Please use this identifier to cite or link to this item: https://doi.org/10.1371/journal.pone.0207720
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dc.titleMuscle atrophy in mechanically-ventilated critically ill children
dc.contributor.authorJohnson R.W.
dc.contributor.authorNg K.W.P.
dc.contributor.authorDietz A.R.
dc.contributor.authorHartman M.E.
dc.contributor.authorBaty J.D.
dc.contributor.authorHasan N.
dc.contributor.authorZaidman C.M.
dc.contributor.authorShoykhet M.
dc.date.accessioned2019-11-01T08:10:47Z
dc.date.available2019-11-01T08:10:47Z
dc.date.issued2018
dc.identifier.citationJohnson 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
dc.identifier.issn19326203
dc.identifier.urihttps://scholarbank.nus.edu.sg/handle/10635/161206
dc.description.abstractImportance 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.
dc.rightsAttribution 4.0 International
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.sourceUnpaywall 20191101
dc.subjectArticle
dc.subjectartificial ventilation
dc.subjectbiceps brachii muscle
dc.subjectchild
dc.subjectclinical article
dc.subjectcohort analysis
dc.subjectcontrolled study
dc.subjectcritically ill patient
dc.subjectdiaphragm
dc.subjectdiaphragm thickness
dc.subjectdisease severity
dc.subjectelectrical impedance myography
dc.subjectelectromyography
dc.subjectelectronic medical record
dc.subjectfemale
dc.subjecthuman
dc.subjectimage quality
dc.subjectincidence
dc.subjectmale
dc.subjectmuscle atrophy
dc.subjectmuscle thickness
dc.subjectpediatric intensive care unit
dc.subjectprospective study
dc.subjectquadriceps femoris muscle
dc.subjectrisk factor
dc.subjecttibialis anterior muscle
dc.subjecttraumatic brain injury
dc.subjectadolescent
dc.subjectartificial ventilation
dc.subjectcomplication
dc.subjectcritical illness
dc.subjectdiagnostic imaging
dc.subjectechography
dc.subjectimpedance
dc.subjectinfant
dc.subjectmuscle atrophy
dc.subjectnewborn
dc.subjectpathology
dc.subjectpreschool child
dc.subjectrespiratory failure
dc.subjectAdolescent
dc.subjectChild
dc.subjectChild, Preschool
dc.subjectCohort Studies
dc.subjectCritical Illness
dc.subjectDiaphragm
dc.subjectElectric Impedance
dc.subjectElectromyography
dc.subjectFemale
dc.subjectHumans
dc.subjectInfant
dc.subjectInfant, Newborn
dc.subjectIntensive Care Units, Pediatric
dc.subjectMale
dc.subjectMuscular Atrophy
dc.subjectProspective Studies
dc.subjectQuadriceps Muscle
dc.subjectRespiration, Artificial
dc.subjectRespiratory Insufficiency
dc.subjectUltrasonography
dc.typeArticle
dc.contributor.departmentMEDICINE
dc.description.doi10.1371/journal.pone.0207720
dc.description.sourcetitlePLoS ONE
dc.description.volume13
dc.description.issue12
dc.description.pagee0207720
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