Department of Nutrition and Dietetics, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
Crit Care Med. 2021 Apr 1;49(4):e350-e359. doi: 10.1097/CCM.0000000000004827.
To investigate the prevalence of low skeletal muscle index (area normalized for height) and density, their trajectory of change, and to determine associations with clinical outcome in adults with severe respiratory failure requiring venovenous extracorporeal membrane oxygenation.
Prospective observational study.
Adults receiving venovenous extracorporeal membrane oxygenation for a minimum of 72 hours and a maximum of 6 months between September 2010 and June 2017, who had a CT scan which included the third lumbar vertebra.
None.
Skeletal muscle index and density was determined using Slice-O-Matic V5.0 (TomoVision, Montreal, QC, Canada). Low skeletal muscle index and density were defined using published criteria. Regression models were used to assess for associations between muscle index and density and clinical outcome. Two-hundred fifteen patients, median (interquartile range) age 46 years (35.0-57.0 yr) were included. Forty-five patients (21.1%) had low skeletal muscle index, and 48 (22.3%) had low skeletal muscle density on commencement of venovenous extracorporeal membrane oxygenation. Low skeletal muscle index was more prevalent in males (28.8% vs 11.6%; χ2 = 9.4; p = 0.002) and was associated with a longer duration of venovenous extracorporeal membrane oxygenation (B = 5.0; 95% CI, 0.2-9.9; p = 0.042). Higher skeletal muscle density was independently associated with ICU survival (odds ratio 1.6 per 10 Hounsfield units; 95% CI, 1.1-2.5; p = 0.025). No relationship was observed between skeletal muscle index nor density and physical function. Adequacy of energy and protein did not influence change in skeletal muscle index or density.
Low skeletal muscle index at the commencement of venovenous extracorporeal membrane oxygenation was associated with a longer duration of venovenous extracorporeal membrane oxygenation, whereas preserved skeletal muscle density was associated with improved survival.
研究需要静脉-静脉体外膜肺氧合（venovenous extracorporeal membrane oxygenation，VV-ECMO）治疗的严重呼吸衰竭成年患者中低骨骼肌指数（身高归一化面积）和密度的流行情况、变化轨迹，并确定其与临床结局的相关性。
前瞻性观察性研究。
2010 年 9 月至 2017 年 6 月期间，至少接受 72 小时、最长 6 个月 VV-ECMO 治疗的成年人，其 CT 扫描包含第三腰椎。
无。
使用 Slice-O-Matic V5.0（TomoVision，蒙特利尔，QC，加拿大）确定骨骼肌指数和密度。使用已发表的标准定义低骨骼肌指数和密度。回归模型用于评估肌肉指数和密度与临床结局之间的关系。共纳入 215 例患者，中位（四分位距）年龄为 46 岁（35.0-57.0 岁）。45 例（21.1%）患者在开始 VV-ECMO 时存在低骨骼肌指数，48 例（22.3%）患者存在低骨骼肌密度。男性低骨骼肌指数更为常见（28.8%比 11.6%；χ2=9.4；p=0.002），且与 VV-ECMO 时间较长相关（B=5.0；95%CI，0.2-9.9；p=0.042）。较高的骨骼肌密度与 ICU 存活独立相关（每增加 10 个亨斯菲尔德单位，比值比为 1.6；95%CI，1.1-2.5；p=0.025）。骨骼肌指数和密度与身体功能之间均无相关性。能量和蛋白质摄入充足并不能影响骨骼肌指数或密度的变化。
开始 VV-ECMO 时低骨骼肌指数与 VV-ECMO 时间较长有关，而保留的骨骼肌密度与生存改善有关。
