Tom Fivez1, Alexandra Hendrickx1, Tom Van Herpe2, Dirk Vlasselaers1, Lars Desmet1, Greet Van den Berghe1, Dieter Mesotten3. 1. Department of Intensive Care Medicine, U Leuven-University of Leuven, University Hospitals Leuven, Leuven, Belgium. 2. Department of Intensive Care Medicine, U Leuven-University of Leuven, University Hospitals Leuven, Leuven, Belgium Department of Electrical Engineering-ESAT-SCD/iMINDS Medical Information Technologies, KU Leuven-University of Leuven, Leuven, Belgium. 3. Department of Intensive Care Medicine, U Leuven-University of Leuven, University Hospitals Leuven, Leuven, Belgium dieter.mesotten@med.kuleuven.be.
Abstract
BACKGROUND: Muscle wasting starts already within the first week in critically patients and is strongly related to poor outcome. Nevertheless, the early detection of muscle wasting is difficult. Therefore, we investigated the reliability and accuracy of ultrasonography to evaluate skeletal muscle wasting in critically ill children and adults. METHODS: This prospective observational study enrolled 30 sedated critically ill children and 14 critically ill adults. Two independent investigators made 210 ultrasonographical assessments of muscle thigh thickness. Inter- and intraobserver reliability and cutoff levels were calculated as a function of muscle thickness and the expected reduction in muscle size (predefined at 20% and 30%). RESULTS: Mean ± SD muscle thickness was 1.67 ± 0.55 cm in the pediatric and 2.10 ± 0.85 cm in the adult population. The median absolute interobserver variability was 0.07 cm (interquartile range [IQR], 0.04-0.20 cm) in the pediatric population and 0.05 cm (IQR, 0.03-0.09 cm) in the adult population. However, the absolute intraobserver accuracy had a 95% confidence interval of 0.43 cm in children and 0.22 cm in adults. Only a 30% decrease (0.50 cm) in muscle thickness can be detected in critically ill children. CONCLUSION: Although the interobserver variability is acceptable in the pediatric population, the intraobserver variability is too large with respect to the expected reduction in muscle thickness. In adults, ultrasonography may be a reliable tool for early detection of muscle mass wasting.
BACKGROUND: Muscle wasting starts already within the first week in critically patients and is strongly related to poor outcome. Nevertheless, the early detection of muscle wasting is difficult. Therefore, we investigated the reliability and accuracy of ultrasonography to evaluate skeletal muscle wasting in critically ill children and adults. METHODS: This prospective observational study enrolled 30 sedated critically ill children and 14 critically ill adults. Two independent investigators made 210 ultrasonographical assessments of muscle thigh thickness. Inter- and intraobserver reliability and cutoff levels were calculated as a function of muscle thickness and the expected reduction in muscle size (predefined at 20% and 30%). RESULTS: Mean ± SD muscle thickness was 1.67 ± 0.55 cm in the pediatric and 2.10 ± 0.85 cm in the adult population. The median absolute interobserver variability was 0.07 cm (interquartile range [IQR], 0.04-0.20 cm) in the pediatric population and 0.05 cm (IQR, 0.03-0.09 cm) in the adult population. However, the absolute intraobserver accuracy had a 95% confidence interval of 0.43 cm in children and 0.22 cm in adults. Only a 30% decrease (0.50 cm) in muscle thickness can be detected in critically ill children. CONCLUSION: Although the interobserver variability is acceptable in the pediatric population, the intraobserver variability is too large with respect to the expected reduction in muscle thickness. In adults, ultrasonography may be a reliable tool for early detection of muscle mass wasting.
Authors: Lyvonne N Tume; Frederic V Valla; Koen Joosten; Corinne Jotterand Chaparro; Lynne Latten; Luise V Marino; Isobel Macleod; Clémence Moullet; Nazima Pathan; Shancy Rooze; Joost van Rosmalen; Sascha C A T Verbruggen Journal: Intensive Care Med Date: 2020-02-20 Impact factor: 17.440
Authors: Carlos Alfredo Galindo Martín; Reyna Del Carmen Ubeda Zelaya; Enrique Monares Zepeda; Octavio Augusto Lescas Méndez Journal: J Nutr Metab Date: 2018-04-01