Annals
of Intensive Care20199:57
Published: 17 May 2019
Abstract
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.
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