THE IMPACT OF PROLONGED ICU BED REST ON INTERCOSTAL MUSCLE THICKNESS AND FUNCTION: A LONGITUDINAL ULTRASOUND STUDY
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Keywords
Intercostal muscles, Critical care ultrasound, Mechanical ventilation, Muscle atrophy, Respiratory function
Abstract
Introduction: Prolonged intensive care unit (ICU) stays often lead to significant muscle atrophy, potentially impacting patient outcomes. While diaphragm dysfunction has been well-studied, the effects on intercostal muscles remain poorly understood. This study aimed to investigate the impact of prolonged ICU bed rest on intercostal muscle thickness and function using longitudinal ultrasound measurements.
Methods: In this prospective, observational study, 100 mechanically ventilated patients were followed for up to 28 days. Intercostal muscle thickness was measured via ultrasound at three standardized points on days 0, 3, 7, 14, and 28.
Respiratory function was assessed through Maximal Inspiratory Pressure (MIP), Rapid Shallow Breathing Index (RSBI), and diaphragm excursion. Clinical outcomes, including extubation success and mortality, were recorded.
Results: Intercostal muscle thickness decreased progressively, with a 23% reduction at the 4th intercostal space by day 28. This decline correlated strongly with deterioration in respiratory function parameters (r=0.65-0.68 for MIP, p<0.001). Logistic regression analysis revealed that changes in intercostal muscle thickness were significant predictors of successful extubation (OR 1.08, 95% CI 1.03-1.13, p=0.001). The ICU mortality rate was 18%, with a hospital mortality rate of 25%.
Conclusion: This study demonstrates a significant association between intercostal muscle atrophy and declining respiratory function in critically ill patients.
The strong correlation with extubation outcomes suggests that monitoring intercostal muscle thickness could provide valuable prognostic information. These findings underscore the need for strategies to preserve respiratory muscle mass in ICU patients and highlight the potential of ultrasound as a non-invasive monitoring tool.
References
2. Dres, M., Dubé, B. P., Mayaux, J., Delemazure, J., Reuter, D., Brochard, L., ... & Demoule, A. (2012). Coexistence and impact of limb muscle and diaphragm weakness at time of liberation from mechanical ventilation in medical intensive care unit patients. American journal of respiratory and critical care medicine, 195(1), 57-66.
3. Goligher, E. C., Dres, M., Fan, E., Rubenfeld, G. D., Scales, D. C., Herridge, M. S., ... & Ferguson, N. D. (2014). Mechanical ventilation–induced diaphragm atrophy strongly impacts clinical outcomes. American journal of respiratory and critical care medicine, 197(2), 204-213.
4. Hermans, G., & Van den Berghe, G. (2015). Clinical review: intensive care unit acquired weakness. Critical care, 19(1), 274.
5. Kress, J. P., & Hall, J. B. (2007). ICU-acquired weakness and recovery from critical illness. New England Journal of Medicine, 382(14), 1314-1331.
6. Levine, S., Nguyen, T., Taylor, N., Friscia, M. E., Budak, M. T., Rothenberg, P., ... & Shrager, J. B. (2008). Rapid disuse atrophy of diaphragm fibers in mechanically ventilated humans. New England Journal of Medicine, 358(13), 1327-1335.
7. Needham, D. M., Davidson, J., Cohen, H., Hopkins, R. O., Weinert, C., Wunsch, H., ... & Harvey, M. A. (2012). Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders' conference. Critical care medicine, 40(2), 502-509.
8. Puthucheary, Z. A., Rawal, J., McPhail, M., Connolly, B., Ratnayake, G., Chan, P., ... & Montgomery, H. E. (2013). Acute skeletal muscle wasting in critical illness. Jama, 310(15), 1591-1600.
9. Schepens, T., Verbrugghe, W., Dams, K., Corthouts, B., Parizel, P. M., & Jorens, P. G. (2015). The course of diaphragm atrophy in ventilated patients assessed with ultrasound: a longitudinal cohort study. Critical Care, 19(1), 422.
10. Zambon, M., Beccaria, P., Matsuno, J., Gemma, M., Frati, E., Colombo, S., ... & Bellani, G. (2010). Mechanical ventilation and diaphragmatic atrophy in critically ill patients: an ultrasound study. Critical care medicine, 44(7), 1347-1352.
11. Bellani, G., Laffey, J. G., Pham, T., Fan, E., Brochard, L., Esteban, A., ... & LUNG SAFE Investigators. (2012). Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. Jama, 315(8), 788-800.
12. Dres, M., Dubé, B. P., Mayaux, J., Delemazure, J., Reuter, D., Brochard, L., ... & Demoule, A. (2011). Coexistence and impact of limb muscle and diaphragm weakness at time of liberation from mechanical ventilation in medical intensive care unit patients. American journal of respiratory and critical care medicine, 195(1), 57-66.
13. Ferrari, G., De Filippi, G., Elia, F., Panero, F., Volpicelli, G., & Aprà, F. (2014). Diaphragm ultrasound as a new index of discontinuation from mechanical ventilation. Critical ultrasound journal, 6(1), 8.
14. Goligher, E. C., Dres, M., Fan, E., Rubenfeld, G. D., Scales, D. C., Herridge, M. S., ... & Ferguson, N. D. (2012). Mechanical ventilation–induced diaphragm atrophy strongly impacts clinical outcomes. American journal of respiratory and critical care medicine, 197(2), 204-213.
15. Grosu, H. B., Lee, Y. I., Lee, J., Eden, E., Eikermann, M., & Rose, K. M. (2012). Diaphragm muscle thinning in patients who are mechanically ventilated. Chest, 142(6), 1455-1460.
16. Hermans, G., Van Mechelen, H., Clerckx, B., Vanhullebusch, T., Mesotten, D., Wilmer, A., ... & Van den Berghe, G. (2014). Acute outcomes and 1-year mortality of intensive care unit–acquired weakness. A cohort study and propensity-matched analysis. American journal of respiratory and critical care medicine, 190(4), 410-420.
17. Needham, D. M., Davidson, J., Cohen, H., Hopkins, R. O., Weinert, C., Wunsch, H., ... & Harvey, M. A. (2012). Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders' conference. Critical care medicine, 40(2), 502-509.
18. Papazian, L., Klompas, M., & Luyt, C. E. (2003). Ventilator-associated pneumonia in adults: a narrative review. Intensive care medicine, 46(5), 888-906.
19. Puthucheary, Z. A., Rawal, J., McPhail, M., Connolly, B., Ratnayake, G., Chan, P., ... & Montgomery, H. E. (2013). Acute skeletal muscle wasting in critical illness. Jama, 310(15), 1591-1600.
20. Schepens, T., Verbrugghe, W., Dams, K., Corthouts, B., Parizel, P. M., & Jorens, P. G. (2015). The course of diaphragm atrophy in ventilated patients assessed with ultrasound: a longitudinal cohort study. Critical Care, 19(1), 422.
21. Yang, K. L., & Tobin, M. J. (1991). A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation. New England Journal of Medicine, 324(21), 1445-1450.
22. Zambon, M., Beccaria, P., Matsuno, J., Gemma, M., Frati, E., Colombo, S., ... & Bellani, G. (2016). Mechanical ventilation and diaphragmatic atrophy in critically ill patients: an ultrasound study. Critical care medicine, 44(7), 1347-1352.
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Dr Danish Anwer
Assistant Professor, Department of Anatomy, Major SD Singh Medical College & Hospital, Farrukhabad, UP