The use of ultrasound in the evaluation of lean body mass and the forethought of clinical outcomes in critical patients

Authors

DOI:

https://doi.org/10.55892/jrg.v7i14.907

Keywords:

Intensive Care Units, Muscular Atrophy, Quadriceps Muscle, Ultrasonography

Abstract

Muscle loss in critically ill patients is common due to prolonged immobilization, inflammatory state, severity of the underlying disease, metabolic complications and difficulty in adequate intake of essential nutrients. In these patients, monitoring nutritional status is essential, but challenging due to practical limitations in intensive care environments. In this context, ultrasound has emerged as a promising bedside tool for muscle mass assessment. This integrative literature review aims to answer the following question: do reductions in muscle quality and quantity have implications for clinical outcomes in critically ill patients? The search for scientific articles was conducted through an electronic search on the PubMed portal, with inclusion criteria that included full articles available electronically, published in Portuguese, English, or Spanish, addressing muscle quality/quantity (evaluated by ultrasound) and clinical outcomes in adult critical patients (age > 18 years). Studies focused on the pectoral and diaphragm muscles, research with non-critical patients, review articles and presentation letters were excluded from the sample. Fifteen studies, totaling 992 patients, met the selection criteria. The reductions observed during the hospitalization period were significant and progressive, establishing a consistent correlation with clinical and functional outcomes in most studies. The increase in echogenicity and reductions in thickness and muscle area appear to be related to increased mortality, mechanical ventilation time, hospitalization time, organ dysfunction and worsening functional capacity. This set of evidence highlights the importance of muscle assessment and ultrasound as a valuable tool to understand and anticipate clinical developments in critically ill patients.

Downloads

Download data is not yet available.

Author Biographies

Yone Gabrielle do Nascimento Sodré, Fundação de Ensino e Pesquisa em Ciências da Saúde, DF, Brasil

[Lattes]
Graduada em Nutrição pela Universidade de Brasília; Residente do Programa de Residência Multiprofissional em Terapia Intensiva SES/DF - Brasília, DF (Brasil).

Polyana Alves Rodrigues, Fundação de Ensino e Pesquisa em Ciências da Saúde, DF, Brasil

[Lattes]
Graduada em Nutrição pela Universidade de Brasília. Mestre(a) em Ciências da Saúde, pela Universidade de Brasília - Brasília, DF (Brasil).

References

ARBEILLE, P. et al. Quantification of Muscle Volume by Echography: Comparison with MRI Data on Subjects in Long-Term Bed Rest. Ultrasound in Medicine and Biology, v. 35, n. 7, p. 1092–1097, 1 jul. 2009.

BABB, T.; LEVINE, B.; PHILLEY, J. ICU-Acquired Weakness: An Extension of the Effects of Bed Rest. American Journal of Respiratory and Critical Care Medicine, v. 185, n. 2, p. 230–231, 15 jan. 2012.

BAGSHAW, S. M. et al. Association between frailty and short- and long-term outcomes among critically ill patients: a multicentre prospective cohort study. Canadian Medical Association Journal, v. 186, n. 2, p. E95–E102, 4 fev. 2014.

BERGER, J. et al. Rectus femoris (RF) ultrasound for the assessment of muscle mass in older people. Archives of Gerontology and Geriatrics, v. 61, n. 1, p. 33–38, 2015.

CENICCOLA, G. D. et al. Current technologies in body composition assessment: advantages and disadvantages. Nutrition, v. 62, p. 25–31, 2019.

CONNOLLY, B. A. et al. Clinical predictive value of manual muscle strength testing during critical illness: an observational cohort study. Critical Care, v. 17, n. 5, p. R229, 2013.

DENEHY, L. 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). Physical Therapy, v. 93, n. 12, p. 1636–1645, 1 dez. 2013.

EARTHMAN, C. P. Body Composition Tools for Assessment of Adult Malnutrition at the Bedside. Journal of Parenteral and Enteral Nutrition, v. 39, n. 7, p. 787–822, 1 set. 2015.

ER, B. et al. Association of baseline diaphragm, rectus femoris and vastus intermedius muscle thickness with weaning from mechanical ventilation. Respiratory medicine, v. 185, p. 106503, 2021.

ER, B. et al. Association of nutritional status, frailty, and rectus femoris muscle thickness measured by ultrasound and weaning in critically ill elderly patients. Tuberk Toraks, v. 71, n. 1, p. 1–6, 10 mar. 2023.

FORMENTI, P. et al. Clinical review: peripheral muscular ultrasound in the ICU. Annals of Intensive Care, v. 9, n. 1, p. 57, 2019.

GRAF, C. The Lawton Instrumental Activities of Daily Living Scale. AJN, American Journal of Nursing, v. 108, n. 4, p. 52–62, abr. 2008.

GRUTHER, W. et al. Muscle Wasting in Intensive Care Patients: Ultrasound Observation of the M. Quadriceps Femoris Muscle Layer. Acta dermato-venereologica, v. 40, n. 3, p. 185–189, 2008.

HERMANS, G. et al. Interobserver agreement of medical research council sum-score and handgrip strength in the intensive care unit. Muscle & Nerve, v. 45, n. 1, p. 18–25, 1 jan. 2012.

HODGSON, C. et al. Feasibility and inter-rater reliability of the ICU Mobility Scale. Heart & Lung, v. 43, n. 1, p. 19–24, jan. 2014.

HRDY, O. et al. Incidence of muscle wasting in the critically ill: a prospective observational cohort study. Scientific reports, v. 13, n. 1, p. 742, 2023.

JUNG LEE, S. et al. Relation between whole-body and regional measures of human skeletal muscle. The American Journal of Clinical Nutrition, v. 80, n. 5, p. 1215–1221, nov. 2004.

LEE, Z.-Y. et al. Association between ultrasound quadriceps muscle status with premorbid functional status and 60-day mortality in mechanically ventilated critically ill patient: A single-center prospective observational study. Clinical Nutrition, v. 40, n. 3, p. 1338–1347, 1 mar. 2021.

MAGALHÃES, L. M. et al. Variability in the rectus femoris muscle area and its association with clinical outcomes in critically ill patients: a prospective cohort study. Revista Brasileira de terapia intensiva, v. 32, n. 1, p. 156–158, 2020.

MAYER, K. P. et al. Acute skeletal muscle wasting and dysfunction predict physical disability at hospital discharge in patients with critical illness. Critical Care, v. 24, n. 1, p. 637, 2020.

MENDES, J. N. DA S. et al. Evaluation of muscle loss by ultrasonography in critically ill patients. Nutrition in clinical practice, v. 38, n. 3, p. 664–671, 2023.

MINOSSO, J. S. M. et al. Validação, no Brasil, do Índice de Barthel em idosos atendidos em ambulatórios. Acta Paulista de Enfermagem, v. 23, n. 2, p. 218–223, abr. 2010.

MOURTZAKIS, M. et al. Skeletal muscle ultrasound in critical care: A tool in need of translation. Annals of the American Thoracic SocietyAmerican Thoracic Society,1 out. 2017.

MUÑOZ-BERMEJO, L. et al. Test-Retest Reliability of Five Times Sit to Stand Test (FTSST) in Adults: A Systematic Review and Meta-Analysis. Biology, v. 10, n. 6, 9 jun. 2021.

NANAS, S. et al. Predisposing factors for critical illness polyneuromyopathy in a multidisciplinary intensive care unit. Acta Neurologica Scandinavica, v. 118, n. 3, p. 175–181, set. 2008.

NAQVI, U.; SHERMAN, A. L. Muscle Strength Grading. [s.l.] StatPearls Publishing LLC, 2023.

OLIVEIRA, A. C. L. DE; REIS, M. M. P. DO; MENDONÇA, S. S. Alterações na composição corporal em pacientes internados em unidades de terapia intensiva . Comun. ciênc. saúde, 2012.

PAGE, M. J. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, p. n71, 29 mar. 2021.

PARIS, M. T. et al. Validation of Bedside Ultrasound of Muscle Layer Thickness of the Quadriceps in the Critically Ill Patient (VALIDUM Study). Journal of Parenteral and Enteral Nutrition, v. 41, n. 2, p. 171–180, 1 fev. 2017.

PARRY, S. M. 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. Journal of Critical Care, v. 30, n. 5, p. 1151.e9-1151.e14, 2015.

PASSOS, L. B. DA S.; MACEDO, T. A. A.; DE-SOUZA, D. A. Nutritional state assessed by ultrasonography, but not by bioelectric impedance, predicts 28-day mortality in critically ill patients. Prospective cohort study. Clinical nutrition (Edinburgh, Scotland), v. 40, n. 12, p. 5742–5750, 2021.

PERKISAS, S. et al. Application of ultrasound for muscle assessment in sarcopenia: 2020 SARCUS update. European Geriatric Medicine, v. 12, n. 1, p. 45–59, 2 fev. 2021.

PUTHUCHEARY, Z. A. et al. Acute Skeletal Muscle Wasting in Critical Illness. JAMA, v. 310, n. 15, p. 1591–1600, 16 out. 2013.

ROCKWOOD, K. A global clinical measure of fitness and frailty in elderly people. Canadian Medical Association Journal, v. 173, n. 5, p. 489–495, 30 ago. 2005.

SILVA, T. M. DA et al. Avaliação da perda de massa muscular em pacientes críticos: utilizando a ultrassonografia como ferramenta. Brazilian Journal of Development, v. 8, n. 12, p. 78589–78598, 12 dez. 2022.

SILVERIO, R. et al. Coronavirus Disease 2019 (COVID-19) and Nutritional Status: The Missing Link? Advances in nutrition (Bethesda, Md.), v. 12, n. 3, p. 682–692, 1 jun. 2021.

TANAKA, K.; YAMADA, T. Ultrasound Measurement of Septic Shock‐induced Acute Skeletal Muscle Atrophy in Intensive Care Unit. PM & R, v. 13, n. 4, p. 347–352, 2021.

TOLEDO, D. O. et al. Peripheral muscular ultrasound as outcome assessment tool in critically ill patients on mechanical ventilation: An observational cohort study. Clinical nutrition ESPEN, v. 43, p. 408–414, 2021.

TOUREL, C. et al. Reliability of standardized ultrasound measurement of quadriceps muscle thickness in critically ill neurological patients: Comparison with computed tomography measures. Journal of Rehabilitation Medicine, v. 52, n. 3, 1 mar. 2020.

UMBRELLO, M. et al. Qualitative and quantitative muscle ultrasound changes in patients with COVID-19–related ARDS. Nutrition, v. 91–92, p. 111449, 2021.

URSI, E. S. PREVENÇÃO DE LESÕES DE PELE NO PERIOPERATÓRIO : REVISÃO INTEGRATIVA DA LITERATURA. Dissertação—Ribeirão Preto: Universidade de São Paulo, 2005.

VIEIRA, L. et al. Confiabilidade da ultrassonografia de músculos esqueléticos em pacientes críticos de trauma. Revista Brasileira de Terapia Intensiva, v. 31, 2019.

YANAGI, N. et al. Assessment of Sarcopenia in the Intensive Care Unit and 1-Year Mortality in Survivors of Critical Illness. Nutrients, v. 13, n. 8, 1 ago. 2021.

ZHAO, R. et al. Evaluation of Appendicular Muscle Mass in Sarcopenia in Older Adults Using Ultrasonography: A Systematic Review and Meta-Analysis. Gerontology, v. 68, n. 10, p. 1174–1198, 25 jul. 2022.

Published

2024-01-23

How to Cite

SODRÉ, Y. G. do N.; ALVES RODRIGUES, P. The use of ultrasound in the evaluation of lean body mass and the forethought of clinical outcomes in critical patients. JRG Journal of Academic Studies, Brasil, São Paulo, v. 7, n. 14, p. e14907, 2024. DOI: 10.55892/jrg.v7i14.907. Disponível em: https://revistajrg.com/index.php/jrg/article/view/907. Acesso em: 24 nov. 2024.

ARK