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

Parry, Selina M.; El-Ansary, Doa; Cartwright, Michael S.; Sarwal, Aarti; Berney, Sue; Koopman, René; Annoni, Raquel; Puthucheary, Zudin; Gordon, Ian; Morris, Peter E.; Denehy, Linda

doi:10.1016/j.jcrc.2015.05.024

Cited by 319 publications

(423 citation statements)

References 36 publications

(49 reference statements)

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“…In our study, muscle wasting occurred earlier than reported in the literature: a previous study found that the cross sectional area of the rectus femoris muscle significantly decreased in the first 7 days of admission, whilst showing no changes in the first 3 days [10]. Further loss of muscle thickness has also been related with loss of muscle function on discharge from critical care [20]. …”

Section: Discussionsupporting

confidence: 50%

Human limb skeletal muscle wasting and architectural remodeling during five to ten days intubation and ventilation in critical care – an observational study using ultrasound

et al. 2016

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BackgroundCritically ill patients frequently suffer muscle weakness whilst in critical care. Ultrasound can reliably track loss of muscle size, but also quantifies the arrangement of the muscle fascicles, known as the muscle architecture. We sought to measure both pennation angle and fascicle length, as well as tracking changes in muscle thickness in a population of critically ill patients.MethodsOn days 1, 5 and 10 after admission to critical care, muscle thickness was measured in ventilated critically ill patients using bedside ultrasound. Elbow flexor compartment, medial head of gastrocnemius and vastus lateralis muscle were investigated. In the lower limb, we determined the pennation angle to derive the fascicle length.ResultsWe recruited and scanned 22 patients on day 1 after admission to critical care, 16 were re-scanned on day 5 and 9 on day 10. We found no changes to the size of the elbow flexor compartment over 10 days of admission. In the gastrocnemius, there were no significant changes to muscle thickness or pennation angle over 5 or 10 days. In the vastus lateralis, we found significant losses in both muscle thickness and pennation angle on day 5, but found that fascicle length is unchanged. Loss of muscle on day 5 was related to decreases in pennation angle. In both lower limb muscles, a positive relationship was observed between the pennation angle on day 1, and the percentage of angle lost by days 5 and 10.DiscussionMuscle loss in critically ill patients preferentially affects the lower limb, possibly due to the lower limb becoming prone to disuse atrophy. Muscle architecture of the thigh changes in the first 5 days of admission, in particular, we have demonstrated a correlation between muscle thickness and pennation angle. It is hypothesised that weakness in the lower limb occurs through loss of force generation via a reduced pennation angle.ConclusionUsing ultrasound, we have been able to demonstrate that muscle thickness and architecture of vastus lateralis undergo rapid changes during the early phase of admission to a critical care environment.

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Section: Discussionsupporting

confidence: 50%

Human limb skeletal muscle wasting and architectural remodeling during five to ten days intubation and ventilation in critical care – an observational study using ultrasound

et al. 2016

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“…Interstitial lung abnormalities have been associated with decreased measures of pulmonary function and 6-minute-walk distance, increased respiratory symptoms, and genetic abnormalities, suggesting they may represent an early or mild form of pulmonary fibrosis (1). They have also recently been associated with an increased risk of death, specifically, death from respiratory failure (2). Patients with fibrotic lung disease can develop acute respiratory failure due to an exacerbation of their underlying disease.…”

Section: Interstitial Lung Abnormalities Are Associated With Acute Rementioning

confidence: 99%

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

Puthucheary

McNelly

Rawal

et al. 2017

Am J Respir Crit Care Med

103

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“…A lower SMD was associated with increased lipid infiltration in muscle biopsies and poor clinical outcomes in non-ICU populations [12–14]. Additionally, a recent study in critically ill patients using ultrasound of the quadriceps muscle found that not only a decrease in muscle quantity but also increased muscle echogenicity was related to a decrease in muscle function [15]. An increased amount of IMAT as assessed on CT scans has been associated with decreased muscle function and increased (systemic) inflammation in non-ICU populations [16, 17].…”

Section: Introductionmentioning

confidence: 99%

Skeletal muscle quality as assessed by CT-derived skeletal muscle density is associated with 6-month mortality in mechanically ventilated critically ill patients

et al. 2016

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BackgroundMuscle quantity at intensive care unit (ICU) admission has been independently associated with mortality. In addition to quantity, muscle quality may be important for survival. Muscle quality is influenced by fatty infiltration or myosteatosis, which can be assessed on computed tomography (CT) scans by analysing skeletal muscle density (SMD) and the amount of intermuscular adipose tissue (IMAT). We investigated whether CT-derived low skeletal muscle quality at ICU admission is independently associated with 6-month mortality and other clinical outcomes.MethodsThis retrospective study included 491 mechanically ventilated critically ill adult patients with a CT scan of the abdomen made 1 day before to 4 days after ICU admission. Cox regression analysis was used to determine the association between SMD or IMAT and 6-month mortality, with adjustments for Acute Physiological, Age, and Chronic Health Evaluation (APACHE) II score, body mass index (BMI), and skeletal muscle area. Logistic and linear regression analyses were used for other clinical outcomes.ResultsMean APACHE II score was 24 ± 8 and 6-month mortality was 35.6%. Non-survivors had a lower SMD (25.1 vs. 31.4 Hounsfield Units (HU); p < 0.001), and more IMAT (17.1 vs. 13.3 cm2; p = 0.004). Higher SMD was associated with a lower 6-month mortality (hazard ratio (HR) per 10 HU, 0.640; 95% confidence interval (CI), 0.552–0.742; p < 0.001), and also after correction for APACHE II score, BMI, and skeletal muscle area (HR, 0.774; 95% CI, 0.643–0.931; p = 0.006). Higher IMAT was not significantly associated with higher 6-month mortality after adjustment for confounders. A 10 HU increase in SMD was associated with a 14% shorter hospital length of stay.ConclusionsLow skeletal muscle quality at ICU admission, as assessed by CT-derived skeletal muscle density, is independently associated with higher 6-month mortality in mechanically ventilated patients. Thus, muscle quality as well as muscle quantity are prognostic factors in the ICU.Trial registrationRetrospectively registered (initial release on 06/23/2016) at ClinicalTrials.gov: NCT02817646.

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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

Cited by 319 publications

References 36 publications

Human limb skeletal muscle wasting and architectural remodeling during five to ten days intubation and ventilation in critical care – an observational study using ultrasound

Human limb skeletal muscle wasting and architectural remodeling during five to ten days intubation and ventilation in critical care – an observational study using ultrasound

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

Skeletal muscle quality as assessed by CT-derived skeletal muscle density is associated with 6-month mortality in mechanically ventilated critically ill patients

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