de Andrade-Junior Mario Chueire, de Salles Isabel Chateaubriand Diniz, de Brito Christina May Moran, Pastore-Junior Laerte, Righetti Renato Fraga, Yamaguti Wellington Pereira
Hospital Sírio-Libanês, São Paulo, Brazil.
Front Physiol. 2021 Mar 11;12:640973. doi: 10.3389/fphys.2021.640973. eCollection 2021.
Intensive care patients commonly develop muscle wasting and functional impairment. However, the role of severe COVID-19 in the magnitude of muscle wasting and functionality in the acute critical disease is unknown. To perform a prospective characterization to evaluate the skeletal muscle mass and functional performance in intensive care patients with severe COVID-19. Thirty-two critically ill patients (93.8% male; age: 64.1 ± 12.6 years) with the diagnosis of the severe COVID-19 were prospectively recruited within 24 to 72 h following intensive care unit (ICU) admission, from April 2020 to October 2020, at Hospital Sírio-Libanês in Brazil. Patients were recruited if older than 18 years old, diagnosis of severe COVID-19 confirmed by RT-PCR, ICU stay and absence of limb amputation. Muscle wasting was determined through an ultrasound measurement of the rectus femoris cross-sectional area, the thickness of the anterior compartment of the quadriceps muscle (rectus femoris and vastus intermedius), and echogenicity. The peripheral muscle strength was assessed with a handgrip test. The functionality parameter was determined through the ICU mobility scale (IMS) and the International Classification of Functioning, Disability and Health (ICF). All evaluations were performed on days 1 and 10. There were significant reductions in the rectus femoris cross-section area (-30.1% [95% IC, -26.0% to -34.1%]; < 0.05), thickness of the anterior compartment of the quadriceps muscle (-18.6% [95% IC, -14.6% to 22.5%]; < 0.05) and handgrip strength (-22.3% [95% IC, 4.7% to 39.9%]; < 0.05) from days 1 to 10. Patients showed increased mobility (0 [0-5] vs 4.5 [0-8]; < 0.05), improvement in respiratory function (3 [3-3] vs 2 [1-3]; < 0.05) and structure respiratory system (3 [3-3] vs 2 [1-3]; < 0.05), but none of the patients returned to normal levels. In intensive care patients with severe COVID-19, muscle wasting and decreased muscle strength occurred early and rapidly during 10 days of ICU stay with improved mobility and respiratory functions, although they remained below normal levels. These findings may provide insights into skeletal muscle wasting and function in patients with severe COVID-19.
重症监护患者通常会出现肌肉萎缩和功能障碍。然而，在这种急性危重病中，重症新型冠状病毒肺炎（COVID-19）对肌肉萎缩程度和功能的影响尚不清楚。本研究旨在进行前瞻性特征分析，以评估重症COVID-19患者的骨骼肌质量和功能表现。2020年4月至2020年10月期间，在巴西圣若泽-利巴嫩医院，对32例确诊为重症COVID-19的危重症患者（男性占93.8%；年龄：64.1±12.6岁）进行前瞻性招募，这些患者在重症监护病房（ICU）入院后24至72小时内入组。纳入标准为年龄大于18岁、经逆转录聚合酶链反应（RT-PCR）确诊为重症COVID-19、入住ICU且无肢体截肢。通过超声测量股直肌横截面积、股四头肌前侧间隙厚度（股直肌和股中间肌）以及回声性来确定肌肉萎缩情况。通过握力测试评估外周肌肉力量。功能参数通过ICU活动量表（IMS）和国际功能、残疾和健康分类（ICF）来确定。所有评估均在第1天和第10天进行。从第1天到第10天，股直肌横截面积显著减少（-30.1%[95%置信区间，-26.0%至-34.1%]；P<0.05），股四头肌前侧间隙厚度显著减少（-18.6%[95%置信区间，-14.6%至-22.5%]；P<0.05），握力显著下降（-22.3%[95%置信区间，-4.7%至-39.9%]；P<0.05）。患者的活动能力有所提高（0[0-5]对4.5[0-
