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Table 1 Principal studies regarding peripheral muscular ultrasound in the ICU setting

From: Clinical review: peripheral muscular ultrasound in the ICU

Study and year of publication Design Parameters Main remarks
Reid 2004 [49] 50 ICU patients Serial measurements of both mid-upper arm circumference (MAC) and muscle thickness, using ultrasound, were made at 1–3 day intervals Muscle thickness decreased in almost every patients; ultrasound technique devised to identify muscle wasting in the presence of severe fluid retention works in the majority of patients; energy balance made no difference to the rate of wasting
Gruther 2008 [37] 118 ICU patients Muscle layer thickness of the quadriceps femoris detected by US Quadriceps femoris thickness showed a significant negative correlation with length of stay in ICU and seems to be higher during the first 2–3 weeks
Gerovasili 2009 [60] 49 ICU patients Electrical muscle stimulation effects on cross-sectional diameter (CSD) of the vastus intermedius and the rectus femoris of the quadriceps muscle The CSD of the right rectus femoris decreased significantly less in the EMS group, and the CSD of the right vastus intermedius decreased significantly less in the EMS group
Derde 2012 [61] 208 ICU patients Markers of muscle atrophy and denervation versus rectus abdominis and vastus lateralis; tissue and electrical physiological analysis Both limb and abdominal wall skeletal muscles of prolonged critically ill patients showed down-regulation of protein synthesis at the gene expression level as well as increased proteolysis
Puthucheary 2013 [15] 63 ICU patients Serial US measurement of the rectus femoris cross-sectional area (CSA) on days 1, 3, 7 and 10; histopathological analysis was performed There were significant reductions in the rectus femoris CSA observed at day 10
Cartwright 2013 [34] 16 ICU patients Serial muscle ultrasound for thickness and grayscale assessment of the tibialis anterior, rectus femoris, abductor digit, biceps, and diaphragm muscles over 14 days The tibialis anterior and rectus femoris had significant decreases in grayscale standard deviation when analyzed over 14 days. No muscles showed significant changes in thickness
Grimm 2013 [53] 28 ICU septic patients versus healthy Biceps brachii and quadriceps femoris muscles, extensor muscles of the forearms and tibialis anterior muscle US, and nerve conduction studies on days 4 and 14 after sepsis A significant difference in mean muscle echotexture between patients and controls was found at day 4 and day 14; day 4 to day 14, the mean grades of muscle echotexture increased in the patient group
Moisey 2013 [13] 149 ICU trauma patients CT muscle cross-sectional area at the 3rd lumbar vertebra quantified and related to clinical parameters including ventilator-free days, ICU-free days, and mortality Increased muscle index was significantly associated with decreased mortality
Baldwing 2014 [51] 16 ICU versus 16 healthy Diaphragm, upper arm, forearm, and thigh muscle thicknesses US; respiratory muscle strength by means of maximal inspiratory pressure; isometric handgrip, elbow flexion, and knee extension forces with the use of portable dynamometry. Fat-free body mass (FFM) measured by bioelectrical impedance spectroscopy Patients’ diaphragm thickness did not differ from that of the control group. Within the patient sample, all peripheral muscle groups were thinner compared with the diaphragm. Within the critically ill group, limb weakness was greater than the already significant respiratory muscle weakness
Puthucheary 2015 [62] 30 ICU patients Vastus lateralis histological specimens and ultrasound assessment of rectus femoris echogenicity Change in muscle echogenicity was greater in patients who developed muscle necrosis. The area under receiver operator curve for ultrasound echogenicity’s prediction of myofiber necrosis was 0.74. Myofiber necrosis and fascial inflammation can be detected noninvasively using ultrasound in the critically ill
Parry 2015 [54] 22 ICU patients Sequential quadriceps US images were obtained over the first 10 days. Quadriceps muscle; CSA, TH, pennation angle and echointensity There was a 30% reduction in vastus intermedius thickness, rectus femoris thickness, and cross-sectional area within 10 days of admission. Muscle echogenicity scores increased for both RF and VI. There was a strong association between function and VI thickness and echogenicity
Sarwal 2015 [44] 20 ICU patients Diaphragm and quadriceps US muscle thickness and echogenicity Excellent inter-observer reliability was obtained for all measurement techniques regardless of expertise level
Greening 2015 [56] 119 ICU COPD patients Multivariate analysis between age, MRC dyspnea grade, home oxygen use, quadriceps (rectus femoris) cross-sectional area and hospitalization in the previous year Patients with the smallest muscle spent more days in hospital than those with largest muscle. Smaller quadriceps muscle size, as measured by US in the acute care setting, is an independent risk factor for unscheduled readmission or death, which may have value both in clinical practice and for risk stratification
Mueller 2016 [55] 102 ICU postsurgical Rectus femoris cross-sectional area US Diagnosis of sarcopenia by ultrasound predicts adverse discharge disposition in SICU patients equally well as frailty
Turton 2016 [46] 22 ICU patients Elbow flexor compartment, medial head of gastrocnemius and vastus lateralis muscle US at day 1,5 and 10th No changes to the size of the elbow flexor compartment over 10 days. In the gastrocnemius, there were no significant changes to muscle. In the vastus lateralis, we found significant losses in muscle thickness
Segaran 2017 [58] 44 ICU patients Muscle depth changes assessed by US on study days 1, 3, 5, 7, 12 and 14 in normal BMI versus higher Obese patients lost muscle depth in a comparable manner to non-obese patients, suggesting that BMI may not prevent muscle depth loss
Annetta 2017 [57] 38 ICU trauma Morphological changes of rectus femoris (RF) and anterior tibialis (AT) muscles up to 3 weeks Progressive loss of muscle mass from day 0 to day 20, that was more relevant for the RF than for the AT; this was accompanied by an increase in echogenicity which is an indicator of myofibers depletion
Valla 2017 [64] 73 PICU Transverse and longitudinal axis measurements of quadriceps femoris anterior thickness Femoris thickness decrease, proposed as a surrogate for muscle mass, is an early, frequent, and intense phenomenon in PICU. Quadriceps femoris ultrasonography is a reliable technique to monitor this process and in future could help to guide rehabilitation and nutrition interventions
Hadda 2018 [60] 45 ICU patients Arm muscle thickness US measured There was an excellent intra- and inter-observer agreement among 5 observers for measurement of arm muscle thickness using bedside USG among patients with sepsis
Palakshappa 2018 [59] 29 ICU patients RF CSA and TH versus muscle strength MRCs RF CSA and TH decreased by 23.2% and 17.9% after 7 days. No correlation was found between US parameters and muscle strength test