Loss of muscle mass occurs rapidly during critical illness and negatively affects quality of life. The incidence of clinically significant muscle wasting in critically ill patients is unclear. This study aimed to assess the incidence of and identify predictors for clinically significant loss of muscle mass in this patient population. This was a single-center observational study. We used ultrasound to determine the rectus femoris cross-sectional area (RFcsa) on the first and seventh day of ICU stay. The primary outcome was the incidence of significant muscle wasting. We used a logistic regression model to determine significant predictors for muscle wasting. Ultrasound measurements were completed in 104 patients. Sixty-two of these patients (59.6%) showed ≥ 10% decreases in RFcsa. We did not identify any predictor for significant muscle wasting, however, age was of borderline significance (p = 0.0528). The 28-day mortality rate was higher in patients with significant wasting, but this difference was not statistically significant (30.6% versus 16.7%; p = 0.165). Clinically significant muscle wasting was frequent in our cohort of patients. Patient age was identified as a predictor of borderline significance for muscle wasting. The results could be used to plan future studies on this topic.Trial registration: ClinicalTrials.gov NCT03865095, date of registration: 06/03/2019.

Department of Anaesthesiology and Intensive Care Medicine Faculty of Medicine Masaryk University Brno Czech Republic

Department of Anaesthesiology and Intensive Care Medicine University Hospital Jihlavska 20 625 00 Brno Czech Republic

Department of Pharmacology Faculty of Medicine Masaryk University Brno Czech Republic

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Shefold JC, et al. Muscular weakness and muscle wasting in the critically ill. J. Cachexia Sarcopenia Muscle. 2020;11:1399–1412. doi: 10.1002/jcsm.12620. PubMed DOI PMC

Puthucheary ZA, et al. Acute skeletal muscle wasting in critical illness. JAMA. 2013;310:1591–1600. doi: 10.1001/jama.2013.278481. PubMed DOI

Biolo G, et al. Inverse regulation of protein turnover and amino acid transport in skeletal muscle of hypercatabolic patients. J. Clin. Endocrinol. Metab. 2002;87:3378–3384. doi: 10.1210/jcem.87.7.8699. PubMed DOI

Paddon-Jones D, et al. Atrophy and impaired muscle protein synthesis during prolonged inactivity and stress. J. Clin. Endocrinol. Metab. 2006;91:4836–4841. doi: 10.1210/jc.2006-0651. PubMed DOI

Mayer KP, et al. Acute skeletal muscle wasting and dysfunction predict physical disability at hospital discharge in patients with critical illness. Crit. Care. 2020;24:1–12. doi: 10.1186/s13054-020-03355-x. PubMed DOI PMC

Lee ZY, et al. Association between ultrasound quadriceps muscle status with premorbid functional status and 60-day mortality in mechanically ventilated critically ill patient: A single-center prospective observational study. Clin. Nutr. 2021;40:1338–1347. doi: 10.1016/j.clnu.2020.08.022. PubMed DOI

Herridge MS, et al. One-year outcomes in survivors of the acute respiratory distress syndrome. N. Engl. J. Med. 2003;348:683–693. doi: 10.1056/NEJMoa022450. PubMed DOI

Dinglas VD, et al. Muscle weakness and 5-year survival in acute respiratory distress syndrome survivors. Crit. Care Med. 2017;45:446–453. doi: 10.1097/CCM.0000000000002208. PubMed DOI PMC

Parry SM, et al. Ultrasonography in the intensive care setting can be used to detect changes in the quality and quantity of muscle and is related to muscle strength and function. J. Crit. Care. 2015;30:e9–14. doi: 10.1016/j.jcrc.2015.05.024. PubMed DOI

Ten Haaf D, et al. The magnitude and time course of muscle cross-section decrease in intensive care unit patients. Am. J. Phys. Med. Rehabil. 2017;96:634–638. doi: 10.1097/PHM.0000000000000711. PubMed DOI

Tillquist M, et al. Bedside ultrasound is a practical and reliable measurement tool for assessing quadriceps muscle layer thickness. JPEN. 2014;38:886–890. doi: 10.1177/0148607113501327. PubMed DOI PMC

Sabatino A, et al. Reliability of bedside ultrasound for measurement of quadriceps muscle thickness in critically ill patients with acute kidney injury. Clin. Nutr. 2017;36:1710–1715. doi: 10.1016/j.clnu.2016.09.029. PubMed DOI

Hadda V, et al. Reliability of ultrasonographic arm muscle thickness measurement by various levels of health care providers in ICU. Clin. Nutr. ESPEN. 2018;24:78–81. doi: 10.1016/j.clnesp.2018.01.009. PubMed DOI

Puthucheary ZA, et al. Rectus femoris cross-sectional area and muscle layer thickness: Comparative markers of muscle wasting and weakness. Am. J. Respir. Crit. Care Med. 2017;195:136–138. doi: 10.1164/rccm.201604-0875LE. PubMed DOI PMC

Palakshappa JA, et al. Quantitative peripheral muscle ultrasound in sepsis: Muscle area superior to thickness. J. Crit. Care. 2018;47:324–330. doi: 10.1016/j.jcrc.2018.04.003. PubMed DOI PMC

Bloch SA, et al. Sustained elevation of circulating growth and differentiation factor-15 and a dynamic imbalance in mediators of muscle homeostasis are associated with the development of acute muscle wasting following cardiac surgery. Crit. Care Med. 2013;41:982–989. doi: 10.1097/CCM.0b013e318274671b. PubMed DOI

Bloch SA, et al. MiR-181a: A potential biomarker of acute muscle wasting following elective high-risk cardiothoracic surgery. Crit. Care. 2015;19:147. doi: 10.1186/s13054-015-0853-5. PubMed DOI PMC

Nascimento TS, et al. Ultrasound protocols to assess skeletal and diaphragmatic muscle in people who are critically ill: A systematic review. Ultrasound Med. Biol. 2021;47:3041–3067. doi: 10.1016/j.ultrasmedbio.2021.06.017. PubMed DOI

Mourtzakis M, Parry S, Connolly B, Puthucheary ZA. Skeletal muscle ultrasound in critical care: A tool in need of translation. Ann. Am. Thorac. Soc. 2017;14:1495–1503. doi: 10.1513/AnnalsATS.201612-967PS. PubMed DOI PMC

Sarwal A, et al. Interobserver reliability of quantitative muscle sonographic analysis in the critically ill population. J. Ultrasound Med. 2015;34:1191–1200. doi: 10.7863/ultra.34.7.1191. PubMed DOI

Hrdy O, Vrbica K, Kovar M, Korbicka T, Gal R. Intra- and interobserver agreement of rectus femoris cross-sectional area in critically ill patients. Minerva Anestesiol. 2021;87:494–495. doi: 10.23736/S0375-9393.20.15149-6. PubMed DOI

McNelly AS, et al. Effect of intermittent or continuous feed on muscle wasting in critical illness: A phase 2 clinical trial. Chest. 2020;158:183–194. doi: 10.1016/j.chest.2020.03.045. PubMed DOI

Mayer KP, et al. Acute skeletal muscle wasting and dysfunction predict physical disability at hospital discharge in patients with critical illness. Crit. Care. 2020;24:637. doi: 10.1186/s13054-020-03355-x. PubMed DOI PMC

Turton P, Hay R, Taylor J, McPhee J, Welters I. Human limb skeletal muscle wasting and architectural remodeling during five to ten days intubation and ventilation in critical care—An observational study using ultrasound. BMC Anesthesiol. 2016;16:119. doi: 10.1186/s12871-016-0269-z. PubMed DOI PMC

Intermittent enteral nutrition shortens the time to achieve nutritional goals in critically ill patients

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NCT03865095