重症患者肌肉质量的超声评估：与营养支持和临床结果的相关性。

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care Pub Date : 2024-10-19 DOI:10.1016/j.jcrc.2024.154938

Maria Leonor Guia Lopes , José Pedro Cidade , David Sousa , Marta Rebelo , Carolina Antunes , Eduarda Carmo , Pedro Póvoa , Pais Martins , Clotilde Limbert , João Sequeira Duarte

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引用次数: 0

摘要

背景：重症监护病房（ICU）的危重病人很容易出现后天性虚弱，这对临床疗效产生了负面影响。传统的肌肉质量和营养状况评估在重症监护病房往往不切实际。超声波是一种很有前景的无创替代方法。本研究评估了重症监护病房中基于超声的肌肉评估、患者营养支持和临床疗效之间的关系：一项前瞻性队列研究在一家三级医疗中心的三间重症监护室进行。在重症监护病房的第 1、3 和 7 天收集每日营养摄入量、股四头肌超声测量值（股直肌横截面积 - RFCSA 和股四头肌肌层厚度 - QMLT）和临床数据：共有 128 名患者参与分析，平均年龄为 65.4（±18.1）岁，入住重症监护室的中位时间为 6（4-10）天。在第 3 天和第 7 天，QMLT 分别下降了 5% 和 13%，RFCSA 分别下降了 10% 和 27%。在入住 ICU 的最初 3 天内，热量和蛋白质摄入量较低与肌肉质量损失较多之间存在明显的相关性。多变量逻辑回归结果表明，QMLT 的降低对 28 天死亡率有显著影响（调整 OR 1.088，95 % CI：1.018-1.113，p = 0.015）。非存活患者的每日热量和蛋白质摄入量较低（p 结论：我们的研究表明，危重病人的每日热量和蛋白质摄入量较低，而非存活患者的每日热量和蛋白质摄入量较高：我们的研究表明，重症患者在进入重症监护室的前 72 小时内会出现明显的肌肉质量下降。QMLT 的减少对 28 天的死亡率有重大影响，每减少 0.1 厘米，死亡几率增加 8.8%。

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Ultrasound assessment of muscle mass in critically ill patients: A correlation with nutritional support and clinical outcomes

Background

Critically ill patients are at high risk of Intensive Care Unit (ICU) Acquired weakness, which negatively impacts clinical outcomes. Traditional muscle mass and nutritional status assessments are often impractical in the ICU. Ultrasound offers a promising, non-invasive alternative. This study evaluates the relationship between ultrasound-based muscle assessments, patients' nutritional support, and clinical outcomes in the ICU.

Methods

A prospective cohort study was conducted in three ICUs of a tertiary center. Daily nutritional intake, ultrasound measurements of the quadriceps muscle (rectus femoris cross-sectional area – RFCSA – and quadriceps muscle layer thickness - QMLT), and clinical data were collected on days 1, 3, and 7 of ICU.

Results

A total of 128 patients were included in the analysis, with a mean age of 65.4 (±18.1) years and a median ICU stay of 6 (4–10) days. QMLT decreased by 5 % and 13 %, and RFCSA decreased by 10 % and 27 % on days 3 and 7, respectively. A significant correlation was found between lower caloric and protein intake and greater muscle mass loss within the initial 3 days of ICU admission. Multivariate logistic regression indicated that QMLT reduction significantly contributed to 28-day mortality (adjusted OR 1.088, 95 % CI: 1.018–1.113, p = 0.015). Lower daily caloric and protein intake was depicted in non-surviving patients (p < 0.001).

Conclusions

Our study demonstrates that critically ill patients experience significant muscle mass loss within the first 72 h of ICU. QMLT reduction significantly impacts 28-day mortality, with an 8.8 % increase in the odds of death per 0.1 cm reduction.

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来源期刊

Journal of critical care 医学-危重病医学

CiteScore

8.60

自引率

2.70%

发文量

237

审稿时长

23 days

期刊介绍： The Journal of Critical Care, the official publication of the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM), is a leading international, peer-reviewed journal providing original research, review articles, tutorials, and invited articles for physicians and allied health professionals involved in treating the critically ill. The Journal aims to improve patient care by furthering understanding of health systems research and its integration into clinical practice. The Journal will include articles which discuss: All aspects of health services research in critical care System based practice in anesthesiology, perioperative and critical care medicine The interface between anesthesiology, critical care medicine and pain Integrating intraoperative management in preparation for postoperative critical care management and recovery Optimizing patient management, i.e., exploring the interface between evidence-based principles or clinical insight into management and care of complex patients The team approach in the OR and ICU System-based research Medical ethics Technology in medicine Seminars discussing current, state of the art, and sometimes controversial topics in anesthesiology, critical care medicine, and professional education Residency Education.