The effect of early mobilization on quadriceps thickness during the stay in Intensive Care Unit

Abstract Description

Proposed Topic (Most preferred): :

Research and Innovations (new projects / technology / innovations / service models)

Authors (including presenting author) :

Tse PY(1), Tam HY(1), Lee KW(1), Lee PK(1), Wong HL(1), Wong SW(1), Tsang HC(1), Lam KN(2), To YL(1)

Affiliation :

(1) Physiotherapy Department, (2) Intensive Care Unit, North District Hospital

Introduction :

Muscle wasting was common among critically ill patients. Intensive care unit(ICU) acquired weakness was associated with longer length of stay (LoS) and intubation duration. [1] Early mobilization (EM) was promoted in recent years to reduce the duration of mechanical ventilation and ICU LoS. Quadriceps thickness(QT) measured by ultrasound had been proven to be reliable to reflect muscle loss during ICU stay. [2] This study aimed at investigating the effect of EM on muscle wasting by measuring QT using ultrasonography.

Objectives :

To study the change of ultrasound measured QT of patients in ICU and its relationship between EM.

Methodology :

This was a prospective cohort pilot study conducted in the ICU of North District Hospital from September 2023 to November 2023. Ultrasound measurement of QT was performed in patients who stayed in ICU for five days or more. EM included in-bed cycling, bedside standing/stepping and assisted walking were prescribed to all patients according to their capability. Ultrasound measurement was performed within 48 hours after ICU admission and upon ICU discharge. QT was measured on both legs at the junction of lower third and upper two-thirds between anterior superior iliac spine and the upper border of patella. Patients with pre-existing neuromuscular pathology, lower-limb amputation, underwent lower limb orthopedic surgery or terminal illness were excluded. Paired T-Test was used to analyze the difference between initial and final QT and Pearson Correlation test was used to review the correlation between percentage change in QT and initial date of weight bearing (WB) exercise (i.e. standing/ walking).

Result & Outcome :

25 patients were recruited in this study (36% female, 64% male). The mean age was 64.32. Average LoS was 14.48days. Although the QT decreased upon ICU discharge, the average percentage decrease in right and left QT was only 6.20%(p=0.015) and 2.98% (p=0.134) respectively. In contrast, profound muscle loss was evidenced in previous studies. Pardo et al. reported QT decreased up to 16% and 24% on day 7 and 21 of ICU admission respectively. [2] Toledo et al. also reported 15% and 12.7% decrease in muscle thickness on day 7. [3] The decrease in QT was also found to be correlated with initiation of WB exercise. (Right side r=0.296 p=0.170, Left side r=0.320 p=0.136) There was a trend that earlier WB exercise could attenuate muscle loss during ICU stay, although statistical significance cannot be reached. In conclusion, EM as a whole might have a protective effect against muscle loss in critically ill patients, in particular, early WB exercise appear to have a more beneficial effect.

Reference:
1. Moisey, L. L., Mourtzakis, M., Cotton, B. A., Premji, T., Heyland, D. K., Wade, C. E., Bulger, E. M., & Kozar, R. A. (2013). Skeletal muscle predicts ventilator-free days, ICU-free days, and mortality in elderly ICU patients. Critical Care, 17(5), R206.
2. Pardo, E., El Behi, H., Boizeau, P., Verdonk, F., Alberti, C., & Lescot, T. (2018). Reliability of ultrasound measurements of quadriceps muscle thickness in critically ill patients. BMC Anesthesiology, 18(1).
3. Toledo DO, Jardini de Freitas B, Dib R, Julie do Amaral Pfeilsticker F, Marques dos Santos D, Gomes BC, et al. Peripheral muscular ultrasound as outcome assessment tool in critically ill patients on mechanical ventilation: An observational cohort study. Clinical Nutrition ESPEN. 2021 Apr