Muscle ultrasonographic changes in critically ill COVID-19 patients

Abstract

Abstract Background: Patients with severe forms of COVID-19 (coronavirus disease 2019) present a systemic inflammatory response and hyper metabolism. The objective of this study was to identify the change in muscle mass of the rectus femoris and vastus internal in patients with severe COVID-19 who required invasive mechanical ventilation and to establish the correlation between the change in muscle size and the amount of calories and proteins administered. Materials & Methods: This prospective observational longitudinal study was conducted in the adult intensive care unit in a tertiary care clinic. Muscle mass was measured with ultrasound from admission, with intervals of seven days, until discharge from the unit. Anthropometric and biochemical data and the amount of calories and proteins administered were taken into account. Results: A total of 39 patients were included (59.6 ± 11.3 years; 79.5% men) with a median BMI of 27.7 kg/m2 (IQR 24.2–29.7). The size of the rectus femoris and vastus internal had diminished significantly at seven days of hospitalization: right middle third 0.38 cm (IQR 0.16-0.47), left middle third 0. 29 cm (IQR 0.08-0.54) and right middle third 0.37 cm (IQR 0.11-0.71) left middle third 0.25 cm (IQR 0.09-0.52), respectively. The changes in both muscles were directly correlated with caloric and protein intake during nutritional support. Conclusions: It is observed that critically ill patients with COVID-19 progressively lost muscle mass by receiving less coverage of caloric and protein requirements.

Keywords

• SARS-CoV-2
• malnutrition
• ultrasonography
• critical care