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. 2025 Jun;28(2):447-454.
doi: 10.1007/s40477-025-01013-y. Epub 2025 Apr 22.

Prospective ultrasonographic evaluation of femoral and vastus intermedius muscles as predictors of ICU-acquired weakness in critically ill patients

A M Chaves  1   2 , S J Torres  1   2 , L Palacios  3 , J I Alvarado  1 , M V Stozitzky  1 , C A Santacruz H  4
Affiliations

Prospective ultrasonographic evaluation of femoral and vastus intermedius muscles as predictors of ICU-acquired weakness in critically ill patients

A M Chaves et al. J Ultrasound. 2025 Jun.

Abstract

Purpose: Intensive care unit-acquired weakness (ICU-AW) is associated with poor functional outcomes and increased healthcare costs. This study aimed to evaluate the diagnostic performance of muscular ultrasound (MUS) measurements in predicting ICU-AW and identify potential predictors.

Methods: Forty-three surgical and medical ICU patients underwent serial MUS measurements of the femoral cross-sectional area (Fcsa) and femoral + vastus intermedius thickness (F + VIth) on days 1, 3 and 5 post-ICU admission. Patients were categorized as having ICU-AW (Medical Research Council (MRC) sum score < 48 at discharge) or not. Univariate and multivariate logistic regression analyses were performed to identify predictors of ICU-AW. The diagnostic performance of MUS measurements was assessed via receiver operating characteristic (ROC) curves. Clinical outcomes (ICU length of stay, ventilator days, extubation failure) were compared between the groups.

Results: Patients with ICU-AW (n = 12, 28%) showed a significant reduction in the Fcsa from Day 1 to Day 5 (p < 0.001). Univariate analysis revealed significant associations between ICU-AW and the Apache II score (OR 1.12, p = 0.03), SOFA score (OR 1.32, p = 0.008), and Day 1 F + VIth score (OR 0.23, p = 0.05). Multivariate analysis confirmed a significant association with the SOFA score (OR 1.35, p = 0.04) and a trend toward an F + VIth score of Day 1 (OR 0.12, p = 0.09). The day 1 Fcsa and F + VIth demonstrated moderate predictive capabilities for ICU-AW (ROC-AUC values of 0.72 and 0.82, respectively). ICU-AW patients experienced longer ICU stays, more ventilator days, and higher extubation failure rates.

Conclusion: Preexisting low muscle mass, combined with a high SOFA score, may be a stronger predictor of ICU-acquired weakness than the degree of subsequent muscle loss.

Keywords: Acute Physiology and Chronic Health Evaluation (APACHE); Femoral cross-sectional area (Fcsa); Femoral + vastus intermedius thickness (F + VIth); Intensive care unit acquired weakness (ICU-AW); Medical Research Council score (MRC); Muscle ultrasound (MUS); Sequential Organ Failure Assessment Score (SOFA).

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Conflict of interest statement

Declarations. Conflict of interest: The authors have no relevant financial or nonfinancial interests to disclose. Ethical approval and consent to participate: This study was approved by the Academic Hospital Fundación Santa Fe de Bogotá ethics committee. The Institutional Review Board approved the study (CCEI-13851–2022). Given that the study was observational following current clinical practices, the requirement for written consent to participate was waived by the ethics committee. Consent to participate: Informed consent was obtained from all individual participants included in the study. Consent for publication: The authors affirm that the human research participants provided informed consent for the publication of the images in Fig. 1a and 1b.

Figures

Fig. 1
Fig. 1
Evolution of ultrasonographic longitudinal changes in rectus femoris cross-sectional area (Fcsa) and the combined thickness of rectus femoris and vastus intermedius (F + VIth) muscles, measured via ultrasound on days 1, 3, and 5 post-ICU admission. A Evolutionary trend of Fth in ICU-AW vs. non-ICU-AW groups. B Evolutionary trend of Fcsa in ICU-AW and non-ICU-AW groups. In the bottom: Evolutionary trend of the two measurements (Fcsa and Fth) in ultrasound images of a patient on admission (Measure 1), day 3 (Measure 2), and day 5 (Measure 3) of ICU stay. Measurements were obtained using a standardized protocol using a linear transducer with measurements taken at the lower third of the quadriceps femoris. The transducer was then positioned in a transverse axis with respect to the extremity at the level of the previously marked point, forming a 90-degree angle with respect to the extremity. Potential confounding factors such as pre-existing muscle conditions were excluded (see text for complete list of exclusion criteria)
Fig. 2
Fig. 2
ROC-AUC plot for predictor with the highest AUC (> 0.8) as compared to APACHE and SOFA scores. APACHE Acute Physiologic and Chronic Health Evaluation, SOFA Sequential Organ Failure Assessment, F + VIth femoral + vastus intermedius muscle
See this image and copyright information in PMC

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