Fivez Tom, Hendrickx Alexandra, Van Herpe Tom, Vlasselaers Dirk, Desmet Lars, Van den Berghe Greet, Mesotten Dieter
Department of Intensive Care Medicine, U Leuven-University of Leuven, University Hospitals Leuven, Leuven, Belgium.
Department of Intensive Care Medicine, U Leuven-University of Leuven, University Hospitals Leuven, Leuven, Belgium Department of Electrical Engineering-ESAT-SCD/iMINDS Medical Information Technologies, KU Leuven-University of Leuven, Leuven, Belgium.
JPEN J Parenter Enteral Nutr. 2016 Sep;40(7):944-9. doi: 10.1177/0148607115575033. Epub 2015 Mar 9.
Muscle wasting starts already within the first week in critically patients and is strongly related to poor outcome. Nevertheless, the early detection of muscle wasting is difficult. Therefore, we investigated the reliability and accuracy of ultrasonography to evaluate skeletal muscle wasting in critically ill children and adults.
This prospective observational study enrolled 30 sedated critically ill children and 14 critically ill adults. Two independent investigators made 210 ultrasonographical assessments of muscle thigh thickness. Inter- and intraobserver reliability and cutoff levels were calculated as a function of muscle thickness and the expected reduction in muscle size (predefined at 20% and 30%).
Mean ± SD muscle thickness was 1.67 ± 0.55 cm in the pediatric and 2.10 ± 0.85 cm in the adult population. The median absolute interobserver variability was 0.07 cm (interquartile range [IQR], 0.04-0.20 cm) in the pediatric population and 0.05 cm (IQR, 0.03-0.09 cm) in the adult population. However, the absolute intraobserver accuracy had a 95% confidence interval of 0.43 cm in children and 0.22 cm in adults. Only a 30% decrease (0.50 cm) in muscle thickness can be detected in critically ill children.
Although the interobserver variability is acceptable in the pediatric population, the intraobserver variability is too large with respect to the expected reduction in muscle thickness. In adults, ultrasonography may be a reliable tool for early detection of muscle mass wasting.
危重症患者在第一周内就已开始出现肌肉萎缩，且与不良预后密切相关。然而，早期检测肌肉萎缩较为困难。因此，我们研究了超声检查评估危重症儿童和成人骨骼肌萎缩的可靠性和准确性。
这项前瞻性观察性研究纳入了30名接受镇静的危重症儿童和14名危重症成人。两名独立研究人员对大腿肌肉厚度进行了210次超声评估。根据肌肉厚度和预期的肌肉大小减少量（预先定义为20%和30%）计算观察者间和观察者内的可靠性及临界值。
儿童人群的平均±标准差肌肉厚度为1.67±0.55厘米，成人群体为2.10±0.85厘米。儿童人群中观察者间绝对变异性的中位数为0.07厘米（四分位间距[IQR]，0.04 - 0.20厘米），成人群体为0.05厘米（IQR，0.03 - 0.09厘米）。然而，观察者内绝对准确性在儿童中的95%置信区间为0.43厘米，在成人中为0.22厘米。在危重症儿童中，仅能检测到肌肉厚度下降30%（0.50厘米）。
尽管儿童人群中观察者间变异性可接受，但相对于预期的肌肉厚度减少，观察者内变异性过大。在成人中，超声检查可能是早期检测肌肉量减少的可靠工具。
