In critical care, preserving a patient’s skeletal muscle mass is an essential component of their recovery trajectory, particularly for those who have suffered trauma, such as a traumatic brain injury. Muscle mass loss can indeed occur rapidly during prolonged immobilization or illness, which is why healthcare professionals are continuously seeking more precise evaluation methods. A recent study published in Clinical Nutrition ESPEN on February 2024, has shed new light on this topic, indicating that ultrasonography may be just as effective as computed tomography (CT) in assessing muscle mass in critically ill patients with varying body mass indexes (BMIs).

DOI: https://doi.org/10.1016/j.clnesp.2023.12.012

A Prospective Validation Study in an Intensive Care Unit

Under the guidance of Leandro Moreira Peres and his team from the University of São Paulo, the study aimed to compare the accuracy of quadriceps femoris muscle measurement by both ultrasonography and thigh CT scans. The research took place in an ICU specialized in trauma care at a tertiary teaching hospital and used a convenience sample of patients, with scans conducted at three distinct intervals: upon admittance, between 24 and 96 hours, and finally, between 96 and 168 hours post-admittance.

Methodology and Results

A total of 252 images from 49 patients were collected during the first time interval, shedding light on the relationship between muscle thickness measured by ultrasound (US) and CT. The group consisted of individuals with normal weight, as well as overweight and obese patients. An excellent correlation and good agreement were found between the results gathered via ultrasonography and CT, suggesting that ultrasonography can be as reliable as CT for muscle assessment in critically ill patients.

Implications for Muscle Mass Evaluation in Critical Care

The findings are significant, particularly as CT scans are generally considered the gold standard for muscle mass assessment. Ultrasound offers various advantages, including being less costly, less invasive, and more accessible, enabling more frequent assessments without the risk of radiation exposure. This could mean that hospitals could implement regular muscle measurement protocols without incurring the logistical constraints of CT imaging.

Registration and Protocol Approval

This clinical trial was registered at REBEC with identifier RBR-2bzspnz and was approved by the Research Ethics Committee of the Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, with the trial registration number 3,475,851. This adds a layer of credibility to the study as the protocols were laid out and closely adhered to the ethical guidelines.

Conclusion

The study by Peres and colleagues makes a compelling case for integrating ultrasonography into regular practice for measuring muscle mass in critically ill patients. Its compatibility in performance with CT could potentially streamline the monitoring process, lower costs, and above all, minimize patient exposure to radiation.

References

1. Clinical Nutrition ESPEN. (2024). Comparison between ultrasonography and computed tomography for measuring skeletal muscle mass in critically ill patients with different body mass index., 59, 214-224. https://doi.org/10.1016/j.clnesp.2023.12.012

2. Peres, L. M., Luis-Silva, F., Menegueti, M. G., et al. (2024). Clinical nutrition ESPEN. https://ensaiosclinicos.gov.br/ identifier: RBR-2bzspnz.

3. Blum, D., O’Leary, M., & Redfern, J. (2018). The use of sonography for muscle assessment in sarcopenia: a systematic review. Geriatric Nursing, 39(3), 271-277.

4. Heyland, D. K., Stapleton, R. D., & Mourtzakis, M. (2016). Using nutrition to modulate illness trajectory in the critically ill. Critical Care Clinics, 32(2), 299-312.

5. Berkel, A. E. M., Biersteker, H. A., & Bijlsma, A. Y. (2019). Ultrasound measurements of muscle thickness: A validation study. Archives of Physical Medicine and Rehabilitation, 100(5), 947-953.

Keywords

1. Critical Care Muscle Assessment
2. Ultrasound vs CT Imaging
3. Muscle Mass Monitoring ICU
4. Traumatic Brain Injury Rehabilitation
5. Nutritional Assessment Critical Patients

Author Information

Leandro Moreira Peres, Fabio Luis-Silva, Mayra Gonçalves Menegueti, Wilson José Lovato, Douglas Alexandre do Espirito Santo, Mariana Derminio Donadel, Lucas Sato, Carolina Hunger Malek-Zadeh, Anibal Basile-Filho, Olindo Assis Martins-Filho, and Maria Auxiliadora-Martins are all affiliated with various divisions of Intensive Care Medicine, Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Brazil or other related institutions, and their collective expertise underpins the validity of this research.