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Muscle wasting in the ICU can be reliably monitored using ultrasound
Critical Care volume 17, Article number: P439 (2013)
The aim of this study was to establish the intraobserver and interobserver variation of ultrasonographic measurements of the rectus femoris muscle cross-section area (RF-CSA). Muscle wasting is frequent in the ICU, affecting more than one-half of the patients with severe sepsis . Muscle mass reduces rapidly, and 15 to 20% is lost within the first week . To monitor muscle mass, ultrasound has the benefits of being both readily available in the ICU and non-invasive. Ultrasonographic measurement of RF-CSA has an almost perfect correlation with MRI (mean interclass correlation (ICC) = 0.999)  and RF-CSA is linearly related to maximum voluntary contraction strength in both healthy subjects and COPD patients (r = 0.78) .
The study had two purposes: to determine the intraobserver variation for RF-CSA by one observer scanning 15 healthy adult volunteers three times each at 2-day intervals; and to determine the interobserver variation for RF-CSA by two observers each scanning 15 adult ICU patients on the same day. Patients were in a supine position, legs in passive extension. The transducer was placed perpendicular to the long axis of the right thigh over the RF, two-thirds of the distance from the anterior superior iliac spine to the superior patellar border . RF-CSA was calculated by planimetry. At each scan, three measurements were made. For intraobserver variation, the 3 × 3 scans were analyzed using the interclass correlation coefficient. For interobserver variation, the three measurements from each observer were averaged and compared using Bland-Altman statistics.
Intraobserver variation: 15 healthy adults, age 39.6 ± 2.4 years, weight 66.8 ± 2.3 kg, sex three male/12 female. ICC: 0.996 (95% CI: 0.990 to 0.998). Interobserver variation: 15 ICU patients, age: 77 ± 8.3 years, weight: 71.3 ± 9.1 kg, sex nine male/six female. Bland-Altman: bias: -0.07 cm2, 95% limits of agreement -0.188 to 0.048 cm2.
Ultrasonographic measurement of RF-CSA is easily learned and quickly performed. It has a very low intraobserver and interobserver variation and can be recommended as a reliable method for monitoring muscle wasting in the ICU.
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Jørgensen, H., Nedergaard, B. & Gilsaa, T. Muscle wasting in the ICU can be reliably monitored using ultrasound. Crit Care 17, P439 (2013). https://doi.org/10.1186/cc12377
- Maximum Voluntary Contraction
- Anterior Superior Iliac Spine
- Healthy Adult Volunteer
- Interclass Correlation
- Interobserver Variation