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Published on: July 26, 2024
Bedside Ultrasound Assessment to Detect Muscle Loss in Critically Ill Children
Mohammad Sabobeh1,2,3, Elizabeth Seewer1, Nicolas Chiriboga1
1Department of Pediatrics Critical Care Medicine, The University of Tennessee Health and Science Center, Memphis, Tennessee, USA.
Insights
Bedside muscle ultrasonography can detect muscle loss in critically ill children, aiding early intervention. This noninvasive method is feasible for routine intensive care unit monitoring.
Area of Science:
- Pediatric Critical Care Medicine
- Diagnostic Imaging
- Muscle Physiology
Background:
- Critically ill children often experience rapid muscle loss, leading to intensive care unit (ICU)-acquired weakness and prolonged ventilation.
- Early identification of muscle wasting is crucial for timely interventions to improve outcomes.
Purpose of the Study:
- To assess the feasibility and inter-rater reliability of using bedside muscle ultrasonography to detect muscle loss in critically ill pediatric patients.
- To explore associations between muscle loss and potential risk factors.
Main Methods:
- A prospective cohort study involving critically ill children (aged 2-18 years) requiring invasive mechanical ventilation for over 24 hours.
- Serial ultrasound assessments of quadriceps femoris muscle thickness and cross-sectional area were conducted.
- Risk factors including corticosteroid use, nutritional status, and inflammation markers were recorded.
Main Results:
- Muscle loss, defined as ≥10% decrease in muscle mass, was detected in 40% of patients via muscle thickness and 57% via cross-sectional area.
- Muscle wasting occurred 3-10 days into critical illness and mechanical ventilation.
- Lower protein intake and higher C-reactive protein levels were significantly associated with muscle loss.
Conclusions:
- Bedside muscle ultrasonography is a feasible and practical tool for early detection of muscle loss in critically ill children.
- Its noninvasive and portable nature supports integration into routine ICU monitoring.
- Further multicenter studies are needed to confirm these findings and guide interventions.
Objectives:
To evaluate the feasibility and inter-rater reliability of bedside muscle ultrasonography for detecting muscle loss in critically ill pediatric patients.
Design:
A single-center prospective cohort study was conducted (January 2024-January 2025).
Methods:
Critically ill children frequently experience rapid muscle loss, a complication associated with intensive care unit (ICU)-acquired weakness, prolonged mechanical ventilation, and increased morbidity. Early detection of muscle wasting may enable targeted interventions to mitigate these adverse outcomes.
Patients:
Critically ill children (aged 2-18 years) requiring invasive mechanical ventilation for >24 hours.
Interventions:
Serial ultrasound assessments of the quadriceps femoris muscle thickness and cross-sectional area were performed at baseline and during ICU stay. Potential risk factors (eg, corticosteroid use, neuromuscular blockade, hyperglycemia, and nutritional status) were recorded.
Results:
Of the 35 patients enrolled in the study, 14 (40%) had significant muscle loss (defined as loss of ≥10% of muscle mass compared to the baseline assessment) detected by decreased muscle thickness, and 20 (57%) had muscle loss detected by reduced cross-sectional area. Muscle loss occurred 3-10 days into their critical illness and invasive mechanical ventilation. Stepwise multivariable logistic associations showed that patients with a lower ratio of actual-to-goal protein intake at the time of scan had higher odds of muscle loss, as it was associated with >10% decrease in cross-sectional area (adjusted OR 3.2, CI 1.22, 3.56) and that a higher mean level of C-reactive protein was associated with a significant decrease in muscle thickness (adjusted OR 1.7, CI 1.23, 3.34).
Conclusion:
Bedside muscle ultrasonography is a feasible, and practical tool for early detection of muscle loss in critically ill children. Its noninvasive nature, portability, and cost-effectiveness support its potential integration into routine ICU monitoring to guide early rehabilitative or nutritional interventions. Further multicenter studies are warranted to validate these findings.
