Evaluation of Changes in Quadriceps Femoris Muscle in Critically III Children Using Ultrasonography
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Published on: July 26, 2024
Agam Jain1, Jhuma Sankar2, Sushil K Kabra2
1Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India. agamjains@gmail.com.
Insights
Ultrasonography revealed no significant change in quadriceps femoris muscle thickness in critically ill children over 7 days. However, rectus femoris echogenicity increased, suggesting muscle quality changes are better detected by echogenicity than thickness.
Area of Science:
- Pediatric critical care medicine
- Musculoskeletal ultrasonography
- Muscle physiology
Background:
- Critically ill children often experience muscle wasting.
- Assessing muscle changes in this population is crucial for understanding recovery and outcomes.
- Current methods for evaluating muscle in pediatric intensive care units (PICU) have limitations.
Purpose of the Study:
- To measure changes in quadriceps femoris (QF) muscle thickness and echogenicity in critically ill children.
- To assess if muscle thickness or echogenicity is a more sensitive indicator of muscle changes.
Main Methods:
- Ultrasound measurements of QF thickness and echogenicity were taken in 58 mechanically ventilated children (aged 1-18 years) on days 1, 3, and 7 of ICU stay.
- Muscle echogenicity was analyzed separately for vastus intermedius and rectus femoris using ImageJ software.
- Statistical analysis compared changes over time and correlated findings with patient outcomes.
Main Results:
- No significant change in QF muscle thickness was observed over the 7-day study period.
- Rectus femoris echogenicity significantly increased by 16.1% over 7 days (p=0.03).
- Higher baseline vastus intermedius echogenicity was associated with increased mortality (p=0.026).
Conclusions:
- Muscle echogenicity, particularly in the rectus femoris, is a more sensitive marker for detecting changes in muscle properties than muscle thickness in critically ill children.
- Echogenicity may serve as a valuable prognostic indicator in this patient group.
Objective:
To measure changes in muscle thickness and echogenicity, reflecting muscle bulk and quality, respectively, of quadriceps femoris (QF), in critically ill children.
Methods:
This study was done on 58 children aged 1-18 y requiring mechanical ventilation, admitted in a pediatric intensive care unit (PICU) of a tertiary care hospital from January 2018 to June 2019. QF thickness was measured twice in longitudinal plane and twice in transverse plane, and an average of these four measurements was used. Muscle quality was assessed using ImageJ software to determine the mean echogenicity, and was calculated separately for vastus intermedius and rectus femoris. These observations were repeated on day 3 and day 7 of the ICU stay.
Results:
The median muscle thickness of QF was 1.58 cm, and vastus intermedius and rectus femoris echogenicity was 35.5 and 25.88 units, respectively in the present cohort, with median age of 6 y. Only 36 of the 58 patients underwent day 7 ultrasonography, as the remainder were either extubated or died. There was no significant change in the muscle thickness over 7 d. Rectus femoris echogenicity increased significantly over 7 d by 16.1% (p = 0.03). Baseline vastus intermedius echogenicity was significantly higher in patients who subsequently died during the course of their illness (p = 0.026).
Conclusion:
There was a significant change in rectus femoris echogenicity, but not in QF thickness. Echogenicity rather than muscle thickness may be a more sensitive marker for changes in muscle properties.
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