Thigh Ultrasound Monitoring Identifies Decreases in Quadriceps Femoris Thickness as a Frequent Observation in Critically Ill Children*

Abstract

Quadriceps femoris thickness decrease, proposed as a surrogate for muscle mass, is an early, frequent, and intense phenomenon in PICU. Quadriceps femoris ultrasonography is a reliable technique to monitor this process and in future could help to guide rehabilitation and nutrition interventions.

Nutritional support for children during critical illness: European Society of Pediatric and Neonatal Intensive Care (ESPNIC) metabolism, endocrine and nutrition section position statement and clinical recommendations

“…Malnutrition at PICU admission is frequent (15-25% prevalence rates) in developing countries; nutritional status deterioration is also an early and frequent phenomenon in this setting with almost onethird of critically ill children presenting with nutritional indices decline [7][8][9]. Muscle wasting is also a constant, intense and rapid phenomenon [10]. Malnourishment and macronutrient deficits during critical illness have been associated with increased morbidity (infections, weakness, prolonged mechanical ventilation and delayed recovery) as well as increased mortality.…”

Reliability of bedside ultrasound of limb and diaphragm muscle thickness in critically ill children

“…A prior study of ultrasound reliability to measure quadriceps femoris muscle thickness in critically ill children concluded that a single transverse ultrasound measurement of the quadriceps femoris was insufficiently reliable to detect the anticipated atrophy (<30%) in the muscle thickness . A subsequent study found that ultrasound measurement of quadriceps femoris thickness was sufficiently reliable to detect a 5% change in muscle thickness when 2 repeated measurements obtained from both transverse and longitudinal planes were averaged . No published studies have assessed the reliability of ultrasound measurements of muscle thickness in other skeletal muscles or in diaphragms of critically ill children who have been intubated.…”

Ultrasound imaging for measuring muscle and subcutaneous fat tissue thickness of the anterior thigh: A two-year longitudinal study in middle age

“…proposed using US imaging in addition to dual X‐ray absorptiometry to assess quadriceps muscle characteristics for early diagnosis of sarcopenia. The technique has been used to monitor lean mass loss at the bedside in critically ill patients who experience quadriceps and skeletal muscle atrophy at a very early stage especially critically ill children . Clinicians can utilize objective data from US imaging to administer an appropriate metabolic support to improve muscle morphology and subsequently function .…”

“…The technique has been used to monitor lean mass loss at the bedside in critically ill patients who experience quadriceps and skeletal muscle atrophy at a very early stage especially critically ill children. 28 Clinicians can utilize objective data from US imaging to administer an appropriate metabolic support to improve muscle morphology and subsequently function. 14,16,29 The authors believe that monitoring both muscle and subcutaneous thickness to assess their relative contributions is important.…”