Muscle Mass Evaluation and Nutritional Support in the Critically Ill Patient
DOI:
https://doi.org/10.24950/rspmi.2022.01.220Keywords:
Anthropometry, Critical Care, Critically Illness, Muscle, Skeletal, Nutritional Support, UltrasonographyAbstract
Introduction: The loss of muscle mass is becoming a very common problem among critically ill patients and it’s also strongly related to their prognosis and quality of life after leaving the intensive care unit. The purpose of this study was to evaluate the loss of muscle mass in the first five days, since the patient is admitted to the intensive care unit, and if there is a relationship between this muscle wasting and the nutritional support provided to patients.
Methods: This prospective observational study enrolled adult patients admitted in the intensive care unit between January and March 2020. On the day of admission and on the fifth day of follow-up, an ultrasound evaluation of the thickness of the biceps brachii and quadriceps femoris was performed. During the five-day period we also analyzed the energy and protein support that was provided to the patients.
Results: Thirty five patients were enrolled in this study with a mean age of 64±15, mostly male gender (62.9%). There was a loss of 1.77 mm in the thickness of the biceps brachii and 2.19 mm in the quadriceps femoris. We observed that the patients received an estimated daily nutritional support that corresponds to 20.0% of their energy and 24.9% of their protein needs.
Conclusion: It is feasible to objectively and non-invasively evaluate the muscle mass in critically ill patients and there was a significant decrease in muscle mass in the first days after admission. The nutritional support provided was significantly lower than recommended.
Downloads
References
Puthucheary Z, Montgomery H, Moxham J, Harridge S, Hart N. Structure to function: Muscle failure in critically ill patients. J Physiol. 2010;588:4641– 8.
Puthucheary ZA, Rawal J, McPhail M, Connolly B, Ratnayake G, Chan P, et al. Acute skeletal muscle wasting in critical illness. JAMA. 2013;310:1591– 600. doi: 10.1001/jama.2013.278481.
Tillquist M, Kutsogiannis DJ, Wischmeyer PE, Kummerlen C, Leung R, Stollery D, et al. Bedside ultrasound is a practical and reliable measurement tool for assessing quadriceps muscle layer thickness. J Parenter Enter Nutr. 2014;38:886–90.
Cartwright MS, Kwayisi G, Griffin LP, Sarwal A, Walker FO, Harris JM, et al. Quantitative neuromuscular ultrasound in the intensive care unit. Muscle and Nerve. 2013;47:255–9.
Joskova V, Patkova A, Havel E, Najpaverova S, Uramova D, Kovarik M, et al. Critical evaluation of muscle mass loss as a prognostic marker of morbidity in critically ill patients and methods for its determination. J Rehabil Med. 2018;50:696–704.
Dusseaux MM, Antoun S, Grigioni S, Béduneau G, Carpentier D, Gi rault C, et al. Skeletal muscle mass and adipose tissue alteration in critically ill patients. PLoS One. 2019;14:e0216991. doi: 10.1371/journal. pone.0216991.
Maramattom BV, Wijdicks EFM. Acute neuromuscular weakness in the intensive care unit. Crit Care Med. 2006;34(11):2835–41.
Lodeserto F, Yende S. Understanding skeletal muscle wasting in critically ill patients. Crit Care. 2014;18:1–3.
Deutz NEP, Ashurst I, Ballesteros MD, Bear DE, Cruz-Jentoft AJ, Genton L, et al. The Underappreciated Role of Low Muscle Mass in the Management of Malnutrition. J Am Med Dir Assoc. 2019;20:22–7.
Moisey LL, Mourtzakis M, Cotton BA, Premji T, Heyland DK, Wade CE, Bulger E, Kozar RA; Nutrition and Rehabilitation Investigators Consortium (NUTRIC). Skeletal muscle predicts ventilator-free days, ICU-free days, and mortality in elderly ICU patients. Crit Care. 2013;17:R206. doi: 10.1186/ cc12901.
Cerra FB, Benitez MR, Blackburn GL, Irwin RS, Jeejeebhoy K, Katz DP, et al. Applied nutrition in ICU patients: A consensus statement of the Ameri can College of Chest Physicians. Chest. 1997;111:769–78.
Lambell KJ, Tatucu-Babet OA, Chapple LA, Gantner D, Ridley EJ. Nutrition therapy in critical illness: a review of the literature for clinicians. Crit Care. 2020;24:35. doi: 10.1186/s13054-020-2739-4.
Segaran E, Wandrag L, Stotz M, Terblanche M, Hickson M. Does body mass index impact on muscle wasting and recovery following critical illness? A pilot feasibility observational study. J Hum Nutr Diet. 2017;30:227– 35.
McClave SA, Taylor BE, Martindale RG, Patel J, Rice TW, Braunschweig C, et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). J Parenter Enter Nutr. 2016;40:159–211.
Singer P, Blaser AR, Berger MM, Alhazzani W, Calder PC, Casaer MP, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 2019;38:48–79. doi:10.1016/j.clnu.2018.08.037
Prado CMM, Heymsfield SB. Lean tissue imaging: A new era for nutritional assessment and intervention. J Parenter Enter Nutr. 2014;38:940–53.
Paris MT, Mourtzakis M, Day A, Leung R, Watharkar S, Kozar R, et al. Validation of Bedside Ultrasound of Muscle Layer Thickness of the Quadriceps in the Critically Ill Patient (VALIDUM Study). J Parenter Enter Nutr. 2017;41:171–80.
Campbell IT, Watt T, Withers D, England R, Sukumar S, Keegan MA, et al. Muscle thickness, measured with ultrasound, may be an indicator of leantissue wasting in multiple organ failure in the presence of edema. Am J Clin Nutr. 1995;62:533–9.
Gruther W, Benesch T, Zorn C, Paternostro-Sluga T, Quittan M, Fialka- -Moser V, et al. Muscle wasting in intensive care patients: Ultrasound observation of the M. quadriceps femoris muscle layer. J Rehabil Med. 2008;40:185–9.
Prado CM, Purcell SA, Alish C, Pereira SL, Deutz NE, Heyland DK, et al. Implications of low muscle mass across the continuum of care: a narrative review. Ann Med. 2018;50:675–93. doi:10.1080/07853890.2018.1511918
Nijholt W, Scafoglieri A, Jager-Wittenaar H, Hobbelen JS, van der Schans CP. The reliability and validity of ultrasound to quantify muscles in older adults: a systematic review. J Cachexia Sarcopenia Muscle. 2017;8:702– 12.
Simpson F, Doig GS. Physical assessment and anthropometric measures for use in clinical research conducted in critically ill patient populations: An analytic observational study. J Parenter Enter Nutr. 2015;39:313–21.
Nakanishi N, Oto J, Tsutsumi R, Iuchi M, Onodera M, Nishimura M. Upper and lower limb muscle atrophy in critically ill patients: an observational ultrasonography study. Intensive Care Med. 2018;44:263–4.
Rustani K, Kundisova L, Capecchi PL, Nante N, Bicchi M. Ultrasound measurement of rectus femoris muscle thickness as a quick screening test for sarcopenia assessment. Arch Gerontol Geriatr. 2019;83:151-4. doi: 10.1016/j.archger.2019.03.021.
Weinel LM, Summers MJ, Chapple LA. Ultrasonography to measure quadriceps muscle in critically ill patients: A literature review of reported methodologies. Anaesth Intensive Care. 2019;47:423–34.
Nakanishi N, Tsutsumi R, Okayama Y, Takashima T, Ueno Y, Itagaki T, Tsutsumi Y, Sakaue H, Oto J. Monitoring of muscle mass in critically ill patients: comparison of ultrasound and two bioelectrical impedance analysis devices. J Intensive Care. 2019;7:61. doi: 10.1186/s40560-019-0416-y.
Monk DN, Plank LD, Franch-Arcas G, Finn PJ, Streat SJ, Hill GL. Sequen tial changes in the metabolic response in critically injured patients during the first 25 days after blunt trauma. Ann Surg. 1996;223:395–405.
Reintam Blaser A, Starkopf J, Alhazzani W, Berger MM, Casaer MP, Deane AM, et al. Early enteral nutrition in critically ill patients: ESCIM clinical practice guidelines. Intensive Care Med. 2017;43:380e98.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2023 Medicina Interna