Mapping peripheral and abdominal sarcopenia acquired in the acute phase of COVID-19 during 7 days of mechanical ventilation

Abstract

Our aim was to map acquired peripheral and abdominal sarcopenia in mechanically ventilated adults with COVID-19 through ultrasound measurements. On Days 1, 3, 5 and 7 after admission to critical care, the muscle thickness and cross-sectional area of the quadriceps, rectus femoris, vastus intermedius, tibialis anterior, medial and lateral gastrocnemius, deltoid, biceps brachii, rectus abdominis, internal and external oblique, and transversus abdominis were measured using bedside ultrasound. A total of 5460 ultrasound images were analyzed from 30 patients (age: 59.8 ± 15.6 years; 70% men). Muscle thickness loss was found in the bilateral anterior tibial and medial gastrocnemius muscles (range 11.5-14.6%) between Days 1 and 3; in the bilateral quadriceps, rectus femoris, lateral gastrocnemius, deltoid, and biceps brachii (range 16.3-39.1%) between Days 1 and 5; in the internal oblique abdominal (25.9%) between Days 1 and 5; and in the rectus and transversus abdominis (29%) between Days 1 and 7. The cross-sectional area was reduced in the bilateral tibialis anterior and left biceps brachii (range 24.6-25.6%) between Days 1 and 5 and in the bilateral rectus femoris and right biceps brachii (range 22.9-27.7%) between Days 1 and 7. These findings indicate that the peripheral and abdominal muscle loss is progressive during the first week of mechanical ventilation and is significantly higher in the lower limbs, left quadriceps and right rectus femoris muscles in critically ill patients with COVID-19.

Figure 1

Ultrasound evaluation in the intensive care unit.

Figure 2

Thickness of peripheral muscles over 7 days. (A) Thickness of lower limb muscles. Significant differences between the corresponding day and Day 1 are indicated by the signal *: between D1-D3 for the right (p = 0.017) and left medial gastrocnemius muscle (p = 0.018); right (p = 0.018) and left tibialis anterior muscle (p = 0.006); between D1-D5 for the right (p = 0.003) and left quadriceps muscle (p = 0.017); the right (p = 0.016) and left rectus femoris muscle (0.033); the right (p = 0.012) and left vastus intermedius muscle (p = 0.05); and the right (p = 0.015) and left lateral gastrocnemius muscle (p = 0.003). In (B) the thickness of upper limb muscles. Significant differences between the corresponding day and Day 1 are indicated by the signal *: between D1-D5 for the right (p = 0.011) and left deltoid muscle (p = 0.014) and the right (p = 0.007) and left biceps brachii (p = 0.001).

Figure 3

Thickness of abdominal muscle mass over 7 days from ICU admission. Significant differences between the corresponding day and Day 1 are indicated by the signal *: between D1-D5 for the rectus abdominis muscle (p = 0.037) and internal oblique muscle (p = 0.004) and between D1-D7 for the transversus abdominis muscle (p = 0.024).

Figure 4

Mapping peripheral and abdominal sarcopenia acquired in the acute phase of COVID-19 during 7 days of mechanical ventilation. In (a), the pattern of muscle loss measured by ultrasound over 7 days is shown. It is observed that there is a loss of up to 3 days in the lower limbs distally (tibial anterior and medial gastrocnemius) that evolves over 5 days from the lower limbs (quadriceps. rectus femoris. vastus intermedius and lateral gastrocnemius) to the upper limbs (biceps and deltoid) and rectus abdominis. Finally, after 7 days, the abdominal muscles (transversus abdominis and internal oblique) are affected. In (b), the percentage of loss of muscle thickness can be quantitatively observed. with the quadriceps and rectus femoris being more affected (> 30.1%); deltoid. biceps brachii. internal oblique. rectus abdominis and transversus abdominis (20.1% to 30%); lateral gastrocnemius (15.1% to 20%); tibialis anterior and medial gastrocnemius (10% to 15%). Source: smart.servier.com.

Figure 5

Cross-sectional area over 7 days in the ICU. Significant differences between the corresponding day and Day 1 are indicated by the signal *: between D1-D5 for the right (p = 0.006) and left tibialis anterior muscle (p = 0.003); left biceps brachii (p = 0.04); between D1-D7 for the right (p = 0.004) and left rectus femoris muscle (p = 0.005); right biceps brachii (p = 0.035).