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Intensive Care Unit-Acquired Weakness (ICUAW): Usefulness of Bedside Ultrasound

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Neurosonology in Critical Care

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Abstract

Intensive care unit-acquired weakness has been characterized by functional weakness, which depends on critical illness neuropathy, myopathy and muscle atrophy. It is a common phenomenon during and after critical care stay. Various causal factors for this functional incapacity have been proposed. Among these, the patient-independent features associated with bed rest and many pharmacological strategies used in the ICU as well as the metabolic approach seem to be all related with the reduction in muscular mass. The currently available tools for the assessment of skeletal muscle mass are represented by methods that are difficult to be performed in the ICU setting. A valid alternative to these imaging modalities is represented by ultrasonography, which allows visualization of muscle characteristics by detecting different parameters. In this chapter, we will describe the current literature about the use of muscular ultrasound for detecting muscle weakness and its impact on critically ill patients’ treatments and prognosis.

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Authors and Affiliations

  1. SC Anestesia e Rianimazione, Ospedale San Paolo – Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy

    Paolo Formenti, Michele Umbrello & Davide Chiumello

  2. Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy

    Davide Chiumello

  3. Centro Ricerca Coordinata di Insufficienza Respiratoria, Università degli Studi di Milano, Milan, Italy

    Davide Chiumello

Authors
  1. Paolo Formenti
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  2. Michele Umbrello
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  3. Davide Chiumello
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Corresponding author

Correspondence to Paolo Formenti .

Editor information

Editors and Affiliations

  1. Department of Critical Care, University of Buenos Aires, Buenos Aires, Argentina

    Camilo N. Rodríguez

  2. Stroke Unit & Neurosonology Lab, University of Padua School of Medicine, Padova, Italy

    Claudio Baracchini

  3. Department of Critical Care and Anesthesiology, Fundación Valle del Lili, Cali, Colombia

    Jorge H. Mejia-Mantilla

  4. Department of Clinical Neurosciences Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK

    Marek Czosnyka

  5. Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Jose I Suarez

  6. President of Hungarian Neurological Society, Department of Neurology, Clinical Center Debrecen University, Debrecen, Hungary

    László Csiba

  7. Intensive Care Unit, Clinics Hospital, Universidad de la Republica School of Medicine, Montevideo, Uruguay

    Corina Puppo

  8. Center for Neurological Vascular Diagnostics, Munich, Germany

    Eva Bartels

Algorithm

Algorithm

figure a

RASS Richmond agitation sedation scale, CAM-ICU Confusion assessment method for the ICU, ICU Intensive care unit, MRC Medical research council scale,; TH Muscle thickness, CSA Cross-sectional area, ICUAW ICU-acquired weakness

A flowchart suggests a protocol for early identification of ICUAW. Ideally, within the first 48 hours, a first muscle ultrasound assessment should be performed for a baseline description of patient muscle characteristics comprehensive of the quadriceps rectus femoris. It should include at least two or more of the following: muscle thickness (mTH), cross-sectional area (CSA), echointensity and pennation angle (PA). At the same time, the cognitive impairment should be evaluated using standard reproducible scales. If these scores are in the normal range, the application of manual muscle testing such as the medical research council scale is possible (MRCS). These first evaluations might be reconsidered within the first week after the admission in the ICU, and their modifications over time, integrated with each other as well as with the re-evaluation of MRC scale, allow an accurate diagnosis of ICUAW and should be used to modify the different patient-dependent factors, such as pharmacological strategies, muscular over-loading or inactivity and metabolic derangements.

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Formenti, P., Umbrello, M., Chiumello, D. (2022). Intensive Care Unit-Acquired Weakness (ICUAW): Usefulness of Bedside Ultrasound. In: Rodríguez, C.N., et al. Neurosonology in Critical Care . Springer, Cham. https://doi.org/10.1007/978-3-030-81419-9_59

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  • DOI: https://doi.org/10.1007/978-3-030-81419-9_59

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