Rodrigues Camila Neves, Ribeiro Henrique Jessimara, Ferreira Álida Rosária SIlva, Correia Maria Isabel Toulson Davisson
CAPES Scholarship, Nutrition and Health Program, Nursing School, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
CAPES Scholarship, Food Sciences Post Graduation Program, Pharmacy School, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
JPEN J Parenter Enteral Nutr. 2021 Jul;45(5):982-990. doi: 10.1002/jpen.1966. Epub 2020 Aug 11.
This study aims to evaluate the use of ultrasonography (US) as an instrument to assess the quadriceps muscles in patients admitted to intensive care units (ICUs), comparing the evolution of US-assessed mass muscle to other nutrition methods.
We conducted a prospective observational study of adult patients aged ≥18 years admitted to an ICU of the Hospital das Clínicas in Brazil. Quadriceps muscle measurements were performed by US, and adductor pollicis muscle thickness and arm, calf, and thigh circumferences were measured at admission and every 2 days within the first week. Nutrition status was assessed at baseline by using the Subjective Global Assessment and the Global Leadership Initiative on Malnutrition criteria. Mechanical ventilation time, length of hospital and ICU stay, and mortality were recorded.
Sixty patients were included. Reductions in quadriceps thickness and rectus femoris cross-sectional area were observed at landmarks two-thirds reduction of both measurements from days 1 and 3 to days 5 and 7 (P = .017 and P = .000, respectively). The mid arm circumference (MAC) was reduced. Malnourished patients had lower initial muscle mass. However, muscle mass loss was similar between nourished and malnourished individuals (P > .005). Clinical outcomes were not impacted by muscle loss.
US muscle mass assessment was able to detect short-term changes in critically ill patients but must be used with caution. MAC was also identified as a useful follow-up tool.
本研究旨在评估超声检查（US）作为评估重症监护病房（ICU）患者股四头肌的工具，并比较超声评估的肌肉质量与其他营养评估方法的变化情况。
我们对巴西临床医院ICU收治的年龄≥18岁的成年患者进行了一项前瞻性观察研究。通过超声测量股四头肌，在入院时以及第一周内每2天测量一次拇收肌厚度、手臂、小腿和大腿周长。在基线时使用主观全面评定法和全球营养不良领导倡议标准评估营养状况。记录机械通气时间、住院时间和ICU住院时间以及死亡率。
纳入60例患者。在第1天和第3天到第5天和第7天，观察到股四头肌厚度和股直肌横截面积在测量点处减少了三分之二（分别为P = 0.017和P = 0.000）。上臂中部周长（MAC）降低。营养不良患者的初始肌肉质量较低。然而，营养良好和营养不良个体的肌肉质量损失相似（P>0.005）。临床结局未受肌肉损失影响。
超声肌肉质量评估能够检测危重症患者的短期变化，但必须谨慎使用。MAC也被确定为一种有用的随访工具。
