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Review
.2023 Dec 20;13(1):26.
doi: 10.3390/jcm13010026.

Ultrasonographic Features of Muscular Weakness and Muscle Wasting in Critically Ill Patients

Affiliations
Review

Ultrasonographic Features of Muscular Weakness and Muscle Wasting in Critically Ill Patients

Michele Umbrello et al. J Clin Med..

Abstract

Muscle wasting begins as soon as in the first week of one's ICU stay and patients with multi-organ failure lose more muscle mass and suffer worse functional impairment as a consequence. Muscle wasting and weakness are mainly characterized by a generalized, bilateral lower limb weakness. However, the impairment of the respiratory and/or oropharyngeal muscles can also be observed with important consequences for one's ability to swallow and cough. Muscle wasting represents the result of the disequilibrium between breakdown and synthesis, with increased protein degradation relative to protein synthesis. It is worth noting that the resulting functional disability can last up to 5 years after discharge, and it has been estimated that up to 50% of patients are not able to return to work during the first year after ICU discharge. In recent years, ultrasound has played an increasing role in the evaluation of muscle. Indeed, ultrasound allows an objective evaluation of the cross-sectional area, the thickness of the muscle, and the echogenicity of the muscle. Furthermore, ultrasound can also estimate the thickening fraction of muscle. The objective of this review is to analyze the current understanding of the pathophysiology of acute skeletal muscle wasting and to describe the ultrasonographic features of normal muscle and muscle weakness.

Keywords: critical care; intensive care unit acquired weakness; muscle weakness; proteolysis; ultrasound evaluation.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Normal features of diaphragm and quadriceps muscle. The figure shows the features that can be seen with skeletal muscle ultrasound. Left Panel (A): a transverse scan of the thigh allows for the visualization of the quadriceps muscle, which is composed of the rectus femoris (RF), the vastus lateralis (Vl), the vastus medialis (Vm), and the vastus intermedius (Vi); the hyperechoic, curvilinear image on the lower part of the figure, with the anechoic shadow is the femur (F), while on the upper part of the image, the subcutaneous tissue is shown (ScT). Right panel (B): a longitudinal scan of the chest wall at the zone of apposition allows for the visualization of the diaphragm at the zone of apposition (i.e., the area of attachment between the diaphragm directly behind the inner aspect of the lower chest wall and rib cage). Lu: lung; ScT: subcutaneous tissue; ICm: intercostal muscles; Li: liver; and Di: diaphragm.
Figure 2
Figure 2
Ultrasonographic images of the quadriceps muscle and the diaphragm during the first week of ICU stay of a critically ill patient. The figure shows the images of the quadriceps muscle (upper panels (A,B)) and the diaphragm (lower panels (C,D)) of a critically ill patient during the first (left panels) and seventh day of ICU stay (right panels) and highlights the loss in muscle mass. Upper panels: The red, shaded line represents the cross-sectional area of the rectus femoris muscle; the grey, shaded area in panel (B) is the cross-sectional area of the first ICU day, and highlights the reduction in mass of the muscle. Lower panels: the red arrows show the diaphragm end-expiratory thickness; the grey, shaded line in panel (D) is the end-expiratory diaphragm thickness of the first ICU day.
Figure 3
Figure 3
Change in rectus femoris echogenicity and pennation angle for a critically ill patient during the first week of ICU stay. The figure shows images of the quadriceps muscle of a critically ill patient during the first (upper panels) and seventh day of ICU stay (lower panels), and highlights the loss in muscle architecture. (A): the rectus femoris muscle is insonated with a transversal scan of the thigh; the red, shaded, line represents the cross-sectional area of the rectus femoris muscle; (B): the pixel enclosed in the red, shaded area of the rectus femoris cross-sectional area in panel (A) was analyzed for echo-genicity; (C): the rectus femoris muscle is insonated with a longitudinal scan at the same point of image (A); the pennation angle is shown by the red lines. Images (D–F) represent the same muscle of the same patient after 7 days of ICU stay. In the late image (panel (E)), the overall histogram is shifted to the right compared to the admission data (Panel (B)); moreover, the mean echo-intensity value increases from 68.9 to 93.1, indicating a brighter muscle, which is generally what happens with in-flammation or edema.
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References

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