Muscle atrophy in mechanically-ventilated critically ill children
| Autor: | Nausheen Hasan, Ryan Johnson, Kay W. P. Ng, Alexander R. Dietz, Michael Shoykhet, Craig M. Zaidman, Mary E. Hartman, Jack Baty |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_treatment Respiratory System Pathology and Laboratory Medicine Biochemistry Biceps Quadriceps Muscle Fats Cohort Studies Families 0302 clinical medicine Thoracic Diaphragm Medicine and Health Sciences Electric Impedance Prospective Studies Child Prospective cohort study Children Musculoskeletal System Ultrasonography Pediatric intensive care unit Multidisciplinary Electrical impedance myography Muscles Muscle Analysis Lipids Muscle atrophy Muscular Atrophy Bioassays and Physiological Analysis Child Preschool Anesthesia Medicine Female Anatomy medicine.symptom Respiratory Insufficiency Infants Research Article Adolescent Critical Illness Science Diaphragm Research and Analysis Methods Intensive Care Units Pediatric 03 medical and health sciences Signs and Symptoms Atrophy Diagnostic Medicine medicine Humans Mechanical ventilation Electromyography business.industry Infant Newborn Biology and Life Sciences Infant 030208 emergency & critical care medicine medicine.disease Respiration Artificial Skeletal Muscles Respiratory failure Age Groups Body Limbs People and Places Population Groupings business 030217 neurology & neurosurgery |
| Zdroj: | PLoS ONE, Vol 13, Iss 12, p e0207720 (2018) PLoS ONE |
| ISSN: | 1932-6203 |
| DOI: | 10.1371/journal.pone.0207720 |
| Popis: | Importance ICU-acquired muscle atrophy occurs commonly and worsens outcomes in adults. The incidence and severity of muscle atrophy in critically ill children are poorly characterized. Objective To determine incidence, severity and risk factors for muscle atrophy in critically ill children. Design, setting and participants A single-center, prospective cohort study of 34 children receiving invasive mechanical ventilation for ≥48 hours. Patients 1 week– 18 years old with respiratory failure and without preexisting neuromuscular disease or skeletal trauma were recruited from a tertiary Pediatric Intensive Care Unit (PICU) between June 2015 and May 2016. We used serial bedside ultrasound to assess thickness of the diaphragm, biceps brachii/brachialis, quadriceps femoris and tibialis anterior. Serial electrical impedance myography (EIM) was assessed in children >1 year old. Medical records were abstracted from an electronic database. Exposures Respiratory failure requiring endotracheal intubation for ≥48 hours. Main outcome and measures The primary outcome was percent change in muscle thickness. Secondary outcomes were changes in EIM-derived fat percentage and “quality”. Results Of 34 enrolled patients, 30 completed ≥2 ultrasound assessments with a median interval of 6 (IQR 6–7) days. Mean age was 5.42 years, with 12 infants 1 year old (60%). In the entire cohort, diaphragm thickness decreased 11.1% (95%CI, -19.7% to -2.52%) between the first two assessments or 2.2%/day. Quadriceps thickness decreased 8.62% (95%CI, -15.7% to -1.54%) or 1.5%/day. Biceps (-1.71%; 95%CI, -8.15% to 4.73%) and tibialis (0.52%; 95%CI, -5.81% to 3.40%) thicknesses did not change. Among the entire cohort, 47% (14/30) experienced diaphragm atrophy (defined a priori as ≥10% decrease in thickness). Eighty three percent of patients (25/30) experienced atrophy in ≥1 muscle group, and 47% (14/30)—in ≥2 muscle groups. On multivariate linear regression, increasing age and traumatic brain injury (TBI) were associated with greater muscle loss. EIM revealed increased fat percentage and decreased muscle “quality”. Conclusions and relevance In children receiving invasive mechanical ventilation, diaphragm and other skeletal muscle atrophy is common and rapid. Increasing age and TBI may increase severity of limb muscle atrophy. Prospective studies are required to link muscle atrophy to functional outcomes in critically ill children. |
| Databáze: | OpenAIRE |
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