Department of Physical Therapy, College of Health Sciences, University of Kentucky, 900 Rose St, Wethington 204D, Lexington, KY, 40536, USA.
Center for Muscle Biology, University of Kentucky, Lexington, USA.
Crit Care. 2020 Nov 4;24(1):637. doi: 10.1186/s13054-020-03355-x.
Patients surviving critical illness develop muscle weakness and impairments in physical function; however, the relationship between early skeletal muscle alterations and physical function at hospital discharge remains unclear. The primary purpose of this study was to determine whether changes in muscle size, strength and power assessed in the intensive care unit (ICU) predict physical function at hospital discharge.
Study design is a single-center, prospective, observational study in patients admitted to the medicine or cardiothoracic ICU with diagnosis of sepsis or acute respiratory failure. Rectus femoris (RF) and tibialis anterior (TA) muscle ultrasound images were obtained day one of ICU admission, repeated serially and assessed for muscle cross-sectional area (CSA), layer thickness (mT) and echointensity (EI). Muscle strength, as measured by Medical Research Council-sum score, and muscle power (lower-extremity leg press) were assessed prior to ICU discharge. Physical function was assessed with performance on 5-times sit-to-stand (5STS) at hospital discharge.
Forty-one patients with median age of 61 years (IQR 55-68), 56% male and sequential organ failure assessment score of 8.1 ± 4.8 were enrolled. RF muscle CSA decreased significantly a median percent change of 18.5% from day 1 to 7 (F = 26.6, p = 0.0253). RF EI increased at a mean percent change of 10.5 ± 21% in the first 7 days (F = 3.28, p = 0.081). At hospital discharge 25.7% of patients (9/35) met criteria for ICU-acquired weakness. Change in RF EI in first 7 days of ICU admission and muscle power measured prior to ICU were strong predictors of ICU-AW at hospital discharge (AUC = 0.912). Muscle power at ICU discharge, age and ICU length of stay were predictive of performance on 5STS at hospital discharge.
ICU-assessed muscle alterations, specifically RF EI and muscle power, are predictors of diagnosis of ICU-AW and physical function assessed by 5x-STS at hospital discharge in patients surviving critical illness.
危重病患者会出现肌肉无力和身体功能障碍；然而，重症监护病房（ICU）中早期骨骼肌变化与出院时身体功能的关系尚不清楚。本研究的主要目的是确定 ICU 中评估的肌肉大小、力量和功率的变化是否可以预测出院时的身体功能。
这是一项单中心、前瞻性、观察性研究，纳入了因败血症或急性呼吸衰竭而入住内科或心胸 ICU 的患者。在 ICU 入院的第一天获取股直肌（RF）和胫骨前肌（TA）的超声图像，并进行连续重复测量，以评估肌肉横截面积（CSA）、层厚（mT）和回声强度（EI）。在 ICU 出院前评估肌肉力量，用医学研究委员会总和评分（Medical Research Council-sum score）测量，肌肉功率（下肢腿举）也进行了评估。出院时通过 5 次坐-站测试（5STS）评估身体功能。
共纳入 41 名中位年龄 61 岁（IQR 55-68）、56%为男性、序贯器官衰竭评估评分 8.1±4.8 的患者。RF 肌肉 CSA 从第 1 天到第 7 天显著下降，中位数百分比变化为 18.5%（F=26.6，p=0.0253）。RF EI 在第 1 天至第 7 天内以平均百分比变化 10.5±21%增加（F=3.28，p=0.081）。出院时，25.7%（9/35）的患者符合 ICU 获得性肌无力的标准。ICU 入院后第 1 天的 RF EI 变化和 ICU 前测量的肌肉力量是 ICU-AW 出院时的强预测指标（AUC=0.912）。ICU 出院时的肌肉力量、年龄和 ICU 住院时间是出院时 5STS 测试表现的预测因素。
在危重病患者中，ICU 评估的肌肉变化，特别是 RF EI 和肌肉力量，是 ICU-AW 诊断和出院时通过 5xSTS 评估的身体功能的预测指标。
