OT-127
Changes in lean body mass in early pediatric critical illness
Brook K, Quraishi S
Massachusetts General Hospital, Brookline, MA, USA
Introduction: Sarcopenia occurs rapidly in critically ill adult patients. Muscle ultrasonography is increasingly recognized as a noninvasive, low-cost, reliable, point-of-care modality to assess longitudinal changes in muscle mass in critically ill adults, with rapid muscle atrophy being visible by ultrasound within 3-5 days of intensive care unit (ICU) admission. Limited longitudinal studies exist evaluating muscle ultrasonography in critically ill pediatric patients.
Aim: We examined quadriceps muscle thickness in critically ill pediatric patients over a period of seven days to better define ultrasonographic skeletal muscle changes in early pediatric critical illness and to determine the feasibility of this method in the pediatric population.
Methods: We longitudinally assessed quadriceps thickness in 50 patients who were admitted to the pediatric ICU at the Massachusetts General Hospital, Boston, Massachusetts. All patients were intubated, sedated, and on bed rest for the duration of the study. Measurements were performed on days 1, 3, 5 and 7 (day 0 being day of admission) using a Sonosite M-Turbo (Fujifilm, Bothell, Washington). We standardized our measurements (performed separately by two different evaluators) by using the midpoint of a line drawn between the anterior superior iliac spine and the mid-patella. An average of three measurements was recorded for every patient on each day.
Results: Mean age of patients enrolled was 8 (SD 2), 44% were females, average Pediatric Risk of Mortality (PRISM III) score was 9 (SD 3), and mean body mass index for age was 61st percentile (SD 29). The average daily decrement in quadriceps thickness was 3% (SD 1), with the greatest loss occurring between days 3 and 5. Intrarater reliability was substantial to excellent (Cohen’s kappa was 0.62-0.87) with an observed percentage agreement of 77-96%. Interrater reliability was also substantial to excellent (Cohen’s kappa was 0.79 - 0.86) with high agreement, ranging from 89-100%.
Discussion: Our data suggests that a significant decrement in lean body mass occurs during early critical illness in pediatric ICU patients. Ultrasonography may be a readily available and objective tool to assess changes in lean body mass. Future studies are needed to assess whether lean body mass measurements using ultrasonography can be used to predict patients at risk for adverse perioperative or critical care outcomes. Additional studies are needed to determine normative curves of quadriceps thickness based on patient age and gender.
Conclusion: Ultrasonography may be a noninvasive, reliable bedside tool to assess changes in lean body mass in critically ill pediatric patients.
References:
1. Tillquist M, Kutsogiannis DJ, Wischmeyer PE, et al. Bedside ultrasound is a practical and reliable measurement tool for assessing quadriceps muscle layer thickness. JPEN J Parenter Enteral Nutr. 2014;38(7):886-890.
2. Fivez T, Hendrickx A, Van Herpe T, et al. An analysis of reliability and accuracy of muscle thickness ultrasonography in critically ill children and adults. Journal of Parenteral and Enteral Nutrition. 2016;40(7):944-949.
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