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Evaluation of Changes in the Quadriceps Femoris Muscle in Critically Ill Children Using Ultrasound Compared with
K Y Bharath1, Siddaroodha Sajjan1, Mallanagouda M Patil2
1Department of Radiodiagnosis, Shri B. M. Patil Medical College, Hospital and Research Centre, BLDE (Deemed to be University), Vijayapura, Karnataka, India.
Insights
Critically ill children experience early skeletal muscle wasting, detectable by ultrasound. This study shows significant quadriceps muscle thinning and increased echogenicity in pediatric intensive care unit patients compared to healthy children.
Area of Science:
- Pediatric critical care medicine
- Diagnostic ultrasound
- Skeletal muscle physiology
Background:
- Critically ill children in the pediatric intensive care unit (PICU) face immobilization, mechanical ventilation, and inflammation, leading to rapid skeletal muscle wasting.
- Quadriceps femoris muscle assessment via ultrasound is a practical bedside method for detecting muscle alterations during critical illness.
Purpose of the Study:
- To assess changes in quadriceps femoris muscle thickness and echogenicity in critically ill children using ultrasound.
- To compare these muscle characteristics with age-matched healthy controls.
Main Methods:
- A prospective observational study involving 348 children (174 PICU patients, 174 controls) from January 2024 to June 2025.
- Standardized ultrasound measurements of quadriceps muscle thickness and echogenicity were performed on PICU patients on days 1, 3, and 5, and once in controls.
Main Results:
- Critically ill children showed a significant reduction in quadriceps muscle thickness by day 5 (7.5% decrease) compared to controls (P < 0.001).
- Muscle thickness reduction occurred in 59.2% of PICU patients, versus none in controls (P < 0.001).
- Increased muscle echogenicity was observed in 16.7% of PICU patients, but not in controls (P < 0.001).
Conclusions:
- Ultrasound effectively identified early decreases in quadriceps muscle thickness and increased echogenicity in critically ill children.
- Serial bedside ultrasound of skeletal muscle may serve as a valuable tool for monitoring early muscle changes in pediatric critical care settings.
Background:
Critically ill children in the pediatric intensive care unit (PICU) are exposed to immobilization, mechanical ventilation, and systemic inflammation, which can lead to early skeletal muscle wasting. Ultrasound assessment of the quadriceps femoris provides a feasible bedside method to detect muscle changes during critical illness.
Aim:
To evaluate changes in quadriceps femoris muscle thickness and echogenicity in critically ill children using ultrasound and compare them with age-matched healthy controls.
Materials And Methods:
This prospective observational study (January 2024-June 2025) included 348 children: 174 critically ill mechanically ventilated PICU patients and 174 age-matched controls. Quadriceps muscle thickness and echogenicity were assessed using standardized ultrasound measurements. Cases were evaluated on day 1, day 3, and day 5, while controls were assessed once.
Results:
Baseline muscle thickness was similar in cases and controls (1.60 cm). In cases, mean thickness declined to 1.54 cm by day 3 ( P = 0.031) and 1.48 cm by day 5 ( P < 0.001), representing a 7.5% reduction, while controls showed no significant change. Thickness reduction occurred in 59.2% of cases versus none of the controls ( P < 0.001). Increased muscle echogenicity was observed in 16.7% of cases and in no controls ( P < 0.001). Muscle changes showed no significant association with age or sex.
Conclusion:
Ultrasound detected early reductions in quadriceps muscle thickness and increased echogenicity in critically ill children. Serial bedside muscle ultrasound may be useful for monitoring early muscle changes in pediatric critical care.
