The online version of this article (doi:10.1186/s13613-017-0263-8) contains supplementary material, which is available to authorized users.
Neuromuscular ultrasound is a noninvasive investigation, which can be easily performed at the bedside on the ICU. A reduction in muscle thickness and increase in echo intensity over time have been described in ICU patients, but the relation to ICU-acquired weakness (ICU-AW) is unknown. We hypothesized that quantitative assessment of muscle and nerve parameters with ultrasound can differentiate between patients with and without ICU-AW. The aim of this cross-sectional study was to investigate the diagnostic accuracy of neuromuscular ultrasound for diagnosing ICU-AW.
Newly admitted ICU patients, mechanically ventilated for at least 48 h, were included. As soon as patients were awake and attentive, an ultrasound was made of four muscles and two nerves (index test) and ICU-AW was evaluated using muscle strength testing (reference standard; ICU-AW defined as mean Medical Research Council score <4). Diagnostic accuracy of muscle thickness, echo intensity and homogeneity (echo intensity standard deviation) as well as nerve cross-sectional area, thickness and vascularization were evaluated with the area under the curve of the receiver operating characteristic curve (ROC–AUC). We also evaluated diagnostic accuracy of z-scores of muscle thickness, echo intensity and echo intensity standard deviation.
Seventy-one patients were evaluated of whom 41 had ICU-AW. Ultrasound was done at a median of 7 days after admission in patients without ICU-AW and 9 days in patients with ICU-AW. Diagnostic accuracy of all muscle and nerve parameters was low. ROC–AUC ranged from 51.3 to 68.0% for muscle parameters and from 51.0 to 66.7% for nerve parameters.
Neuromuscular ultrasound does not discriminate between patients with and without ICU-AW at the time the patient awakens and is therefore not able to reliably diagnose ICU-AW in ICU patients relatively early in the disease course.
Additional file 1: Figure E1. Muscle measurements predefined measurement sites. Table E1. Muscle measurements predefined measurement sites. Figure E2. Ultrasound image of the rectus femoris. Table E2. Regression model formulas for normal values of muscle thickness and muscle echo intensity. Table E3. Characteristics of new healthy control cohort. Figure E3. Muscle thickness and echo intensity.
Gallardo E, Noto Y, Simon NG. Ultrasound in the diagnosis of peripheral neuropathy: structure meets function in the neuromuscular clinic. J Neurol Neurosurg Psychiatry. 2015;86:1066–74.
Goedee HS, Brekelmans GJF, van Asseldonk JTH, Beekman R, Mess WH, Visser LH. High resolution sonography in the evaluation of the peripheral nervous system in polyneuropathy—a review of the literature. Eur J Neurol. 2013;20:1342–51.
Connolly B, MacBean V, Crowley C, Lunt A, Moxham J, Rafferty GF, et al. Ultrasound for the assessment of peripheral skeletal muscle architecture in critical illness: a systematic review. Crit Care Med. 2014;7:1–10.
Campbell IT, Watt T, Withers D, England R, Sukumar S, Keegan MA, et al. Muscle thickness, measured with ultrasound, may be an indicator of lean tissue wasting in multiple organ failure in the presence of edema. Am J Clin Nutr. 1995;62(3):533–9. PubMed
Cartwright MS, Kwayisi G, Griffin LP, Sarwal A, Walker FO, Harris JM, et al. Quantitative neuromuscular ultrasound in the intensive care unit. Muscle Nerve. 2013;47(2):255–9.
Puthucheary ZA, Rawal J, Mcphail M, Connolly B, Ratnayake G, Chan P, et al. Acute skeletal muscle wasting in critical illness. JAMA. 2013;310(15):1591–600.
Bossuyt PPM, Reitsma JJB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig LM, et al. The STARD statement for reporting studies of diagnostic accuracy: explanation and elaboration. Ann Intern Med. 2003;138(1):1–12. CrossRef
Wieske L, Verhamme C, Witteveen E, Bouwes A, Dettling-Ihnenfeldt DS, van der Schaaf M, et al. Feasibility and diagnostic accuracy of early electrophysiological recordings for ICU-acquired weakness: an observational cohort study. Neurocrit Care. 2015;22(3):385–94.
Abe T, Kawakami Y, Suzuki Y, Gunji A, Fukunaga T. Effects of 20 days bed rest on muscle morphology. J Gravit Physiol. 1997;4(1):S10–4. PubMed
Rodriguez PO, Setten M, Maskin LP, Bonelli I, Vidomlansky SR, Attie S, et al. Muscle weakness in septic patients requiring mechanical ventilation: protective effect of transcutaneous neuromuscular electrical stimulation. J Crit Care. 2012;27(3):319.e1-8. CrossRef
Mohammadi A, Ghasemi-Rad M, Mladkova-Suchy N, Ansari S. Correlation between the severity of carpal tunnel syndrome and color Doppler sonography findings. Am J Roentgenol. 2012;198(2):W181-4. CrossRef
- Diagnostic accuracy of quantitative neuromuscular ultrasound for the diagnosis of intensive care unit-acquired weakness: a cross-sectional observational study
Nens van Alfen
Marcus J. Schultz
Ivo N. van Schaik
- Springer Paris
Neu im Fachgebiet AINS
Meistgelesene Bücher aus dem Fachgebiet AINS
Mail Icon II