Valla Frederic V, Young David K, Rabilloud Muriel, Periasami Uvaraj, John Manoj, Baudin Florent, Vuillerot Carole, Portefaix Aurélie, White Deborah, Ridout Jenna A, Meyer Rosan, Gaillard Le Roux Bénédicte, Javouhey Etienne, Pathan Nazima
1Pediatric Intensive Care, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France. 2Physiotherapy Department, Addenbrooke's Hospital, Cambridge, United Kingdom. 3Hospices Civils de Lyon, Service de Biostatistique et Bioinformatique, Lyon, France. 4Université Lyon 1, Villeurbanne, France. 5CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France. 6Paediatric Intensive Care Unit, Addenbrooke's Hospital, Cambridge, United Kingdom. 7Pediatric Neurology and Rehabilitation Unit, Hôpital Femme Mere Enfant, Hospices Civils de Lyon, Lyon, France. 8EPICIME-CIC 1407 de Lyon, Inserm, Service de Pharmacologie Clinique, CHU-Lyon, Bron, France. 9Department Paediatrics, Imperial College London, St. Mary's Campus, London, United Kingdom. 10Pediatric Intensive Care Unit, Réanimation Pédiatrique, Hôpital Mère enfants, CHU de Nantes, Nantes cedex, France. 11Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France. 12Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom.
Pediatr Crit Care Med. 2017 Aug;18(8):e339-e347. doi: 10.1097/PCC.0000000000001235.
Significant muscle wasting develops in critically ill adults, with subsequent worse outcomes. In the pediatric setting, occurrence and effects of muscle wasting are undescribed; this is in part due to a lack of validated, objective methods for assessing muscle wasting. A single measurement of quadriceps femoris thickness has failed to show consistent reproducibility. We hypothesized that averaging repeated measurements could afford good reproducibility to allow for quadriceps femoris thickness decline detection and monitoring.
A prospective bedside observational study.
Two PICUs.
Mechanically ventilated critically ill children were 15 years and younger.
Transverse and longitudinal axis measurements of quadriceps femoris anterior thickness were undertaken using bedside ultrasound. The average of four measurement values was recorded. The location of measurement was marked for consistency within subsequent measurements by the same or another trained operator, to assess intra- and interoperator repeatability and reproducibility of the technique. Where feasible, serial measurements were undertaken until the time of extubation in a group of children with prolonged PICU stay (> 5 d).
Seventy-three children were enrolled to assess intra- and interoperator ultrasound reliability. Their median (25-75 interquartile range) age and weight were 30 months (4.5-96) and 10 kg (5-23.5). In the intraoperator repeatability study, mean relative difference in quadriceps femoris muscle thickness was 0.36% ± 2.5% (lower and upper limits of agreement: -4.5/+5.2%). In the interoperator reproducibility study, intraclass correlation coefficient was 0.998. In the 17 children monitored over their PICU stay, quadriceps femoris thickness significantly decreased at day 5 by 9.8% (p = 0.006) and by 13.3% (< 0.001) at the last performed measurement.
Quadriceps femoris thickness decrease, proposed as a surrogate for muscle mass, is an early, frequent, and intense phenomenon in PICU. Quadriceps femoris ultrasonography is a reliable technique to monitor this process and in future could help to guide rehabilitation and nutrition interventions.
危重症成年患者会出现明显的肌肉萎缩，随后导致更差的预后。在儿科领域，肌肉萎缩的发生情况及其影响尚无描述；部分原因是缺乏用于评估肌肉萎缩的经过验证的客观方法。单次测量股四头肌厚度未能显示出一致的可重复性。我们推测，对重复测量值进行平均可以提供良好的可重复性，以便检测和监测股四头肌厚度的下降情况。
一项前瞻性床边观察性研究。
两个儿科重症监护病房。
机械通气的15岁及以下危重症儿童。
使用床边超声对股四头肌前侧厚度进行横轴和纵轴测量。记录四个测量值的平均值。测量位置做了标记，以便同一名或另一名经过培训的操作人员在后续测量中保持一致，以评估该技术在操作人员内部和之间的可重复性和再现性。在可行的情况下，对一组儿科重症监护病房住院时间延长（>5天）的儿童进行连续测量，直至拔管时。
纳入73名儿童以评估操作人员内部和之间超声检查的可靠性。他们的年龄中位数（四分位间距25%-75%）和体重分别为30个月（4.5-96）和10千克（5-23.5）。在操作人员内部可重复性研究中，股四头肌厚度的平均相对差异为0.36%±2.5%（一致性下限和上限：-4.5/+5.2%）。在操作人员之间再现性研究中，组内相关系数为0.998。在17名在儿科重症监护病房住院期间接受监测的儿童中，股四头肌厚度在第5天显著下降了9.8%（p=0.006），在最后一次测量时下降了13.3%（<0.001）。
股四头肌厚度下降作为肌肉量的替代指标，在儿科重症监护病房是一种早期、频繁且严重的现象。股四头肌超声检查是监测这一过程的可靠技术，未来可能有助于指导康复和营养干预。
