Quantitative peripheral muscle ultrasound in sepsis: Muscle area superior to thickness

Purpose: The objective of this study is to describe the relationship between two quantitative muscle ultrasound measures, the rectus femoris cross‐sectional area (RF‐CSA) and quadriceps muscle thickness, with volitional measures of strength and function in critically ill patients with sepsis. Materials and methods: We performed a prospective study of patients admitted to a medical ICU with sepsis and shock or respiratory failure. We examined the association of two ultrasound measurements – the RF‐CSA and quadriceps muscle thickness – with strength and function at day 7. Strength was determined using the Medical Research Council Score and function using Physical Function in the ICU Test, scored. Results: Twenty‐nine patients were enrolled; 19 patients had outcome testing performed. Over 7 days, RF‐CSA and thickness decreased by an average of 23.2% and 17.9%, respectively. The rate of change per day of RF‐CSA displayed a moderate correlation with strength (&rgr; 0.51, p‐value 0.03) on day 7. Baseline and day 7 RF‐CSA did not show a significant correlation with either outcome. Quadriceps muscle thickness did not significantly correlate with either outcome. Conclusions: Muscle atrophy as detected by the rate of change in RF‐CSA moderately correlated with strength one week after sepsis admission. HighlightsMuscle atrophy occurs early in sepsis and can be detected by peripheral muscle ultrasound.Change in rectus femoris cross‐sectional area detected by ultrasound over the first week of sepsis moderately correlates with strength.Quantitative muscle ultrasound complements volitional measures of strength and function in describing skeletal muscle dysfunction in sepsis.

[1]  Arthur S Slutsky,et al.  Functional disability 5 years after acute respiratory distress syndrome. , 2011, The New England journal of medicine.

[2]  C. Roussos,et al.  Predisposing factors for critical illness polyneuromyopathy in a multidisciplinary intensive care unit , 2008, Acta neurologica Scandinavica.

[3]  L. Visser,et al.  Risk factors for the development of polyneuropathy and myopathy in critically ill patients , 2001, Critical care medicine.

[4]  Carlo Reggiani,et al.  Fiber types in mammalian skeletal muscles. , 2011, Physiological reviews.

[5]  F. Kainberger,et al.  Effects of neuromuscular electrical stimulation on muscle layer thickness of knee extensor muscles in intensive care unit patients: a pilot study. , 2010, Journal of rehabilitation medicine.

[6]  Rik Gosselink,et al.  Acute outcomes and 1-year mortality of intensive care unit-acquired weakness. A cohort study and propensity-matched analysis. , 2014, American journal of respiratory and critical care medicine.

[7]  D. Recupero,et al.  Critical illness myopathy and neuropathy , 1996, The Lancet.

[8]  K. Langa,et al.  Long-term cognitive impairment and functional disability among survivors of severe sepsis. , 2010, JAMA.

[9]  I. Campbell,et al.  Muscle thickness, measured with ultrasound, may be an indicator of lean tissue wasting in multiple organ failure in the presence of edema. , 1995, The American journal of clinical nutrition.

[10]  M. Neuhäuser,et al.  Muscle force and fatigue in patients with sepsis and multiorgan failure , 2006, Intensive Care Medicine.

[11]  L. Dušek,et al.  Risk factors for critical illness polyneuromyopathy , 2005, Journal of Neurology.

[12]  Rahul Phadke,et al.  Acute skeletal muscle wasting in critical illness. , 2013, JAMA.

[13]  Linda Denehy,et al.  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. , 2015, Journal of critical care.

[14]  Neuromuscular dysfunction acquired in critical illness: a systematic review , 2007, Intensive Care Medicine.

[15]  L. Portney,et al.  Foundations of Clinical Research: Applications to Practice , 2015 .

[16]  Linda Denehy,et al.  Interobserver Reliability of Quantitative Muscle Sonographic Analysis in the Critically Ill Population , 2015, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[17]  G. Van den Berghe,et al.  Clinical review: intensive care unit acquired weakness , 2015, Critical Care.

[18]  S. Bagshaw,et al.  Long-Term Association Between Frailty and Health-Related Quality of Life Among Survivors of Critical Illness: A Prospective Multicenter Cohort Study* , 2015, Critical care medicine.

[19]  S. Berney,et al.  Development of a physical function outcome measure (PFIT) and a pilot exercise training protocol for use in intensive care. , 2009, Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine.

[20]  Christina Routsi,et al.  Short-term systemic effect of electrical muscle stimulation in critically ill patients. , 2009, Chest.

[21]  P. Pronovost,et al.  Physical Complications in Acute Lung Injury Survivors: A Two-Year Longitudinal Prospective Study , 2014, Critical care medicine.

[22]  Bronwen Connolly,et al.  Rectus Femoris Cross-Sectional Area and Muscle Layer Thickness: Comparative Markers of Muscle Wasting and Weakness. , 2017, American journal of respiratory and critical care medicine.

[23]  C. Doig,et al.  Assessment and predictors of physical functioning post-hospital discharge in survivors of critical illness , 2016, Annals of Intensive Care.

[24]  F. Kainberger,et al.  Muscle wasting in intensive care patients: ultrasound observation of the M. quadriceps femoris muscle layer. , 2008, Journal of rehabilitation medicine.

[25]  Leslie G. Portney Dpt PhD Fapta,et al.  Foundations of Clinical Research: Applications to Practice , 2015 .

[26]  J Moxham,et al.  Comparative study of linear and curvilinear ultrasound probes to assess quadriceps rectus femoris muscle mass in healthy subjects and in patients with chronic respiratory disease , 2016, BMJ Open Respiratory Research.

[27]  C. Hough,et al.  ICU-Acquired Weakness. , 2016, Chest.

[28]  Arthur S Slutsky,et al.  One-year outcomes in survivors of the acute respiratory distress syndrome. , 2003, The New England journal of medicine.

[29]  J. Garnacho-Montero,et al.  Critical illness polyneuropathy: risk factors and clinical consequences. A cohort study in septic patients , 2001, Intensive Care Medicine.

[30]  I. Campbell,et al.  Muscle wasting and energy balance in critical illness. , 2004, Clinical nutrition.

[31]  A. Bersten,et al.  Alterations in Respiratory and Limb Muscle Strength and Size in Patients With Sepsis Who Are Mechanically Ventilated , 2013, Physical Therapy.

[32]  J. Vincent,et al.  The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure , 1996, Intensive Care Medicine.

[33]  M. Sandri,et al.  Cellular and molecular mechanisms of muscle atrophy , 2013, Disease Models & Mechanisms.

[34]  W. Knaus,et al.  Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. , 1992, Chest.

[35]  C. Hough,et al.  Manual muscle strength testing of critically ill patients: feasibility and interobserver agreement , 2011, Critical care.

[36]  P. Morris,et al.  A conceptual framework: the early and late phases of skeletal muscle dysfunction in the acute respiratory distress syndrome , 2015, Critical Care.

[37]  Thuy-Tien L. Dam,et al.  The feasibility of measuring frailty to predict disability and mortality in older medical intensive care unit survivors. , 2014, Journal of critical care.

[38]  M. Sandri.  Protein breakdown in muscle wasting: Role of autophagy-lysosome and ubiquitin-proteasome☆☆☆ , 2013, The international journal of biochemistry & cell biology.

[39]  C. Hough,et al.  Quantitative neuromuscular ultrasound in intensive care unit–acquired weakness: A systematic review , 2015, Muscle & nerve.

[40]  J. Garnacho-Montero,et al.  Effect of critical illness polyneuropathy on the withdrawal from mechanical ventilation and the length of stay in septic patients* , 2005, Critical care medicine.

[41]  Isabelle Durand-Zaleski,et al.  Paresis acquired in the intensive care unit: a prospective multicenter study. , 2002, JAMA.

[42]  S. Berney,et al.  A Physical Function Test for Use in the Intensive Care Unit: Validity, Responsiveness, and Predictive Utility of the Physical Function ICU Test (Scored) , 2013, Physical Therapy.

[43]  J Moxham,et al.  Ultrasound measurement of rectus femoris cross-sectional area and the relationship with quadriceps strength in COPD , 2009, Thorax.

[44]  L. Purcell,et al.  Therapeutic exercise attenuates neutrophilic lung injury and skeletal muscle wasting , 2015, Science Translational Medicine.