Please use this identifier to cite or link to this item: https://doi.org/10.1371/journal.pone.0207720
Title: Muscle atrophy in mechanically-ventilated critically ill children
Authors: Johnson R.W.
Ng K.W.P. 
Dietz A.R.
Hartman M.E.
Baty J.D.
Hasan N.
Zaidman C.M.
Shoykhet M.
Keywords: Article
artificial ventilation
biceps brachii muscle
child
clinical article
cohort analysis
controlled study
critically ill patient
diaphragm
diaphragm thickness
disease severity
electrical impedance myography
electromyography
electronic medical record
female
human
image quality
incidence
male
muscle atrophy
muscle thickness
pediatric intensive care unit
prospective study
quadriceps femoris muscle
risk factor
tibialis anterior muscle
traumatic brain injury
adolescent
artificial ventilation
complication
critical illness
diagnostic imaging
echography
impedance
infant
muscle atrophy
newborn
pathology
preschool child
respiratory failure
Adolescent
Child
Child, Preschool
Cohort Studies
Critical Illness
Diaphragm
Electric Impedance
Electromyography
Female
Humans
Infant
Infant, Newborn
Intensive Care Units, Pediatric
Male
Muscular Atrophy
Prospective Studies
Quadriceps Muscle
Respiration, Artificial
Respiratory Insufficiency
Ultrasonography
Issue Date: 2018
Citation: Johnson R.W., Ng K.W.P., Dietz A.R., Hartman M.E., Baty J.D., Hasan N., Zaidman C.M., Shoykhet M. (2018). Muscle atrophy in mechanically-ventilated critically ill children. PLoS ONE 13 (12) : e0207720. ScholarBank@NUS Repository. https://doi.org/10.1371/journal.pone.0207720
Abstract: Importance ICU-acquired muscle atrophy occurs commonly and worsens outcomes in adults. The incidence and severity of muscle atrophy in critically ill children are poorly characterized. Objective To determine incidence, severity and risk factors for muscle atrophy in critically ill children. Design, setting and participants A single-center, prospective cohort study of 34 children receiving invasive mechanical ventilation for 48 hours. Patients 1 week– 18 years old with respiratory failure and without preexisting neuromuscular disease or skeletal trauma were recruited from a tertiary Pediatric Intensive Care Unit (PICU) between June 2015 and May 2016. We used serial bedside ultrasound to assess thickness of the diaphragm, biceps brachii/brachialis, quadriceps femoris and tibialis anterior. Serial electrical impedance myography (EIM) was assessed in children >1 year old. Medical records were abstracted from an electronic database. Exposures Respiratory failure requiring endotracheal intubation for 48 hours. Main outcome and measures The primary outcome was percent change in muscle thickness. Secondary outcomes were changes in EIM-derived fat percentage and “quality”. Results Of 34 enrolled patients, 30 completed 2 ultrasound assessments with a median interval of 6 (IQR 6–7) days. Mean age was 5.42 years, with 12 infants <1 year (40%) and 18 children >1 year old (60%). In the entire cohort, diaphragm thickness decreased 11.1% (95%CI, -19.7% to -2.52%) between the first two assessments or 2.2%/day. Quadriceps thickness decreased 8.62% (95%CI, -15.7% to -1.54%) or 1.5%/day. Biceps (-1.71%; 95%CI, -8.15% to 4.73%) and tibialis (0.52%; 95%CI, -5.81% to 3.40%) thicknesses did not change. Among the entire cohort, 47% (14/30) experienced diaphragm atrophy (defined a priori as 10% decrease in thickness). Eighty three percent of patients (25/30) experienced atrophy in 1 muscle group, and 47% (14/30)—in 2 muscle groups. On multivariate linear regression, increasing age and traumatic brain injury (TBI) were associated with greater muscle loss. EIM revealed increased fat percentage and decreased muscle “quality”. Conclusions and relevance In children receiving invasive mechanical ventilation, diaphragm and other skeletal muscle atrophy is common and rapid. Increasing age and TBI may increase severity of limb muscle atrophy. Prospective studies are required to link muscle atrophy to functional outcomes in critically ill children. © 2018 Johnson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Source Title: PLoS ONE
URI: https://scholarbank.nus.edu.sg/handle/10635/161206
ISSN: 19326203
DOI: 10.1371/journal.pone.0207720
Appears in Collections:Staff Publications
Elements

Show full item record
Files in This Item:
File Description SizeFormatAccess SettingsVersion 
10_1371_journal_pone_0207720.pdf1.56 MBAdobe PDF

OPEN

NoneView/Download

SCOPUSTM   
Citations

8
checked on Jul 5, 2020

Page view(s)

66
checked on Jul 2, 2020

Google ScholarTM

Check

Altmetric


Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.