Dados do Trabalho

Título

Distinct patterns of muscle atrophy during mechanical ventilation: a prospective ultrasonographic study of diaphragm and quadriceps in critically ill patients

Objetivo

To evaluate, through bedside ultrasound imaging, the correlation between the evolution of diaphragmatic and quadriceps muscle thickness in patients undergoing invasive mechanical ventilation and their respective clinical outcomes.

Métodos

This was a prospective, observational, single-center study. Patients were evaluated for diaphragmatic and quadriceps muscle thickness using ultrasonography within the first 24 hours post-intubation and 24 hours post-extubation. Data on severity (SAPS III, SOFA, comorbidity index), use of sedation, vasoactive drugs, corticosteroids, neuromuscular blockers, fluid balance, protein intake, ICU and hospital stay, reintubation, and mortality were collected.

Resultados

51 patients were enrolled [median 65 years, interquartile range (IQR) 53–73], 60.8% male (n=31), with an MV duration of 5.0 days (IQR 2.4–7.5). A median -17.7% variation in diaphragm thickness [(0.19 x 0.16 cm; p < 0.001)] was observed between intubation and extubation and -5% for quadriceps [(1.7 x 1.5 cm; p = 0.027)]. Thickness decreased in 72% (n=37) for the diaphragm and 64% (n=33) for quadriceps, but only 43% exhibited atrophy in both muscles. A weak correlation existed between quadriceps muscle loss and increased SAPS III and MV duration. No correlation was found between diaphragm muscle loss and studied outcomes.

Conclusão

Most patients experienced muscle mass loss in both respiratory and peripheral muscles, with no significant correlation between them. Diaphragm thickness loss was more pronounced but not associated with any isolated risk factors. Quadriceps thickness reduction correlated with patient severity and MV duration, with no association with evaluated clinical outcomes.