This study aimed to defne early muscle weakness, 28-days morbidity, or mortality prediction in patients with critical illnesses using muscle atrophy parameters by muscle ultrasound. The presence of muscle atrophy of>10% in the frst 72 h is believed to predict outcomes in patients in our ICU.
The study was approved by the Research Ethics Committee of the Hospital Universitario Nacional de Colombia and was designed as a prospective, observational, single-center cohort study. Adult patients (>18 years) admitted to the ICU with medical or surgical pathologies, under mechanical ventilation (MV) for more than 24 hours, and expected to stay at least 96 hours were included. Patients with MV >36 hours, neuromuscular diseases, central or peripheral nervous system lesions, orthopedic limitations, or expected death within 48 hours were excluded. Ultrasound measurements of the rectus femoris muscle were performed at two time points: within the first 24 hours and on day three. Muscle atrophy, defined as a ≥10% reduction in serial measurements, was considered the exposure factor. Muscle strength and risk factors for morbidity were evaluated. The primary outcomes included muscle weakness, morbidity, and 28-day mortality, analyzed using statistical tests (IBM-SPSS-19, GrahPad Prism-6.0)
A total of 391 ICU patients were screened, with 83 meeting the main eligibility criteria for mechanical ventilation (MV). Of these, 31 were included in the study. Significant muscle atrophy (>10%) was observed in 58% of patients, with a mean muscle loss of 13.02% to 16.96%. Although there were no significant statistical differences between groups, patients with muscle atrophy had lower dynamometry values and increased limb weakness. Muscle atrophy was associated with a 3.2 times greater risk of limb weakness. Mortality at 28 days occurred in 19.3% of the cohort, with no significant difference between subgroups.
Muscle atrophy, as assessed by ultrasound, occurs early in critically ill patients and presents a high clinical risk of limb muscle weakness, although no significant differences were found in key outcomes such as mortality or mechanical ventilation duration. Ultrasound is suggested as a useful tool for early detection of muscle mass loss in the ICU, enabling individualized interventions.
Early intervention strategies aimed at mitigating muscle mass loss, such as nutritional support and physical rehabilitation, are essential in the ICU to enhance clinical outcomes.
Further research is necessary to deepen our understanding of the underlying mechanisms and optimize interventions to prevent or reduce muscle atrophy in critically ill patients.
Muscular atrophy
Mortality
