Reliability of ultrasound measurements of quadriceps muscle thickness in critically ill patients

Background and aims: Critically ill patients with acute kidney injury (AKI) undergo major muscle wasting in the first few days of ICU stay. An important concern in this clinical setting is the lack of adequate tools for routine bedside evaluation of the skeletal muscle mass, both for the determination of nutritional status at admission, and for monitoring. In this regard, the present study aims to ascertain if ultrasound (US) is able to detect changes in quadriceps muscle thickness of critically ill patients with acute kidney injury (AKI) over short periods of time.Methods: This is a prospective observational study with a follow-up at 5 days. All adult patients with AKI hospitalized at the Renal ICU of the Parma University Hospital over 12 months, with a hospital stay before ICU admission no longer than 72 h, and with a planned ICU stay of at least 5 days, were eligible for the study. An experienced investigator assessed quadriceps rectus femoris and vastus intermedius thickness (QRFT and QVIT) at baseline and after 5 days of ICU stay.Results: We enrolled 30 patients with 74 ± 11 years of age and APACHE II score of 22 ± 5. Muscle thickness decreased by 15 ± 13% within the first 5 days of ICU stay (P < 0.001 for all sites as compared to ICU admission). Patients with more severe muscle loss had lower probability of being discharged home (OR: 0.04, 95%CI: 0.00–0.74; P = 0.031).Conclusions: In critically ill patients with AKI, bedside muscle US identifies patients with accelerated muscle wasting.

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Ultrasonography to measure quadriceps muscle in critically ill patients: A literature review of reported methodologies

Anaesthesia and Intensive Care ◽

10.1177/0310057x19875152 ◽

2019 ◽

Vol 47 (5) ◽

pp. 423-434 ◽

Cited By ~ 4

Author(s):

Luke M Weinel ◽

Matthew J Summers ◽

Lee-Anne Chapple

Keyword(s):

Layer Thickness ◽

Critically Ill ◽

Critically Ill Patients ◽

Muscle Wasting ◽

Muscle Layer ◽

Quadriceps Muscle ◽

Cross Sectional Area ◽

Muscle Size ◽

Sectional Area ◽

Cross Sectional

Muscle wasting in the intensive care unit (ICU) is common and may impair functional recovery. Ultrasonography (US) presents a modern solution to quantify skeletal muscle size and monitor muscle wasting. However, no standardised methodology for the conduct of ultrasound-derived quadriceps muscle layer thickness or cross-sectional area in this population exists. The aim of this study was to compare methodologies reported for the measurement of quadriceps muscle layer thickness (MLT) and cross-sectional area (CSA) using US in critically ill patients. Databases PubMed, Ovid, Embase, and CINAHL were searched for original research publications that reported US-derived quadriceps MLT and/or CSA conducted in critically ill adult patients. Data were extracted from eligible studies on parameters relating to US measurement including anatomical location, patient positioning, operator technique and image analysis. It was identified that there was a clear lack of reported detail and substantial differences in the reported methodology used for all parameters. A standardised protocol and minimum reporting standards for US-derived measurement of quadriceps muscle size in ICU is required to allow for consistent measurement techniques and hence interpretation of results.

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Assessment of quadriceps muscle mass with ultrasound in critically ill patients: intra- and inter-observer agreement and sensitivity

Intensive Care Medicine ◽

10.1007/s00134-015-3668-6 ◽

2015 ◽

Vol 41 (3) ◽

pp. 562-563 ◽

Cited By ~ 19

Author(s):

Johan Segers ◽

Greet Hermans ◽

Noppawan Charususin ◽

Tom Fivez ◽

Ilse Vanhorebeek ◽

...

Keyword(s):

Critically Ill ◽

Muscle Mass ◽

Critically Ill Patients ◽

Quadriceps Muscle ◽

Observer Agreement

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SO018NON-INVASIVE ASSESSMENT AND MONITORING OF SKELETAL MUSCLE MASS IN CRITICALLY ILL PATIENTS WITH AKI BY QUADRICEPS MUSCLE ULTRASOUND

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa139.so018 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Alice Sabatino ◽

Giuseppe Regolisti ◽

Chiara Cantarelli ◽

Andrea Palladini ◽

Tommaso Di motta ◽

...

Keyword(s):

Skeletal Muscle ◽

Hospital Stay ◽

Critically Ill ◽

Muscle Mass ◽

Critically Ill Patients ◽

Skeletal Muscle Mass ◽

Muscle Wasting ◽

Quadriceps Muscle ◽

Invasive Technique ◽

Icu Stay

Abstract Background and Aims Critically ill patients undergo important muscle wasting during ICU stay, and a significant loss of muscle mass still occurs in the first few days of hospital stay. This may delay both functional recovery and weaning from mechanical ventilation, being also a well-known predictor of mortality. Quite often, muscle wasting is masked by fluid overload, increasing the risk for underestimating the presence of malnutrition, as frequently occurs in critically ill patients with AKI. An important concern in this clinical setting is the lack of adequate tools for routine bedside evaluation of the skeletal muscle mass. Lately, the use of ultrasound (US) for the assessment of muscle mass has aroused considerable interest. It is a non-invasive technique, applicable at the bedside and even in non-collaborative patients, it is economically viable, safe and do not require specialized staff. Recently, its reliability and validity have been demonstrated in critically ill patients with AKI. On this premise, in the present study, we aimed to evaluate the clinical application of US for both evaluation and monitoring of quadriceps muscle thickness in critically ill patients with AKI. Method This is an observational study, conducted in the renal ICU of the Parma University Hospital. All adult patients with AKI, with no distinction regarding the severity of AKI, admitted in the renal ICU from 15/03/2017 to 15/03/2018, with previous hospital stay less than 72h, with a likely ICU stay of at least 5 days were eligible for entering the study. The diagnosis of AKI was made according to KDIGO. Quadriceps rectus femoris and vastus intermedius thickness (QRFT and QVIT) were measured at the midpoint and at the border between the upper third and lower two-thirds between the anterior superior iliac spine (ASIS) and the upper pole of the patella. US was performed twice during ICU stay, i.e., at baseline (within 72h from admission) and after 5 days since the first measurement. Results We enrolled 30 patients, 70% (n= 21/30) were male, mean age ± SD age 74±11 years, APACHE II mean ± SD, 22 ± 5. Ultrasonography took less than 10 minutes to set up and complete image acquisition and less than 10 minutes per image to complete measurement analysis in all patients. A total of 472 images were analyzed across the 30 subjects.

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