Topics

ICU Associated Weakness and Bedside Ultrasound Assessment

2019-09-25 06:13:40 | BioPortfolio

Summary

ICU-associated weakness is a common experience for people following a critical illness. It is associated with important patient and system-relevant outcomes. Diagnosing ICU-associated weakness can be challenging because making the diagnosis relies on volitional participation in strength testing by the patient in a very ill population that is often sedated or restrained.

This study proposes to test if bedside ultrasound of tibialis anterior (a non-invasive test that doesn't require active participation by the patient) correlates with clinical whole-body weakness in critically ill patients admitted to an ICU with sepsis.

Description

BACKGROUND

Physical weakness is a common during and after critical illness. Weakness can develop for multiple reasons, but it can be generally be grouped into three overlapping categories:

1. Nervous system dysfunction - weakness can result from impairments in the nervous system control of muscles;

2. Muscle size reductions (i.e. sarcopenia) - muscles become smaller with disuse, and;

3. Muscle force reductions (i.e. dynapenia) - muscles develop contractile impairments.

In critical care, diagnostic criteria have been developed for a syndrome of weakness called intensive care unit-acquired weakness (ICU-AW). ICU-AW has important clinical implications. It is associated with delayed ventilator weaning, increased mortality, and longer lengths of stay in the hospital. ICU-AW can also have consequences for patients after they leave the hospital. ICU-AW can be implicated in impairments in quality of life and physical function such as difficulty climbing stairs, and delays in returning to work.

Diagnosing ICU-AW is not trivial and it is centered on assessments targeted primarily to assessing dynapenia. The diagnostic criteria are clear but making the diagnosis relies on the active participation of patients, and the reliable subjective assessment by clinicians at the bedside. Factors such as sedation, restraint use, paralytic medications, pain, and dressings can all confound the assessment of a patient's strength.

To augment patient assessments, it is possible that assessments of sarcopenia might be helpful in highlighting who might be at risk for muscle dysfunction in the ICU.

RESEARCH QUESTION AND OBJECTIVES Do serial measurements of tibialis anterior muscle cross-sectional area (a muscle in the leg) using bedside ultrasound correlate with clinical weakness in people admitted to the ICU for sepsis?

Primary Outcome:

Determine if the rates of decline of tibialis anterior muscle cross-sectional areas (%/day) measured by bedside ultrasound on participants admitted to an ICU for sepsis correlate with bedside clinical measures of strength using the medical research council (MRC) sum score (a score between 0 and 60).

Secondary Outcomes:

Determine if rates of decline of tibialis anterior muscle cross-sectional areas correlate with:

1. Ankle dorsiflexion strength, measured using the Medical Research Council (MRC) Scale for muscle strength (a score between 0 and 5);

2. Illness severity at admission to the ICU, measured by the Sequential Organ Failure Assessment (SOFA) score (a score between 0 and 24);

3. Duration of mechanical ventilation (days),

4. Duration of ICU length of stay (days), and;

5. Duration of hospital length of stay (days).

METHOD Each day, new admissions to a mixed medical-surgical ICU will be screened. Any person admitted with a diagnosis of sepsis will be considered for invitation to the study. Potential participants will be excluded if they are children (age < 18 years), if they have preexisting diagnoses that would plausibly affect the size of the muscles in their leg, or if they have medical conditions that would preclude an assessment of their strength. Participants who are appropriate for inclusion in the study will be approached for informed consent.

For participants who consent, every second day the cross-sectional area of the tibialis anterior muscle bulk on each leg will be measured (cm^2) using bedside ultrasound. These measurements will be accompanied by a clinical assessment of strength using the Medical Research Council (MRC) strength scale on six muscle groups bilaterally (shoulder abduction, elbow flexion, wrist extension, hip flexion, knee extension, and ankle dorsiflexion). Participants will continue to be evaluated every other day until they leave the ICU, or until their 14th day of admission to the ICU. Chart reviews will supplement these data to allow for the determination of the secondary objectives (e.g. SOFA scores, hospital lengths of stay).

Study Design

Conditions

Sarcopenia

Intervention

Tibialis anterior muscle cross-sectional area assessment by ultrasound, Muscle strength assessment

Status

Not yet recruiting

Source

University of Calgary

Results (where available)

View Results

Links

Published on BioPortfolio: 2019-09-25T06:13:40-0400

Clinical Trials [4223 Associated Clinical Trials listed on BioPortfolio]

Ultrasound Measurements Hamstring Muscles Thickness

No previous studies have compared the association between muscle thickness (MT) and muscle cross-sectional area (CSA) in healthy volunteers. The main aim of this study is to investigate th...

Correlation Between Muscle Thickness and Inflammation With Ventilator Use in Critically Ill Patients

Decrease thickness of diaphragm muscle, cross-sectional area of rectus femoris and biceps brachii muscle, and increase in CRP would affect ventilator length of use in critically ill patien...

A Difference in Subclavian Vein Catheterization Between Supine and Lateral Tilt Position - Stage I

Central venous catheterization is widely used for various purposes during surgery. For central venous catheterization, subclavian vein is selected because of the relatively low risk of inf...

Muscle Mass Loss in Critically Ill Patients.

The purpose of the study is to describe the change in muscle mass in critically ill patients. The study will examine rectus femoris cross sectional area with ultrasound and identify risk f...

Internal Jugular Vein Cross Sectional Area

The Trendelenburg position is used to distend the central veins, improving both success and safety of vascular cannulation. The purpose of this study is to measure the cross-sectional are...

PubMed Articles [20395 Associated PubMed Articles listed on BioPortfolio]

Intra- and inter-rater reliability in the cross-sectional area of feline lumbar epaxial musculature evaluated via abdominal CT scan.

The aim of this study was to evaluate the intra- and inter-rater reliability of epaxial muscle cross-sectional area measurement on feline CT images and to determine the relationship between normalized...

Changes in Cross-sectional Area and Signal Intensity of Healing Anterior Cruciate Ligaments and Grafts in the First 2 Years After Surgery.

The quality of a repaired anterior cruciate ligament (ACL) or reconstructed graft is typically quantified in clinical studies by evaluating knee, lower extremity, or patient performance. However, magn...

Cigarette Smoking Exacerbates Skeletal Muscle Injury Without Compromising its Regenerative Capacity.

Skeletal muscle dysfunction (SMD) in patients with Chronic Obstructive Pulmonary Disease (COPD) negatively impacts on quality of life and survival. Cigarette smoking (CS) is the major risk factor for ...

Nerve ultrasound normal values in children and young adults.

The objective of the study was to determine the reference values for cross-sectional area (CSA) of the nerves in healthy subjects between the age of 2 and 30 years.

Muscle cross-sectional area and motor unit properties of the medial gastrocnemius and vastus lateralis in normal weight and overfat children.

What is the central question of this study? Are differences in muscle size and motor unit properties between normal weight and overfat children muscle specific? What is the main finding and its import...

Medical and Biotech [MESH] Definitions

A value equal to the total volume flow divided by the cross-sectional area of the vascular bed.

Excessive periodic leg movements during sleep that cause micro-arousals and interfere with the maintenance of sleep. This condition induces a state of relative sleep deprivation which manifests as excessive daytime hypersomnolence. The movements are characterized by repetitive contractions of the tibialis anterior muscle, extension of the toe, and intermittent flexion of the hip, knee and ankle. (Adams et al., Principles of Neurology, 6th ed, p387)

Descriptive anatomy based on three-dimensional imaging (IMAGING, THREE-DIMENSIONAL) of the body, organs, and structures using a series of computer multiplane sections, displayed by transverse, coronal, and sagittal analyses. It is essential to accurate interpretation by the radiologist of such techniques as ultrasonic diagnosis, MAGNETIC RESONANCE IMAGING, and computed tomography (TOMOGRAPHY, X-RAY COMPUTED). (From Lane & Sharfaei, Modern Sectional Anatomy, 1992, Preface)

A microscope with a light source that can be projected into a linear beam. It allows cross-sectional viewing of the AQUEOUS HUMOR; CONJUNCTEIVA; CORNEA; EYELIDS; IRIS; and lens (see LENS, EYE) of the eye.

Studies in which the presence or absence of disease or other health-related variables are determined in each member of the study population or in a representative sample at one particular time. This contrasts with LONGITUDINAL STUDIES which are followed over a period of time.

More From BioPortfolio on "ICU Associated Weakness and Bedside Ultrasound Assessment"

Quick Search

Relevant Topics

Radiology
Radiology is the branch of medicine that studies imaging of the body; X-ray (basic, angiography, barium swallows), ultrasound, MRI, CT and PET. These imaging techniques can be used to diagnose, but also to treat a range of conditions, by allowing visuali...

Sepsis, septicaemia and blood poisoning
Septicaemia (another name for blood poisoning) refers to a bacterial infection of the blood, whereas sepsis can also be caused by viral or fungal infections.  Sepsis is not just limited to the blood and can affect the whole body, including the organ...


Searches Linking to this Trial