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

• Published in: Journal of critical care 2018-10, Vol.47, p.324-330
• Main Authors: Palakshappa, Jessica A., Reilly, John P., Schweickert, William D., Anderson, Brian J., Khoury, Viviane, Shashaty, Michael G., Fitzgerald, David, Forker, Caitlin, Butler, Kelly, Ittner, Caroline A., Feng, Rui, Files, D. Clark, Bonk, Michael P., Christie, Jason D., Meyer, Nuala J.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Critical Care; Critical Illness; Cross-Sectional Studies; Female; Hospitals; Humans; ICU acquired weakness; Illnesses; Intensive care; Male; Middle Aged; Muscle weakness; Muscular Atrophy - diagnostic imaging; Musculoskeletal system; Ostomy; Patients; Prospective Studies; Quadriceps muscle; Quadriceps Muscle - diagnostic imaging; Quadriceps Muscle - physiopathology; Respiratory failure; Sepsis; Sepsis - diagnostic imaging; Sepsis - therapy; Shock, Septic; Ultrasonic imaging; Ultrasonography; Ventilators
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2018.04.003

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. 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. Twenty-nine patients were enrolled; 19 patients had outcome testing performed. Over 7days, 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 (ρ 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. Muscle atrophy as detected by the rate of change in RF-CSA moderately correlated with strength one week after sepsis admission. •Muscle 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.