Assessing Clinical Variables Associated With Femoral Muscle Decay as Measured by Point-of-Care Ultrasound in Critically Ill Children

Authors

Esther J. Kim, Department of Critical Care Medicine, Children's National Hospital and George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Kitman Wai, Department of Critical Care Medicine, Children's National Hospital and George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Leah Pedoeim, Department of Critical Care Medicine, Children's National Hospital and George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Sonali Basu, Department of Critical Care Medicine, Children's National Hospital and George Washington University School of Medicine and Health Sciences, Washington, DC, USA.

Document Type

Journal Article

Publication Date

9-23-2024

Journal

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine

DOI

10.1002/jum.16579

Keywords

ICU length of stay; caloric intake; critically ill children; hospital length of stay; muscle decay; point‐of‐care ultrasound

Abstract

OBJECTIVES: Skeletal muscle wasting is a common occurrence in critical illness, often resulting in intensive care unit (ICU)-acquired weakness. This study aims to identify clinical factors associated with muscle decay in mechanically ventilated critically ill children. Utilizing point-of-care ultrasound, a noninvasive and cost-effective tool, we assess muscle decay through ultrasound of the quadriceps femoris. METHODS: A prospective observational study was conducted in a single-center quaternary-care pediatric intensive care unit at a children's hospital. A convenience sample of 103 sedated and mechanically ventilated patients were enrolled in this study. Ultrasound measurements of quadriceps femoris muscle thickness were taken, and daily muscle decay rates were calculated. Demographic, clinical, and outcome data were analyzed for correlations with muscle decay. RESULTS: Among the enrolled patients, 67 had repeat measurements. Muscle thickness change aligned with prior studies, with a mean daily change of -1.9% [IQR -0.8, -5.0]. Adequate cumulative caloric intake (>60% of goal) correlated with less muscle decay compared with inadequate intake (-1.8 vs -2.4%, P < .001). Average daily muscle change correlated with both ICU and hospital length of stay (LOS) (r = .328, P = .007 and r = .393, P = .001). No significant correlations emerged between muscle change and mortality, disease severity, fluid balance, early mobilization, steroid exposure, or sedative and paralytic use. CONCLUSION: This study demonstrates early and frequent muscle decay in critically ill children, as detected by point-of-care ultrasound. Average daily muscle decay was associated with longer ICU and hospital LOS. Adequate cumulative caloric intake is linked to reduced muscle decay. These findings contribute to understanding muscle wasting in critically ill pediatric patients.

APA Citation

Kim, Esther J.; Wai, Kitman; Pedoeim, Leah; and Basu, Sonali, "Assessing Clinical Variables Associated With Femoral Muscle Decay as Measured by Point-of-Care Ultrasound in Critically Ill Children" (2024). GW Authored Works. Paper 5604.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/5604

Department

Pediatrics