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

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

Nobuto Nakanishi  1 , Rie Tsutsumi  2 , Yoshihiro Okayama  3 , Takuya Takashima  1 , Yoshitoyo Ueno  1 , Taiga Itagaki  1 , Yasuo Tsutsumi  4 , Hiroshi Sakaue  2 , Jun Oto  5
Affiliations

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

Nobuto Nakanishi et al. J Intensive Care. .

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.

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Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Percentage change in muscle mass, monitored by an ultrasound and two BIAs. Percentage change in muscle mass was calculated in the comparison with the value of day 1. Muscle mass, monitored by an ultrasound, statistically significantly (p <  0.01) decreased, whereas muscle mass, monitored by two BIAs, did not statistically significantly decrease (Bioscan, p = 0.14; Physion, p = 0.60). p values were derived from mixed-effects models for repeated measures. Data are presented as means and 95% confidence intervals. The number of patients daily is displayed below the graph. BIA bioelectrical impedance analysis
Fig. 2
Fig. 2
Relationship between ultrasound and BIA in muscle mass evaluation. The correlation between ultrasound and two BIAs. a Muscle mass. b Muscle mass change. a Muscle mass was compared at one point in each measurement day. BIA was correlated with ultrasound in some measurement days (Bioscan, days 1, 5, 7, and 10; Physion, days 1 and 5). b Muscle mass change was compared from day 1 to each measurement day. The percentage change of muscle mass in BIA did not correlate with the findings using ultrasound. The correlations were shown under every graph. Pearson correlation coefficient was used to investigate the relationships. BIA bioelectrical impedance analysis
Fig. 3
Fig. 3
Relationship among ultrasound, BIA, and CT in muscle mass evaluation. The correlation among ultrasound, BIA, and CT. a Muscle mass. b Muscle mass change. a Muscle mass was compared in 17 patients at day 1. Both ultrasound and BIA were correlated with CT measurements. b Muscle mass change was compared from day 1 to each measurement day (1, 2, 3, and 2 patients at days 3, 5, 7, and 10). Ultrasound, not BIA, was correlated with CT measurements. The correlations were shown under both graphs. Pearson correlation coefficient was used to investigate the relationships. BIA bioelectrical impedance analysis, CT computed tomography
See this image and copyright information in PMC

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