Changes in Quantitative Muscle Ultrasound for Diagnosis of Intensive Care Unit-Acquired Weakness in Critically Ill Patients

Abstract Background: A common occurrence in severe illness is muscle wasting, which is defined as intensive care unit acquired weakness (ICU-AW) and characterized by flaccid tetraparesis with areflexia or hyporeflexia. Many studies revealed the tendency of changes in quantitative muscle ultrasound parameters in critical illnesses; however, the relation between those changes in muscle parameters and intensive care unit acquired weakness was unknown.Objectives: Using the Medical Research Council Criteria, test the accuracy in diagnosis of changes in quantitative muscle ultrasound for diagnosing intensive care unit acquired weakness.Methods: Patients who were conscious and positively responded to verbal commands with facial muscles were subjected to quantitative muscle ultrasonography including measuring thickness and cross-sectional area of biceps brachii (BB) muscle, vastus intermedius (VI) muscle, and rectus femoris (RF) muscles for 4 times in the next 10 days after assessing their muscle strength using the Medical Research Council score. Assessment of the diagnostic accuracy of changes in cross-sectional area and thickness of different muscle groups was made using area under the curve of the receiver operating characteristic curve (ROC–AUC). We also calculated specificity, sensitivity, negative predictive value, positive predictive value, and diagnostic accuracy of 15% threshold for reduction of thickness and 12% threshold for reduction of cross-sectional area.Results: 37 patients underwent muscle ultrasonography for 4 times and 24 were found to have ICW-AW. ROC–AUC of changes in muscle parameters were acceptable and ranged from 0.647 to 0.727. The changes in the thickness of vastus intermedius muscle on both sides while the change in thickness and cross-sectional area of rectus femoris muscle on the right side showed good diagnostic accuracy and ranged from 75.7% to 78.4%.Conclusions: Ultrasonography of the changes in muscle parameters with good diagnostic accuracy is an alternative approach for making a diagnosis of intensive care unit acquired weakness. Particularly, changes in the thickness of vastus intermedius muscle on both sides and changes in thickness and cross-sectional area of rectus femoris muscle on the right side have diagnostic potential.

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Changes in muscle ultrasound for the diagnosis of intensive care unit acquired weakness in critically ill patients

Scientific Reports ◽

10.1038/s41598-021-97680-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Weiqing Zhang ◽

Jun Wu ◽

Qiuying Gu ◽

Yanting Gu ◽

Yujin Zhao ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Diagnostic Accuracy ◽

Biceps Brachii ◽

Rectus Femoris ◽

Apache Ii ◽

Cross Sectional ◽

Icu Admission ◽

The Right ◽

Muscle Ultrasound

AbstractTo test diagnostic accuracy of changes in thickness (TH) and cross-sectional area (CSA) of muscle ultrasound for diagnosis of intensive care unit acquired weakness (ICU-AW). Fully conscious patients were subjected to muscle ultrasonography including measuring the changes in TH and CSA of biceps brachii (BB) muscle, vastus intermedius (VI) muscle, and rectus femoris (RF) muscles over time. 37 patients underwent muscle ultrasonography on admission day, day 4, day 7, and day 10 after ICU admission, Among them, 24 were found to have ICW-AW. Changes in muscle TH and CSA of RF muscle on the right side showed remarkably higher ROC-AUC and the range was from 0.734 to 0.888. Changes in the TH of VI muscle had fair ROC-AUC values which were 0.785 on the left side and 0.779 on the right side on the 10th day after ICU admission. Additionally, Sequential Organ Failure Assessment (SOFA), Acute Physiology, and Chronic Health Evaluation II (APACHE II) scores also showed good discriminative power on the day of admission (ROC-AUC 0.886 and 0.767, respectively). Ultrasonography of changes in muscles, especially in the TH of VI muscle on both sides and CSA of RF muscle on the right side, presented good diagnostic accuracy. However, SOFA and APACHE II scores are better options for early ICU-AW prediction due to their simplicity and time efficiency.

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Evaluation of Sarcopenia by Ultrasound of the Rectus Femoris Muscle as a Predictor of Outcomes of Surgical Intensive Care Unit Patients, A Prospective, Observational Study

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2021/v33i1030908 ◽

2021 ◽

pp. 43-52

Author(s):

Aya Hassan Hegazy ◽

Mohammad Samir Abd El-Ghafar ◽

Nagat Sayed El-shmaa ◽

Sohair Moustafa Soliman

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Rectus Femoris ◽

Cross Sectional Area ◽

Surgical Intensive Care Unit ◽

Sectional Area ◽

Surgical Intensive Care ◽

Cross Sectional ◽

Rectus Femoris Muscle ◽

Femoris Muscle

Background: Muscle wasting is a frequent finding in critically ill patients and is associated with worse short- and long term outcomes. Loss of mass and function of skeletal muscles starts early - in the first 24 hours after admission to Intensive Care Unit (ICU) - and may persist for years ‘Post-ICU syndrome’. Ultrasound of rectus femoris muscle is a valid and simple technique that could be used for longitudinal assessment of treatment success and facilitates the use of postoperative interventions that help in problems related to critical illness. The aim of this study is to evaluate sarcopenia by ultrasound of rectus femoris muscle as a predictor of outcomes of surgical intensive care unit. Materials and Methods: This prospective observational study was performed on 40 patients admitted to the surgical ICU, Tanta University Hospitals, Egypt, after approval of the Institutional Ethical Committee, Tanta University. The study started from April 2019 till January 2020. An informed consent was taken from the nearest relatives of the patients. All data of the patients was confidential with secret codes and private files for each patient. All given data was used for the current medical research only. Any unexpected risks appeared during the course of the research were cleared to the participants and ethical committee at time. Results: Cross-sectional area of rectus femoris muscle decreased significantly at all-time measurements as compared to the baseline at day 0 (within 24 hours from SICU admission), 5, 10, 15, 20, 25 and 30. There were negative correlations between delta cross-sectional area of rectus femoris muscle and age, height, weight, Body Mass Index and baseline cross-sectional area of rectus femoris muscle. There was a positive correlation between delta cross-sectional area of rectus femoris muscle and duration of mechanical ventilation, ICU length of stay and mortality. Conclusion: Rectus femoris cross-sectional area measured by B-mode ultrasonography showed significant role in nutritional assessment as it decreases in critically ill patients with positive correlation with duration of mechanical ventilation and ICU stay.

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Comparison of Ultrasound-Derived Muscle Thickness With Computed Tomography Muscle Cross-Sectional Area on Admission to the Intensive Care Unit: A Pilot Cross-Sectional Study

Journal of Parenteral and Enteral Nutrition ◽

10.1002/jpen.1822 ◽

2020 ◽

Cited By ~ 3

Author(s):

Kate J. Lambell ◽

Audrey C. Tierney ◽

Jessica C. Wang ◽

Vinodh Nanjayya ◽

Adrienne Forsyth ◽

...

Keyword(s):

Computed Tomography ◽

Intensive Care Unit ◽

Intensive Care ◽

Muscle Thickness ◽

Cross Sectional Study ◽

Cross Sectional Area ◽

Sectional Area ◽

Sectional Study ◽

Cross Sectional ◽

Muscle Cross Sectional Area

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Rectus Femoris Mimicking Ultrasound Phantom for Muscle Mass Assessment: Design, Research, and Training Application

Journal of Clinical Medicine ◽

10.3390/jcm10122721 ◽

2021 ◽

Vol 10 (12) ◽

pp. 2721

Author(s):

Nobuto Nakanishi ◽

Shigeaki Inoue ◽

Rie Tsutsumi ◽

Yusuke Akimoto ◽

Yuko Ono ◽

...

Keyword(s):

Measurement Accuracy ◽

Rectus Femoris ◽

Cross Sectional Area ◽

Sectional Area ◽

Cross Sectional ◽

Phantom Model ◽

Ultrasound Measurements ◽

Ultrasound Phantom

Ultrasound has become widely used as a means to measure the rectus femoris muscle in the acute and chronic phases of critical illness. Despite its noninvasiveness and accessibility, its accuracy highly depends on the skills of the technician. However, few ultrasound phantoms for the confirmation of its accuracy or to improve technical skills exist. In this study, the authors created a novel phantom model and used it for investigating the accuracy of measurements and for training. Study 1 investigated how various conditions affect ultrasound measurements such as thickness, cross-sectional area, and echogenicity. Study 2 investigated if the phantom can be used for the training of various health care providers in vitro and in vivo. Study 1 showed that thickness, cross-sectional area, and echogenicity were affected by probe compression strength, probe angle, phantom compression, and varying equipment. Study 2 in vitro showed that using the phantom for training improved the accuracy of the measurements taken within the phantom, and Study 2 in vivo showed the phantom training had a short-term effect on improving the measurement accuracy in a human volunteer. The new ultrasound phantom model revealed that various conditions affected ultrasound measurements, and phantom training improved the measurement accuracy.

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Intra- and inter-muscular differences in the cross-sectional area of the quadriceps muscles assessed by extended field-of-view ultrasonography

Medical Ultrasonography ◽

10.11152/mu-2302 ◽

2020 ◽

Vol 22 (2) ◽

pp. 152 ◽

Cited By ~ 2

Author(s):

Chrysostomos Sahinis ◽

Eleftherios Kellis ◽

Nikiforos Galanis ◽

Konstantinos Dafkou ◽

Athanasios Ellinoudis

Keyword(s):

Vastus Lateralis ◽

Intraclass Correlation ◽

Cross Sectional Area ◽

Field Of View ◽

Cost Evaluation ◽

Sectional Area ◽

Cross Sectional ◽

Vastus Intermedius ◽

Extended Field ◽

Extended Field Of View

Aim: Τo examine the inter- and intra-muscular differences in the anatomical cross-sectional area (CSA) of the quadricep muscles, using extended - field of view (EFOV) ultrasonography (US).Material and methods: Panoramic transverse US images of the thigh were acquired from 10 young participants at five different locations across the thigh, in two sessions, spaced a week apart. The CSA of the vastus medialis (VM), rectus femoris (RF), vastus intermedius (VI), vastus lateralis (VL) and tensor vastus intermedius (TVI) was quantified.Results: The intraclass correlation coefficients ranged from 0.75 to 0.97 and the standard error of measurement ranged from 0.78% to 6.61%, indicating high test-retest reliability. Analysis of the variance indicated that among the 5 quadriceps muscles the VL and the RF displayed the greater CSA proximally, the VI medially and the VM distally across the thigh (p <0.05). No differences in the quadriceps CSA measured with and without including the TVI were found (p >0.05).Conclusions: The EFOV US technique provides transverse scans of the quadriceps muscle in vivo and allowed a reliable and non-invasive determination of CSA at a low cost. Evaluation of CSA along the thigh largely depends on the measurement site. Future studies that examine the quadriceps CSA using EFOV after any form of intervention should consider changes of at least 6.5% as meaningful.

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Intra- and interobserver agreement of rectus femoris cross-sectional area in critically ill patients

Minerva Anestesiologica ◽

10.23736/s0375-9393.20.15149-6 ◽

2021 ◽

Vol 87 (4) ◽

Author(s):

Ondrej HRDY ◽

Kamil VRBICA ◽

Marek KOVAR ◽

Tomas KORBICKA ◽

Roman GAL

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Interobserver Agreement ◽

Rectus Femoris ◽

Cross Sectional Area ◽

Sectional Area ◽

Cross Sectional

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Validation of Psoas Muscle Index as a predictor of successful extubation in elderly intensive care patients: a retrospective cohort study

10.21203/rs.2.22396/v1 ◽

2020 ◽

Author(s):

Fumimasa Kobori ◽

Kazunari Azuma ◽

Shiro Mishima ◽

Jun Oda

Keyword(s):

Intensive Care ◽

Psoas Muscle ◽

Extubation Failure ◽

Cross Sectional Area ◽

Sectional Area ◽

Cross Sectional ◽

Predictive Values ◽

Failure Group ◽

Success Group ◽

Sensitivity Specificity

Abstract Background Extubation failure-associated factors haven't been investigated in elderly patients. We hypothesized that psoas cross-sectional area, an emerging indicator of frailty, can be a predictor of extubation outcomes. Methods This retrospective study analyzed data from patients admitted between January and April 2016 at the intensive care unit (ICU) of the Tokyo Medical University Hospital. Patients were considered eligible if aged ≥65 years, required intubation at the emergency room, and were admitted to ICU for <24 h. Overall, 39 ICU patients were eligible and categorized into two groups: extubation success (n = 24) and extubation failure (n = 15) groups. The psoas cross-sectional area was measured at the third lumbar level on computer tomography images. Regions of interest were drawn freehand to outline the left and right psoas by an emergency physician. The average left and right psoas cross-sectional areas, used as the patient’s psoas cross-sectional area, were calculated. Psoas Muscle Index (PMI) was defined as the psoas cross-sectional area/height 2 . Primary outcome was to evaluate differences between the psoas cross-sectional area and f(PMI) between the groups, if any. Secondary outcome was to derive cut-off values using ROC curves. Results Both groups were comparable in terms of demographic characteristics. Psoas cross-sectional area (success group, 1776.5 ± 498.2 mm 2 , failure group, 1391.2 ± 589.4 mm 2 ; p = 0.022) and PMI (success group, 1089 ± 270.7 mm 2 /m 2 , failure group, 889 ± 338.5 mm 2 /m 2 ; p = 0.032) were significantly greater in the success group than in the failure group. ROC curve of the psoas cross-sectional area and PMI were used to calculate sensitivity and speciﬁcity. ROC AUC was 0.74 for psoas cross-sectional area, and at a cut-off of 1260 points, the sensitivity, speciﬁcity, and positive and negative predictive values were 95.8%, 60.0%, 79.3%, and 90.0%, respectively. ROC AUC for PMI was 0.73, and at a cut-off of 812 points, the sensitivity, speciﬁcity, and positive and negative predictive values were 95.8%, 46.7%, 74.2%, and 87.5%, respectively. Conclusions The psoas cross-sectional area and PMI can predict extubation outcomes in elderly intensive care patients.

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Sonographic Measurement of Cross-sectional Area of the Median Nerve in Academic Dentists Without Symptoms or Signs of Carpal Tunnel Syndrome

Journal of Diagnostic Medical Sonography ◽

10.1177/8756479318816951 ◽

2018 ◽

Vol 35 (2) ◽

pp. 105-111

Author(s):

Akram Asbeutah ◽

Mohsen Dashti ◽

Abdullah AlMajran ◽

Aref Ghayyath

Keyword(s):

Median Nerve ◽

Statistical Significance ◽

Working Hours ◽

Cross Sectional Area ◽

Dominant Hand ◽

Sectional Area ◽

Cross Sectional ◽

Increased Risk ◽

Bone Level ◽

The Right

The objective was to evaluate the distribution of the cross-sectional area (CSA) and flattening ratio (FR) of the median nerve (MN) in asymptomatic academic dentists using ultrasonography (US). Fifty academic dentists underwent US of the MN in transverse section at the pisiform bone level and the CSA (mm2) and FR were measured bilaterally. A CSA of <10 mm2 was considered normal. Paired t-test showed no statistical significance between either hand for CSA and FR ( P> .05). Two independent t-tests showed significant statistical differences ( P= .023) between males and females in the right dominant hand for CSA. Linear correlation analysis showed no significant correlation between CSA and FR for number of years of experience or number of working hours per day in either hand ( P>.05). The CSA was abnormal in the right dominant hand in 20 (40%) of the subjects. These male academic dentists were at increased risk of having an enlarged MN without symptoms.

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