT: β-coefficient: 0.04 cm, p = 0.01; RF-CSA: β-coefficient: 0.06 cm2, p < 0.001). Muscle force increased significantly more in the exercise group than in the control group (β-coefficient: 3.102 N, p < 0.001) between 6 and 12 weeks. Besides a marginally significant effect for the BSHS-B domains ‘affect’ and ‘interpersonal relationships’ between 6 and 12 weeks, no benefits were observed in the other assessed quality-of-life measures. No serious adverse events were reported in the exercise group. Conclusions The results of this study support the use of early exercise training as a feasible and efficacious therapeutic strategy to manage burn-related changes in muscle size and strength in adults with acute severe burn injury.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Effects of early exercise training following severe burn injury: a randomized controlled trial

Schieffelers,

Ru,

Dai

et al. 2024

Burns &Amp; Trauma

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“…In future, blood protein biomarkers or metabolomics analysis, if implemented in daily practice, could provide an insight on substrate needs [32]. Ultrasound assessment of the quadriceps mass has been proved to be feasible in burn patients [33]. However, it is still unknown how such monitoring could help optimizing their nutritional care.…”

Section: How To Individualize Nutritional Support In Burn Patients?mentioning

confidence: 99%

Nutrition after severe burn injury

Rousseau

Pantet

Heyland

2023

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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Purpose of reviewSevere burn injury causes significant metabolic changes and demands that make nutritional support particularly important. Feeding the severe burn patient is a real challenge in regard to the specific needs and the clinical constraints. This review aims to challenge the existing recommendations in the light of the few recently published data on nutritional support in burn patients.Recent findingsSome key macro- and micro-nutrients have been recently studied in severe burn patients. Repletion, complementation or supplementation of omega-3 fatty acids, vitamin C, vitamin D, antioxidant micronutrients may be promising from a physiologic perspective, but evidence of benefits on hard outcomes is still weak due to the studies’ design. On the contrary, the anticipated positive effects of glutamine on the time to discharge, mortality and bacteremias have been disproved in the largest randomized controlled trial investigating glutamine supplementation in burns. An individualized approach in term of nutrients quantity and quality may proof highly valuable and needs to be validated in adequate trials. The combination of nutrition and physical exercises is another studied strategy that could improve muscle outcomes.SummaryDue to the low number of clinical trials focused on severe burn injury, most often including limited number of patients, developing new evidence-based guidelines is challenging. More high-quality trials are needed to improve the existing recommendations in the very next future.

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Reliability and feasibility of skeletal muscle ultrasound in the acute burn setting

Cited by 2 publications

References 66 publications

Effects of early exercise training following severe burn injury: a randomized controlled trial

Effects of early exercise training following severe burn injury: a randomized controlled trial

Nutrition after severe burn injury

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