Clinical review: peripheral muscular ultrasound in the ICU

Annals of Intensive Care

Michele Umbrello¹  Silvia Coppola¹  Paolo Formenti¹  Sara Froio¹  Davide Chiumello² 

[1] SC Anestesia e Rianimazione, Ospedale San Paolo – Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy;0000 0004 1757 2822, grid.4708.b, Centro Ricerca Coordinata di Insufficienza Respiratoria, Università degli Studi di Milano, Milan, Italy;SC Anestesia e Rianimazione, Ospedale San Paolo – Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy;0000 0004 1757 2822, grid.4708.b, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy;0000 0004 1757 2822, grid.4708.b, Centro Ricerca Coordinata di Insufficienza Respiratoria, Università degli Studi di Milano, Milan, Italy;

关键词: ICU-acquired weakness;    Skeletal muscle;    Peripheral muscular ultrasound;    Muscle cross-sectional area;    Muscle layer thickness;    Pennation angle;    Muscle echointensity;   

DOI  :  10.1186/s13613-019-0531-x

来源: publisher

【 摘 要 】

Muscular weakness developing from critical illness neuropathy, myopathy and muscle atrophy has been characterized as intensive care unit-acquired weakness (ICUAW). This entity occurs commonly during and after critical care stay. Various causal factors for functional incapacity have been proposed. Among these, individual patient characteristics (such as age, comorbidities and nutritional status), acting in association with sustained bed rest and pharmacological interventions (included the metabolic support approach), seem influential in reducing muscular mass. Long-term outcomes in heterogeneous ICUAW populations include transient disability in 30% of patients and persistent disabilities that may occur even in patients with nearly complete functional recovery. Currently available tools for the assessment of skeletal muscle mass are imprecise and difficult to perform in the ICU setting. A valid alternative to these imaging modalities is muscular ultrasonography, which allows visualization and classification of muscle characteristics by cross-sectional area, muscle layer thickness, echointensity by grayscale and the pennation angle). The aim of this narrative review is to describe the current literature addressing muscular ultrasound for the detection of muscle weakness and its potential impact on treatment and prognosis of critically ill patients when combined with biomarkers of muscle catabolism/anabolism and bioenergetic state. In addition, we suggest a practical flowchart for establishing an early diagnosis.

【 授权许可】

CC BY