Point-of-care ultrasound to evaluate thickness of rectus femoris, vastus intermedius muscle, and fat as an indicator of muscle and fat wasting in critically ill patients in a multidisciplinary intensive care unit
Citation Information :
Katari Y, Muneer S, Arvind P. Point-of-care ultrasound to evaluate thickness of rectus femoris, vastus intermedius muscle, and fat as an indicator of muscle and fat wasting in critically ill patients in a multidisciplinary intensive care unit. Indian J Crit Care Med 2018; 22 (11):781-788.
Background: Muscular atrophy is the universal feature in patients with ICUAW. Muscles of the lower limb are more prone to early atrophy. Measurement of fat thickness is used to assess malnutrition. This study was designed to evaluate if, subcutaneous fat also reduces along with muscle thickness and if it can be reliably used as an indicator of nutritional assessment in critically ill patients using point of care ultrasound.
Materials and Methods: An observational clinical study of 100 patients admitted to multidisciplinary intensive care units (ICUs). Total anterior thigh thickness, thickness of the rectus femoris muscle, fat thickness, and the combined thickness of vastus intermedius and rectus femoris were taken on day 1, 3, and 7 of ICU admission.
Results: There was progressive loss of muscle mass from day 1 to day 7. Muscle loss was not only limited to rectus femoris, but vastus intermedius also showed a significant decrease as indicated by the bone to muscle measurement. Skin to bone measurement which includes both muscle and fat compartment showed a decline.
Conclusions: There is potential utility of ultrasound for early detection and probable corrective measures to prevent ICUAW. The rectus femoris thickness, skin to bone, and bone to muscle thickness show statistically significant difference on day 3, day 7 compared to day 1. Fat layer did not show statistically significant decrease.
Fan E, Cheek F, Chlan L, Gosselink R, Hart N, Herridge MS, et al. An official American Thoracic Society Clinical Practice Guideline: The diagnosis of intensive care unit-acquired weakness in adults. Am J Respir Crit Care Med 2014;190:1437-46.
Casaer MP. Muscle weakness and nutrition therapy in ICU. Curr Opin Clin Nutr Metab Care 2015;18:162-8.
Bender DV, Krznaric Z, Kunovic A, Rupcic I. Malnutrition in ICU. In: Croatian International Symposium on Intensive Care Medicine. Zagreb: Croatia; 2012.
Files DC, Sanchez MA, Morris PE. A conceptual framework: The early and late phases of skeletal muscle dysfunction in the acute respiratory distress syndrome. Crit Care 2015;19:266.
Puthucheary ZA, Rawal J, McPhail M, Connolly B, Ratnayake G, Chan P, et al. Acute skeletal muscle wasting in critical illness. JAMA 2013;310:1591-600.
Casaer MP, Wilmer A, Hermans G, Wouters PJ, Mesotten D, Van den Berghe G, et al. Role of disease and macronutrient dose in the randomized controlled EPaNIC trial: A post hoc analysis. Am J Respir Crit Care Med 2013;187:247-55.
De Jonghe B, Bastuji-Garin S, Durand MC, Malissin I, Rodrigues P, Cerf C, et al. Respiratory weakness is associated with limb weakness and delayed weaning in critical illness. Crit Care Med 2007;35:2007-15.
Weijs PJ, Looijaard WG, Dekker IM, Stapel SN, Girbes AR, Oudemans-van Straaten HM, et al. Low skeletal muscle area is a risk factor for mortality in mechanically ventilated critically ill patients. Crit Care 2014;18:R12.
Hermans G, Van Mechelen H, Clerckx B, Vanhullebusch T, Mesotten D, Wilmer A, et al. Acute outcomes and 1-year mortality of intensive care unit-acquired weakness. A cohort study and propensity-matched analysis. Am J Respir Crit Care Med 2014;190:410-20.
Gruther W, Benesch T, Zorn C, Paternostro-Sluga T, Quittan M, Fialka-Moser V, et al. Muscle wasting in intensive care patients: Ultrasound observation of the M. quadriceps femoris muscle layer. J Rehabil Med 2008;40:185-9.
Manning EM, Shenkin A. Nutritional assessment in the critically ill. Crit Care Clin 1995;11:603-34.
Fischer M, JeVenn A, Hipskind P. Evaluation of muscle and fat loss as diagnostic criteria for malnutrition. Nutr Clin Pract 2015;30:239-48.
Turton P, Hay R, Taylor J, McPhee J, Welters I. Human limb skeletal muscle wasting and architectural remodeling during five to ten days intubation and ventilation in critical care – An observational study using ultrasound. BMC Anesthesiol 2016;16:119.
Tillquist M, Kutsogiannis DJ, Wischmeyer PE, Kummerlen C, Leung R, Stollery D, et al. Bedside ultrasound is a practical and reliable measurement tool for assessing quadriceps muscle layer thickness. JPEN J Parenter Enteral Nutr 2014;38:886-90.
Paris MT, Mourtzakis M, Day A, Leung R, Watharkar S, Kozar R, et al. Validation of bedside ultrasound of muscle layer thickness of the quadriceps in the critically ill patient (VALIDUM study). JPEN J Parenter Enteral Nutr 2017;41:171-80.
Annetta MG, Pittiruti M, Silvestri D, Grieco DL, Maccaglia A, La Torre MF, et al. Ultrasound assessment of rectus femoris and anterior tibialis muscles in young trauma patients. Ann Intensive Care 2017;7:104.
Rosner B. Fundamentals of Biostatistics. Cengage Learning, 5th ed. Boston, Massachusetts: Duxbury; 2000. p. 80-240.
Riffenburg RH. Statistics in Medicine. 2nd ed. “Cambridge, Massachusetts: Academic Press; 2005. p. 85-125.
Sunder Rao PS, Richard J. An Introduction to Biostatistics, a Manual for Students in Health Sciences. 4th ed. New Delhi: Prentice Hall of India; 2006. p. 86-160.
Suresh K, Chandrashekara S. Sample size estimation and power analysis for clinical research studies. J Hum Reprod Sci 2012;5:7-13.
Seymour JM, Ward K, Sidhu PS, Puthucheary Z, Steier J, Jolley CJ, et al. Ultrasound measurement of rectus femoris cross-sectional area and the relationship with quadriceps strength in COPD. Thorax 2009;64:418-23.
Campbell SE, Adler R, Sofka CM. Ultrasound of muscle abnormalities. Ultrasound Q 2005;21:87-94.
Pillen S, Arts IM, Zwarts MJ. Muscle ultrasound in neuromuscular disorders. Muscle Nerve 2008;37:679-93.
Guerreiro AC, Tonelli AC, Orzechowski R, Dalla Corte RR, Moriguchi EH, de Mello RB, et al. Bedside ultrasound of quadriceps to predict rehospitalization and functional decline in hospitalized elders. Front Med (Lausanne) 2017;4:122.
