Monitoring of muscle mass in critically ill patients: comparison of ultrasound and two bioelectrical impedance analysis devices

Nobuto Nakanishi; Rie Tsutsumi; Yoshihiro Okayama; Takuya Takashima; Yoshitoyo Ueno; Taiga Itagaki; Yasuo Tsutsumi; Hiroshi Sakaue; Jun Oto

doi:10.1186/s40560-019-0416-y

Monitoring of muscle mass in critically ill patients: comparison of ultrasound and two bioelectrical impedance analysis devices

J Intensive Care. 2019 Dec 16:7:61. doi: 10.1186/s40560-019-0416-y. eCollection 2019.

Authors

Nobuto Nakanishi¹, Rie Tsutsumi², Yoshihiro Okayama³, Takuya Takashima¹, Yoshitoyo Ueno¹, Taiga Itagaki¹, Yasuo Tsutsumi⁴, Hiroshi Sakaue², Jun Oto⁵

Affiliations

¹ 1Emergency and Critical Care Medicine, Tokushima University Hospital, 2-50-1 Kuramoto, Tokushima, 770-8503 Japan.
² 2Department of Nutrition and Metabolism, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto, Tokushima, 770-8503 Japan.
³ 3Clinical Trial Center for Developmental therapeutics, Tokushima University Hospital, 2-50-1 Kuramoto, Tokushima, 770-8503 Japan.
⁴ 4Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Hiroshima, 734-8551 Japan.
⁵ 5Emergency and Disaster Medicine, Tokushima University Hospital, 2-50-1 Kuramoto, Tokushima, 770-8503 Japan.

Abstract

Background: Skeletal muscle atrophy commonly occurs in critically ill patients, and decreased muscle mass is associated with worse clinical outcomes. Muscle mass can be assessed using various tools, including ultrasound and bioelectrical impedance analysis (BIA). However, the effectiveness of muscle mass monitoring is unclear in critically ill patients. This study was conducted to compare ultrasound and BIA for the monitoring of muscle mass in critically ill patients.

Methods: We recruited adult patients who were expected to undergo mechanical ventilation for > 48 h and to remain in the intensive care unit (ICU) for > 5 days. On days 1, 3, 5, 7, and 10, muscle mass was evaluated using an ultrasound and two BIA devices (Bioscan: Malton International, England; Physion: Nippon Shooter, Japan). The influence of fluid balance was also evaluated between each measurement day.

Results: We analyzed 93 images in 21 patients. The age of the patients was 69 (interquartile range, IQR, 59-74) years, with 16 men and 5 women. The length of ICU stay was 11 days (IQR, 9-25 days). The muscle mass, monitored by ultrasound, decreased progressively by 9.2% (95% confidence interval (CI), 5.9-12.5%), 12.7% (95% CI, 9.3-16.1%), 18.2% (95% CI, 14.7-21.6%), and 21.8% (95% CI, 17.9-25.7%) on days 3, 5, 7, and 10 (p < 0.01), respectively, with no influence of fluid balance (r = 0.04, p = 0.74). The muscle mass did not decrease significantly in both the BIA devices (Bioscan, p = 0.14; Physion, p = 0.60), and an influence of fluid balance was observed (Bioscan, r = 0.37, p < 0.01; Physion, r = 0.51, p < 0.01). The muscle mass assessment at one point between ultrasound and BIA was moderately correlated (Bioscan, r = 0.51, p < 0.01; Physion, r = 0.37, p < 0.01), but the change of muscle mass in the same patient did not correlate between these two devices (Bioscan, r = - 0.05, p = 0.69; Physion, r = 0.23, p = 0.07).

Conclusions: Ultrasound is suitable for sequential monitoring of muscle atrophy in critically ill patients. Monitoring by BIA should be carefully interpreted owing to the influence of fluid change.

Trial registration: UMIN000031316. Retrospectively registered on 15 February 2018.

Keywords: Bioelectrical impedance analysis; Critically ill patients; Fluid balance; Muscle mass; Ultrasound.