Qualitative and quantitative muscle ultrasound changes in patients with COVID-19–related ARDS

• Published in: Nutrition (Burbank, Los Angeles County, Calif.) Vol. 91-92; p. 111449
• Main Authors: Umbrello, Michele, Guglielmetti, Luigi, Formenti, Paolo, Antonucci, Edoardo, Cereghini, Sergio, Filardo, Clelia, Montanari, Giulia, Muttini, Stefano
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2021; Elsevier Limited
• Subjects: Applied Nutritional Investigation; ARDS; Body mass index; Body size; Calories; Catabolism; Coronaviruses; COVID-19; Critical Illness; Density; Diaphragm; Diaphragm ultrasound; Female; Fluid management; Gas exchange; Humans; Male; Mortality; Muscle ultrasound; Muscles; Nitrogen Balance; Nutrition; Observational studies; Patients; Proteins; Quadriceps Muscle - diagnostic imaging; Respiratory Distress Syndrome - diagnostic imaging; SARS-CoV-2; Survival; Ultrasonic imaging; Ultrasonography; COVID-19; Muscle ultrasound; Catabolism; Diaphragm ultrasound; Nitrogen Balance; ARDS
• DOI: 10.1016/j.nut.2021.111449
• ISSN: 0899-9007

•COVID-19–related acute hypoxemic respiratory failure is associated with hyperinflammation and increased catabolism.•Muscle ultrasound is increasingly used as a tool to assess and track changes in muscle structure and composition.•In a prospective investigation, we compared the changes over the first week in the size and quality of both rectus femoris and diaphragm muscles between critically ill, COVID-19 patients who did and did not survive a stay in the intensive care unit.•During the first week of intensive care unit stay, both rectus femoris and diaphragm size and quality significantly worsened compared to admission. This change was greater in non-survivors.•The change in muscle size was related to the cumulative protein deficit, whereas the change in muscle quality was related to the cumulative positive fluid balance.•Early changes in muscle size and quality seem related to the outcome of critically ill, COVID-19 patients, and might be influenced by nutritional and fluid management strategies.•Muscle ultrasound might improve the classification of patients who may be at risk for muscle wasting. Severe forms of the novel coronavirus-19 (COVID-19) are associated with systemic inflammation and hypercatabolism. The aims of this study were to compare the time course of the size and quality of both rectus femoris and diaphragm muscles between critically ill, COVID-19 survivors and non-survivors and to explore the correlation between the change in muscles size and quality with the amount of nutritional support delivered and the cumulative fluid balance. This was a prospective observational study in the general intensive care unit (ICU) of a tertiary care hospital for COVID-19. The right rectus femoris cross-sectional area and the right diaphragm thickness, as well as their echo densities were assessed within 24 h from ICU admission and on day 7. We recorded anthropometric and biochemical data, respiratory mechanics and gas exchange, daily fluid balance, and the number of calories and proteins administered. Twenty-eight patients were analyzed (65 ± 10 y of age; 80% men, body mass index 30 ± 7.8 kg/m2). Rectus femoris and diaphragm sizes were significantly reduced at day 7 (median = –26.1 [interquartile ratio [IQR], = –37.8 to –15.2] and –29.2% [–37.8% to –19.6%], respectively) and this reduction was significantly higher in non-survivors. Both rectus femoris and diaphragm echo density were significantly increased at day 7, with a significantly higher increase in non-survivors. The change in both rectus femoris and diaphragm size at day 7 was related to the cumulative protein deficit (R = 0.664, P < 0.001 and R = 0.640, P < 0.001, respectively), whereas the change in rectus femoris and diaphragm echo density was related to the cumulative fluid balance (R = 0.734, P < 0.001 and R = 0.646, P < 0.001, respectively). Early changes in muscle size and quality seem related to the outcome of critically ill COVID-19 patients, and to be influenced by nutritional and fluid management strategies.