To evaluate the intra- and inter-observer reliability of muscle mass measurements and sarcopenia status using ultrasound in patients hospitalized in the ICU.
- Establish intra-observer reliability of Cross-Sectional Area (CSA), Rectus Anterior Muscle Thickness (RAMT), and Quadriceps Muscle Thickness (QMT) measurements.
- Establish inter-observer reliability of CSA, RAMT, and QMT measurements.
- Describe the sarcopenia status in a sample of ICU patients and its relationship with clinical characteristics.
Adult patients (>18 years) admitted to the ICU were included, excluding those with protein-calorie malnutrition or lower limb limitations. Ultrasound measurements of CSA, RAMT, and QMT were taken using a 9-14MHz linear probe connected to a Sonoscape E2 ultrasound system. Patients were placed in a supine position with the head at 30°. The measurement point was 60% of the distance between the anterior superior iliac spine and the upper edge of the patella, and measurements were taken on the right lower limb. Measurements were performed by an expert physiotherapist and a physiotherapy student, both with theoretical and practical training. Intra-observer reliability was assessed through two consecutive measurements by each operator, and inter-observer reliability was assessed without the evaluators knowing each other’s results.
A total of 240 ultrasound images were taken from 20 patients, with an average age of 55 years. 60% were men, and 20% were on mechanical ventilation. Sarcopenia was found in 75% of the evaluated patients. Intra-observer reliability for observer 1 ranged from ICC 0.847 to 0.995, and for observer 2 from ICC 0.991 to 0.998, indicating almost perfect agreement. Inter-observer reliability had an ICC of 0.992 for CSA, 0.920 for RAMT, and 0.942 for QMT, all within the almost perfect agreement range. A significant difference was observed in age and BMI between patients with and without sarcopenia, being higher in the sarcopenia subgroup. Additionally, a possible relationship between hemoglobin levels and sarcopenia was suggested, although this did not constitute a clinically significant difference.
Ultrasound is a reliable tool for assessing muscle mass in critically ill patients.
Adequate training allows physiotherapy students to perform reliable evaluations.
Sarcopenia is prevalent in critically ill patients and is associated with advanced age and higher BMI.
Ultrasound in critical care physiotherapy enhances muscle atrophy assessment and treatment, offering a cost-effective, safe alternative to CT and MRI. Proper training optimizes patient care, reduces costs, and supports real-time-evaluation, aiding preventive and therapeutic decisions and objective diagnosis.
Sarcopenia
Reproducibility of Results
