Assessing Clinical Variables Associated With Femoral Muscle Decay as Measured by Point-of-Care Ultrasound in Critically Ill Children

IF 2.1 4区 医学 Q2 ACOUSTICS Journal of Ultrasound in Medicine Pub Date : 2024-09-23 DOI:10.1002/jum.16579
Esther J. Kim MD, Kitman Wai MD, Leah Pedoeim MD, Sonali Basu MD
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Abstract

Objectives

Skeletal muscle wasting is a common occurrence in critical illness, often resulting in intensive care unit (ICU)-acquired weakness. This study aims to identify clinical factors associated with muscle decay in mechanically ventilated critically ill children. Utilizing point-of-care ultrasound, a noninvasive and cost-effective tool, we assess muscle decay through ultrasound of the quadriceps femoris.

Methods

A prospective observational study was conducted in a single-center quaternary-care pediatric intensive care unit at a children's hospital. A convenience sample of 103 sedated and mechanically ventilated patients were enrolled in this study. Ultrasound measurements of quadriceps femoris muscle thickness were taken, and daily muscle decay rates were calculated. Demographic, clinical, and outcome data were analyzed for correlations with muscle decay.

Results

Among the enrolled patients, 67 had repeat measurements. Muscle thickness change aligned with prior studies, with a mean daily change of −1.9% [IQR −0.8, −5.0]. Adequate cumulative caloric intake (>60% of goal) correlated with less muscle decay compared with inadequate intake (−1.8 vs −2.4%, P < .001). Average daily muscle change correlated with both ICU and hospital length of stay (LOS) (r = .328, P = .007 and r = .393, P = .001). No significant correlations emerged between muscle change and mortality, disease severity, fluid balance, early mobilization, steroid exposure, or sedative and paralytic use.

Conclusion

This study demonstrates early and frequent muscle decay in critically ill children, as detected by point-of-care ultrasound. Average daily muscle decay was associated with longer ICU and hospital LOS. Adequate cumulative caloric intake is linked to reduced muscle decay. These findings contribute to understanding muscle wasting in critically ill pediatric patients.

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评估重症儿童通过护理点超声波测量到的与股骨肌肉衰退相关的临床变量。
目的:骨骼肌萎缩是危重病人的常见病,通常会导致重症监护室(ICU)获得性虚弱。本研究旨在确定与机械通气重症患儿肌肉萎缩相关的临床因素。我们利用护理点超声这种无创、经济有效的工具,通过股四头肌超声评估肌肉衰减情况:一项前瞻性观察研究在一家儿童医院的单中心四级儿科重症监护病房进行。103名使用镇静剂和机械通气的患者被纳入了这项研究。研究人员通过超声波测量了股四头肌的厚度,并计算了每日肌肉衰减率。研究人员还分析了人口统计学、临床和结果数据与肌肉衰减的相关性:在登记的患者中,67 人进行了重复测量。肌肉厚度变化与之前的研究一致,平均每日变化率为-1.9% [IQR -0.8, -5.0]。与摄入不足相比,充足的累积热量摄入(>目标值的 60%)与较少的肌肉衰减相关(-1.8 vs -2.4%,P 结论:这项研究表明,重症儿童肌肉衰减很早且频繁,可通过护理点超声波检测到。平均每天的肌肉衰减与较长的重症监护室和住院时间有关。充足的累积热量摄入与减少肌肉衰减有关。这些发现有助于了解重症儿科病人的肌肉萎缩情况。
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来源期刊
CiteScore
5.10
自引率
4.30%
发文量
205
审稿时长
1.5 months
期刊介绍: The Journal of Ultrasound in Medicine (JUM) is dedicated to the rapid, accurate publication of original articles dealing with all aspects of medical ultrasound, particularly its direct application to patient care but also relevant basic science, advances in instrumentation, and biological effects. The journal is an official publication of the American Institute of Ultrasound in Medicine and publishes articles in a variety of categories, including Original Research papers, Review Articles, Pictorial Essays, Technical Innovations, Case Series, Letters to the Editor, and more, from an international bevy of countries in a continual effort to showcase and promote advances in the ultrasound community. Represented through these efforts are a wide variety of disciplines of ultrasound, including, but not limited to: -Basic Science- Breast Ultrasound- Contrast-Enhanced Ultrasound- Dermatology- Echocardiography- Elastography- Emergency Medicine- Fetal Echocardiography- Gastrointestinal Ultrasound- General and Abdominal Ultrasound- Genitourinary Ultrasound- Gynecologic Ultrasound- Head and Neck Ultrasound- High Frequency Clinical and Preclinical Imaging- Interventional-Intraoperative Ultrasound- Musculoskeletal Ultrasound- Neurosonology- Obstetric Ultrasound- Ophthalmologic Ultrasound- Pediatric Ultrasound- Point-of-Care Ultrasound- Public Policy- Superficial Structures- Therapeutic Ultrasound- Ultrasound Education- Ultrasound in Global Health- Urologic Ultrasound- Vascular Ultrasound
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