Point-of-care ultrasound to evaluate thickness of rectus femoris, vastus intermedius muscle, and fat as an indicator of muscle and fat wasting in critically ill patients in a multidisciplinary intensive care unit

IntroductIonMuscle weakness, usually generalized in intensive care units (ICUs) which cannot be attributed to any cause other than critical illness is termed ICU associated weakness (ICUAW) and is associated with long-term consequences from the medical and socioeconomic point of view.[1,2] Hospital malnutrition is associated with increased morbidity and mortality, particularly among patients admitted to ICUs.Increased calorie deficits are common in the ICU.Consuming <75% of daily calorie requirements in the hospital setting is linked to poor outcomes.[3] Muscular atrophy is the universal feature in patients with ICUAW, and it can start in early stages of critical illness (within hours of onset of the disease).Its development has been related to the acute inflammatory process and immobilization.Factors such as age, medications, comorbidities, muscular function before critical illness, nutrition, nervous, and muscular damage can contribute to the extent of damage and the muscular and functional recovery capacity.[4] Few studies have shown that increase in protein intake in the early phase of critical illness will probably accelerate muscle loss during the 1 st week.[5,6] The underlying mechanism for this Background: Muscular atrophy is the universal feature in patients with ICUAW.Muscles of the lower limb are more prone to early atrophy.Measurement of fat thickness is used to assess malnutrition.This study was designed to evaluate if, subcutaneous fat also reduces along with muscle thickness and if it can be reliably used as an indicator of nutritional assessment in critically ill patients using point of care ultrasound.Materials and Methods: An observational clinical study of 100 patients admitted to multidisciplinary intensive care units (ICUs).Total anterior thigh thickness, thickness of the rectus femoris muscle, fat thickness, and the combined thickness of vastus intermedius and rectus femoris were taken on day 1, 3, and 7 of ICU admission.Results: There was progressive loss of muscle mass from day 1 to day 7. Muscle loss was not only limited to rectus femoris, but vastus intermedius also showed a significant decrease as indicated by the bone to muscle measurement.Skin to bone measurement which includes both muscle and fat compartment showed a decline.Conclusions: There is potential utility of ultrasound for early detection and probable corrective measures to prevent ICUAW.The rectus femoris thickness, skin to bone, and bone to muscle thickness show statistically significant difference on day 3, day 7 compared to day 1.Fat layer did not show statistically significant decrease.