Thoracic skeletal muscle quantification using computed tomography and prognosis of elderly ICU patients

AbstractIn elderly ICU patients, the prevalence of skeletal muscle loss is high. Longitudinal effect of thoracic muscles, especially in elderly ICU patients, are unclear although skeletal muscle loss is related with the short- and long-term outcomes. This study aimed to evaluate whether pectoralis muscle mass loss could be a predictor of prognosis in elderly ICU patients. We retrospectively evaluated 190 elderly (age > 70 years) patients admitted to the ICU. We measured the cross-sectional area (CSA) of the pectoralis muscle (PMCSA) at the fourth vertebral region. CT scans within two days before ICU admission were used for analysis. Mortality, prolonged mechanical ventilation, and longitudinal changes in Sequential Organ Failure Assessment (SOFA) scores were examined. PMCSA below median was significantly related with prolonged ventilation (odds ratio 2.92) and a higher SOFA scores during the ICU stay (estimated mean = 0.94). PMCSA below median was a significant risk for hospital mortality (hazards ratio 2.06). In elderly ICU patients, a low ICU admission PMCSA was associated with prolonged ventilation, higher SOFA score during the ICU stay, and higher mortality. Adding thoracic skeletal muscle CSA at the time of ICU admission into consideration in deciding the therapeutic intensity in elderly ICU patients may help in making medical decisions.

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Thoracic Skeletal Muscle Quantification Using Computed Tomography And Prognosis Of Elderly ICU Patients

10.21203/rs.3.rs-144315/v1 ◽

2021 ◽

Author(s):

Sung Woo Moon ◽

Song Yee Kim ◽

Ji Soo Choi ◽

Ah Young Leem ◽

Su Hwan Lee ◽

...

Keyword(s):

Computed Tomography ◽

Skeletal Muscle ◽

Muscle Mass ◽

Sofa Score ◽

Pectoralis Muscle ◽

Muscle Loss ◽

Icu Patients ◽

Icu Admission ◽

Prolonged Ventilation ◽

Skeletal Muscle Loss

Abstract Background: In elderly ICU patients, the prevalence of skeletal muscle loss is high. And the consequences of skeletal muscle loss can be severe in elderly. Correlations have been found between the muscle cross-sectional area (CSA) at a single thoracic level on chest computed tomography (CT). Correlation between thoracic muscle mass and mortality has been found in ICU patients. But longitudinal effect of thoracic muscles especially in elderly ICU patients are unclear although skeletal muscle loss is related with the short- and long-term outcomes. Objective: This study aimed to evaluate whether pectoralis muscle mass could be a predictor of prognosis in elderly ICU patients.Methods: We retrospectively evaluated 190 elderly patients admitted in the ICU between January 2010 and December 2015 in one tertiary care hospital in South Korea. We measured the CSA of the pectoralis muscle area (PMCSA) at the fourth vertebral region. CT scans within two days before ICU admission were used for analysis. Mortality, prolonged mechanical ventilation, and longitudinal change in Sequential Organ Failure Assessment (SOFA) scores were examined. Multivariate logistic regression, linear mixed, and multivariate Cox proportional hazards models were used.Results: PMCSA below median was significantly related with prolonged ventilation. (odds ratio 2.92, 95% CI: 1.02-1.42, P=0.06) and a higher SOFA score during the ICU stay (estimated mean = 0.94, P = 0.03). PMCSA below median was a significant risk for all-cause mortality (HR: 2.06, 95% CI: 1.23-3.47, P=0.01)Conclusions: In elderly ICU patients, low ICU admission PMCSA was associated with prolonged ventilation, a higher SOFA score during the ICU stay and higher mortality. Adding thoracic skeletal muscle CSA at the time of ICU admission into consideration in deciding therapeutic intensity in elderly ICU patients may help in making medical decisions.

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Time course of skeletal muscle loss and oxidative stress in rats with walker 256 solid tumor

Muscle & Nerve ◽

10.1002/mus.21798 ◽

2010 ◽

Vol 42 (6) ◽

pp. 950-958 ◽

Cited By ~ 38

Author(s):

Flávia A. Guarnier ◽

Alessandra L. Cecchini ◽

Andréia A. Suzukawa ◽

Ana Leticia G.C. Maragno ◽

Andréa N.C. Simão ◽

...

Keyword(s):

Oxidative Stress ◽

Skeletal Muscle ◽

Solid Tumor ◽

Time Course ◽

Muscle Loss ◽

Skeletal Muscle Loss ◽

Walker 256 ◽

And Oxidative Stress

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Skeletal muscle loss and prognosis of breast cancer patients

Supportive Care in Cancer ◽

10.1007/s00520-017-3628-5 ◽

2017 ◽

Vol 25 (7) ◽

pp. 2221-2227 ◽

Cited By ~ 7

Author(s):

Yoshiko Kubo ◽

Tateaki Naito ◽

Keita Mori ◽

Gakuji Osawa ◽

Etsuko Aruga

Keyword(s):

Breast Cancer ◽

Skeletal Muscle ◽

Cancer Patients ◽

Muscle Loss ◽

Breast Cancer Patients ◽

Skeletal Muscle Loss

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384 Post-Operative ICU Admission for Elective Craniotomy for Intra-axial Brain Tumor Resection

Neurosurgery ◽

10.1093/neuros/nyx417.384 ◽

2017 ◽

Vol 64 (CN_suppl_1) ◽

pp. 291-292

Author(s):

Farhan A Mirza ◽

Catherine Y Wang ◽

Thomas Pittman

Keyword(s):

Brain Tumor ◽

Pediatric Patients ◽

Prolonged Mechanical Ventilation ◽

Pediatric Population ◽

External Ventricular Drain ◽

Tumor Resection ◽

Retrospective Chart Review ◽

Icu Admission ◽

Icu Stay ◽

Brain Tumor Resection

Abstract INTRODUCTION We reviewed our practice at the University of Kentucky in order to assess the safety of admitting adult and pediatric patients to floor beds after craniotomy, exclusively for intra-axial brain tumor resection. METHODS Retrospective chart review of patients, adults and pediatric, who underwent craniotomy by a single surgeon (TP) for intra axial brain tumor resection between January 2012 and December 2015. 413 patient charts were reviewed, 16 were omitted due to incomplete records. RESULTS >421 craniotomies for intra axial brain tumor resection were performed. 397 patients underwent surgery, 35 of whom were <18 years of age.188 females and 209 males. 351 patients (331 adults, 20 pediatric) were admitted to floor beds. In this group, length of operation was <4 hours in 346 patients (99.1%) and >4 hours in only 5 patients (0.9%). 3 patients (0.8%) required transfer to ICU within 24 hours of floor admission. 55 adult patients required ICU stay for various reasons: 9 patients had pre-operative or intra operative EVD placement; 15 patients required prolonged ventilation; 1 patient had to be taken back to the operating room for hemorrhage evacuation; 5 had intraventricular tumors and were planned ICU admissions; 26 patients were admitted pre-operatively to an ICU bed on a non neurosurgical service and were returning to their assigned beds. In the pediatric population, 15 patients required ICU stay: 8 were for EVD management and 7 for prolonged operation or frequent neurological evaluations. In this group, the length of operation was <4 hours in 40 patients(57.1%) and >4 hours in 30 patients (42.9%). CONCLUSION Admitting adult and pediatric patients to floor beds after craniotomy for intra-axial brain tumor resection is safe. There are some conditions that mandate ICU admission: these include prolonged mechanical ventilation and the presence of an external ventricular drain.

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