Association of quadriceps muscle thickness with the rectus femoris cross-sectional area, muscle strength and gait speed of critically ill patients
DOI:
https://doi.org/10.5902/2236583440611Keywords:
Intensive Care Unit, Ultrasonography, Quadriceps muscle, Muscle strength.Abstract
Objective: To verify whether there is an association between quadriceps muscle thickness (QMT) and rectus femoral cross-sectional area (RF), muscle strength and gait speed of critically ill patients. Methods: Cross-sectional study conducted at an adult intensive care unit of a tertiary hospital in southern Brazil. The QMT and RF were measured by ultrasonography, within the first 24 hours of mechanical ventilation, muscle strength was measured using the Medical Research Council scale on the awakening of patient. Gait speed was measured by the 6-m gait speed test at hospital discharge. Results: The sample consisted of 28 patients (46 ± 18 years, 20 males). The QMT showed a strong positive correlation with RF (r=0.708; p <0.0001) and moderate positive correlation with gait speed (r = 0.627; p = 0.003). Multivariate analysis showed the RF was the independent predictor variable of the QMT (β=0.14; p=0.003). Conclusion: The study showed that QMT was associated with rectus femoral cross-sectional area and gait speed of critically ill patients at the evaluated moments. In addition, RF was an independent predictor of EMQ. These results are clinically relevant because they describe the early applicability of quantitative ultrasound measurements in the setting of critically ill patients, as well as the relationship with functional outcomes.Downloads
References
Martinez BP, Alves GAA. Avaliação muscular em terapia intensiva. Profisio - Programa de Atualização em Fisioterapia em Terapia Intensiva Adulto. 2017;3:51–79.
Mesquita TMJC, Gardenghi G. Imobilismo e fraqueza muscular adquirida na unidade de terapia intensiva. Rev Bras de Saúde Func. 2016;1(3):1-12.
Koukourikos K, Tsaloglidou A, Kourkouta L. Muscle atrophy in Intensive Care Unit patients. Acta Inform Med. 2014;22(6):406-410.
Pardo E, El Behi H, Boizeau P, Verdonk F, Alberti C, Lescot T. Reliability of ultrasound measurements of quadriceps muscle thickness in critically ill patients. BMC Anesthesiol 2018;18(205):1-8.
Chlan LL, Tracy MF, Guttormson J, Savik K. Description of peripheral muscle strength measurement and correlates of muscle weakness in patients receiving prolonged mechanical ventilatory support. Am J Crit Care. 2015;24(6):91-98.
Santos LJ, Silveira FS, Müller FF, Araújo HD, Comerlato JB, Silva MC, Silva PB. Avaliação funcional de pacientes internados na Unidade de Terapia Intensiva adulto do Hospital Universitário de Canoas. Fisioter Pesqui. 2017;24(4):437-443.
Katari Y, Srinivasan R, Arvind P, Hiremathada S. Point-of-Care ultrasound to evaluate thickness of rectus femoris, vastus intermedius muscle, and fat as an indicator of muscle and fat wasting in critically ill patients in a multidisciplinary intensive care unit. Indian J Crit Care Med. 2018;22(11):781-788.
Mourtzakis M, Parry S, Connolly B, Puthucheary Z. Skeletal muscle ultrasound in critical care: A tool in need of translation. Ann Thorac Soc. 2017;14(10):1495-1503.
Hernández-Socorro CR, Saavedra P, López-Fernández JC, Ruiz-Santana S. Assessment of muscle wasting in long-stay ICU patients using a new ultrasound protocol. Nutrients. 2018;10(12):1-11.
Parry SM, El-Ansary D, Cartwright MS, Sarwal A, Berney S, Koopman R, Annoni R, Puthucheary Z, Gordon IR, Morris PE, Denehy L. 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. J Crit Care. 2015;30(5):1-6.
Borges RC, Soriano FG. Association between muscle wasting and muscle strength in patients who developed severe sepsis and septic shock. Shock. 2019;51(3):312-320.
Palakshappa JA, Reilly JP, Schweickert WD, Anderson BJ, Khoury V, Shashaty MG, Fitzgerald D, Forker C, Butler K, Ittner CA, Feng R, Files DC, Bonk MP, Christie JD, Meyer NJ. Quantitative peripheral muscle ultrasound in sepsis: muscle area superior to thickness. Journal of Critical Care. 2018;47:324-330.
Sessler CN, Gosnell M, Grap MJ, Brophy GT, O’Neal PV, Keane KA et al. The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care patients. Am J Respir Crit Care Med 2002; 166:1338- 1344.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13(10):818-29.
Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;22:707–710.
Fivez T, Hendrickx A, Van Herpe T, Vlasselaers D, Desmet L, Van den Berghe G, et al. An analysis of reliability and accuracy of muscle thickness ultrasonography in critically ill children and adults. JPEN. 2016;40(7):944-949.
Hacker ED, Peters T, Garkova M. Ultrasound assessment of the rectus femoris cross-sectional area: subject position implications. West J Nurs Res. 2016;38(9):1221-1230.
Martinez BP, Batista AKMS, Ramos IR, J Dantas JC, Gomes IB, Forgiarini Jr LA, Camelier FRW, Camelier AA. Viabilidade do teste de velocidade de marcha em idosos hospitalizados. J Bras Pneumol. 2016;42(3):196-202.
Abellan van Kan G, Rolland Y, Andrieu S, Bauer J, Beauchet O, Bonnefoy M, et al. Gait speed at usual pace as a predictor of adverse outcomes in community-dwelling older people an International Academy on Nutrition and Aging (IANA) Task Force. J Nutr Health Aging. 2009;13(10): 881-9.
Hernández-Socorro CR, Saavedra P, López-Fernández JC, Ruiz-Santana S. Assessment of Muscle Wasting in Long-Stay ICU Patients Using a New Ultrasound Protocol. Nutrients. 2018;10(12):1-12.
Carvalho MTX, Ludke E, Cardoso DM, Paiva DN, Soares JC, Albuquerque IM. Efeitos do exercício passivo precoce em cicloergômetro na espessura muscular do quadríceps femoral de pacientes críticos: estudo-piloto randomizado controlado. Fisioter Pesqui. 2019;26(3):227-234.
Puthucheary ZA, McNelly AS, Rawal J, Connolly B, Sidhu PS , Rowlerson A. Rectus Femoris Cross-Sectional Area and Muscle Layer Thickness: Comparative Markers of Muscle Wasting and Weakness. Am J Respir Crit Care Med. 2017;195(1):136-138.
Fritz S, Lusardi M. White paper: “Walking Speed: the Sixth vital sign”. J Geriatr Phys Ther. 2009;32(2):46-9.
Cordeiro ALL, Borges DL, Peruna MP, Guimarães AR, Cacau LA. Correlação entre tempo de internação e velocidade da marcha em pacientes submetidos à cirurgia cardíaca. Int J Cardiovasc Sci. 2017;30(2):123-127.
Britto HMJS, Mendes LC, Moreno CC, Silva EMGS, Lindquist ARR. Correlation between balance, speed, and walking ability in individuals with chronic hemiparesis. Fisioter Mov. 2016;29(1):87-94.
Tanaka S, Kamiya K, Hamazaki N, Matsuzawa R, Nozaki K, Nakamura T, et al. Short-term change in gait speed and clinical outcomes in older patients with acute heart failure. Circulation Journal. 2019;83(9):1860-1867.
Guerreiro AC, Tonelli AC, Orzechowski R, Corte RRD, Moriguchi EH, Mello RB. Bedside ultrasound of quadriceps to predict rehospitalization and functional decline in hospitalized elders. Front Med (Lausana). 2017;4(122):1-8.
Baldwin CE, Bersten AD. Alterations in respiratory and limb muscle strength and size in patients with sepsis who are mechanically ventilated. Phys Ther. 2014;94(1):68–82.
Hermans G, Wilmer A, Meersseman W, Milants I, Wouters PJ, Bobbaers H, et al. Impact of intensive insulin therapy on neuromuscular complications and ventilator-dependency in the medical intensive care unit. Am J Respir Crit Care Med. 2007;175(5):480-9. (5):480-9.