Quantitative neuromuscular ultrasound in the intensive care unit
Department of Neurology, Wake Forest University School of Medicine, Reynolds Tower, Winston-Salem, North Carolina 27157, USA. . Muscle & Nerve
(Impact Factor: 2.28).
02/2013; 47(2). DOI: 10.1002/mus.23525
Intensive care unit acquired weakness (ICU-AW) results from a complex mixture of nerve and muscle pathology, and early identification is challenging. This pilot study was designed to examine the ultrasonographic changes that occur in muscles during ICU hospitalization.
Patients admitted to the ICU for acute respiratory failure were enrolled prospectively and underwent serial muscle ultrasound for thickness and gray-scale assessment of the tibialis anterior, rectus femoris, abductor digiti minimi, biceps, and diaphragm muscles over 14 days.
Sixteen participants were enrolled. The tibialis anterior (P = 0.001) and rectus femoris (P = 0.041) had significant decreases in gray-scale standard deviation when analyzed over 14 days. No muscles showed significant changes in thickness.
Ultrasound is an informative technique for assessing muscles of patients in the ICU, and lower extremity muscles demonstrated increased homogeneity during ICU stays. This technique should be examined further for diagnosing and tracking those with ICU-AW.
Figures in this publication
Available from: Otto W Witte
- "We found significant alterations in muscle echotexture in the early stage of sepsis compared with healthy controls. Similar changes have also been described in a recent study of 16 patients with acute respiratory distress syndrome . The marked changes in muscle echotexture during sepsis may refer to muscle edema due to capillary leak in the acute stage and to fibrosis and fatty degeneration in the subacute stage of sepsis. "
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ABSTRACT: Muscle ultrasound is emerging as a promising tool in the diagnosis of neuromuscular diseases. The current observational study evaluates the usefulness of muscle ultrasound in patients with severe sepsis for assessment of critical illness polyneuropathy and myopathy (CINM) in the intensive care unit.
28 patients with either septic shock or severe sepsis underwent clinical neurological examinations, muscle ultrasound, and nerve conduction studies on days 4 and 14 after onset of sepsis. 26 healthy controls of comparable age underwent clinical neurological evaluation and muscle ultrasound only.
26 of the 28 patients exhibited classic electrophysiological characteristics of CINM, and all showed typical clinical signs. Ultrasonic echogenicity of muscles was graded semiquantitatively and fasciculations were evaluated in muscles of proximal and distal arms and legs. 75% of patients showed a mean echotexture greater than 1.5, which was the maximal value found in the control group. A significant difference in mean muscle echotexture between patients and controls was found at day 4 and day 14 (both p < 0.001). In addition, from day 4 to day 14, the mean grades of muscle echotexture increased in the patient group, although the values did not reach significance levels (p = 0.085). Controls revealed the lowest number of fasciculations. In the patients group, fasciculations were detected in more muscular regions (lower and upper arm and leg) in comparison to controls (p = 0.08 at day 4 and p = 0.002 at day 14).
Muscle ultrasound represents an easily applicable, non-invasive diagnostic tool which adds to neurophysiological testing information regarding morphological changes of muscles early in the course of sepsis. Muscle ultrasound could be useful for screening purposes prior to subjecting patients to more invasive techniques such as electromyography and/or muscle biopsy.
German Clinical Trials Register, DRKS-ID: DRKS00000642.
Critical care (London, England) 10/2013; 17(5):R227. DOI:10.1186/cc13050 · 4.48 Impact Factor
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ABSTRACT: Acute Respiratory Failure patients experience significant muscle weakness which contributes to prolonged hospitalization and functional impairments post-hospital discharge. Based on our previous work, we hypothesize that an exercise intervention initiated early in the intensive care unit aimed at improving skeletal muscle strength could decrease hospital stay and attenuate the deconditioning and skeletal muscle weakness experienced by these patients.
Early exercise has the potential to decrease hospital length of stay and improve function in Acute Respiratory Failure patients.
Exercise and sport sciences reviews 07/2013; 41(4). DOI:10.1097/JES.0b013e3182a4e67c · 4.26 Impact Factor
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ABSTRACT: Although it has been demonstrated that physical functional impairments are common among survivors of critical illness, few studies have proven benefits of intervention. This review will discuss assessment of physical functional impairment, recent and ongoing interventional studies, and implementation of rehabilitation beginning in the ICU, hospital ward, and after hospital discharge.
New studies confirm challenges around measurement of physical function both during and after critical illness, and offer potential new modalities that could inform mechanism and treatment. Longitudinal cohort studies emphasize the importance of recognition and measurement of premorbid status. Although no recent studies have proven new approaches to improving physical function in survivors of critical illness, emerging data support the safety, feasibility, and cost-effectiveness of providing physical rehabilitation early in the course of critical illness. Pilot and ongoing studies hold promise for improving physical function and quality of life for future survivors of critical illness.
Improving physical function for survivors of critical illness will require careful application of current knowledge, as well as rigorous investigation into causes, research methodologies, and implementation of results of future interventional studies.
Current opinion in critical care 08/2013; 19(5). DOI:10.1097/MCC.0b013e328364d7ef · 2.62 Impact Factor
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