Muscular mass and subcutaneous fat changes according to duration of ICU hospitalization with corticosteroid and muscle relaxant intake

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Introduction

In the present study we profit from the high U/S sensitivity and specificity in order to study the muscular mass (MM) and subcutaneous fat (SBF) changes during Intensive Care Unit hospitalization. In addition, we investigate the influence of the administration of muscle relaxants and corticosteroids.

Materials and methods

Thirty patients (19 male aged 51.1 ± 14.15 years hospitalized for 18.84 ± 3.5 days and 11 female aged 64.36 ± 12.4 years hospitalized for 19.18 ± 4.6 days) entered the study. Clinical examination and computerized tomographic scan proved intracerebral hemorrhage in 14 of them and brain infarction in 16 of them. The patient's nutrition schedule included 30 Kcal/kg/day with protein uptake of 1 g/kg/day. Physiotherapy (passive movements of the limbs) was applied for 1 h/day in all patients. Muscle relaxation was applied to 9 patients with atracurium (0.6–0.7 mg/kg). The mean duration was 2.77 ± 0.44. Dexamethasone (24 mg/d iv) was applied to 14 patients for a mean duration of 4 days. Two ultrasonographic measurements were done for each patient; one on the first and another on the last hospitalization day in the ICU. Upper arm biceps MM and SBF thickness were assessed by M-mode ultrasonography using a 10 MHz linear-array high resolution transducer. All scans were performed with the same ultrasonographer. MM and SBF thickness are expressed in cm. MM, and SBF changes were calculated as differences of the 2nd measurement minus the 1st and they were expressed as ΔMM[cm] and ΔSBF[cm], respectively.

Results

A significant loss of MM and SBF was observed in all patients included in the study. SBF loss (mean ΔSBF%=41.1± 16.70) was significantly higher than corresponding MM reduction (ΔMM%=21.4± 4.90). A significant correlation was found between ΔMM% and the duration of hospitalization (19± 4 days), (r=0.62, P<0.05). On the contrary ΔSBF% was poorly correlated with the duration of the hospitalization (r=0.10, P>0.05). Neither ΔMM% nor ΔSBF were correlated with patients' age. Patients who took corticosteroids (n=5) showed a non-significantly higher percentage of MM loss in comparison to those who did not take corticosteroid (n=15; corresponding ΔMM%: 22.1± 5.22 versus 20.0± 4.83%). Nevertheless, ΔMM% for the patients, who did not take muscle relaxation was slightly different (20.4± 4.53) from ΔMM% of patients who did not take corticosteroids or corticosteroids and muscle relaxants. A significantly higher reduction of MM was observed in patients who took corticosteroids and muscle relaxants in comparison to those who did not take either corticosteroids or muscle relaxants (corresponding ΔMM%: 23.8± 4.90 versus 19.8± 4.47). SBF did not differ significantly between patients who took and did not take corticosteroids (corresponding ΔSBF%: 47.5± 26.47 versus 40.6± 18.91). Not significant was also the SBF difference between those who took corticosteroids and muscle relaxants (ΔSBF%: 35.9± 17.39) in comparison to those who did not take either corticosteroids or muscle relaxants (ΔSBF%: 42.0± 12.69). ΔSBF% for patients who did not take muscle relaxation (43.2± 15.95) did not differ significantly from corresponding ΔSBF values of the other formatted groups.

Conclusions

Our study shows that MM loss is correlated with the duration of hospitalization as well as with the synchronous corticosteroids and muscle relaxants administration. On the contrary SBF, although decreased during the period of our study, is not statistically correlated with any of the studied factors.