Low muscle mass in COVID-19 critically-ill patients: Prognostic significance and surrogate markers for assessment.

INTRODUCTION: Low muscle mass is a common condition in the critically ill population and is associated with adverse clinical outcomes. The primary aim of this study was to analyze the prognostic significance of low muscle mass using computed tomography (CT) scans in COVID-19 critically ill patients. A second objective was to determine the accuracy and agreement in low muscle mass identification using diverse markers compared to CT as the gold standard. METHODS: This was a prospective cohort study of COVID-19 critically ill patients. Skeletal muscle area at the third lumbar vertebra was measured. Clinical outcomes (intensive care unit [ICU] and hospital length of stay [LOS], tracheostomy, days on mechanical ventilation [MV], and in-hospital mortality) were assessed. Phase angle, estimated fat-free mass index, calf circumference, and mid-upper arm circumference were measured as surrogate markers of muscle mass. RESULTS: Eighty-six patients were included (mean age ± SD: 48.6 ± 12.9; 74% males). Patients with low muscle mass (48%) had a higher rate of tracheostomy (50 vs 20%, p = 0.01), prolonged ICU (adjusted HR 0.53, 95%CI 0.30-0.92, p = 0.024) and hospital LOS (adjusted HR 0.50, 95% CI 0.29-0.86, p = 0.014). Bedside markers of muscle mass showed poor to fair agreement and accuracy compared to CT-assessed low muscle mass. CONCLUSION: Low muscle mass at admission was associated with prolonged length of ICU and hospital stays. Further studies are needed to establish targeted nutritional interventions to halt and correct the catabolic impact of COVID-19 in critically ill patients, based on standardized and reliable measurements of body composition.

Pulmonary and critical care medicine as a single specialty. The mandatory response in the era of respiratory pandemics

Mexico experiences great challenges in public health and its health system. Demographic transition combines the coexistence of infectious and chronic-degenerative diseases. Respiratory diseases are some of the major public health problems and have been aggravated by the advent of respiratory pandemics: Influenza A H1N1 in 2009 and COVID-19 by SARS-CoV-2 during 2020. In this period, the National Institute of Respiratory Diseases (INER), the main training center for specialized human resources in Mexico, like other centers for the specialty of pulmonary medicine, has undergone a profound transformation towards the healthcare integration of respiratory and critical care medicine. Nevertheless, the great lack of specialized human resources in this area has become more evident during the current epidemiological emergency. It confirms that the proposal to integrate pulmonary and critical care medicine into a single specialty may be one of the compelling and effective responses to match some of the greatest challenges of medicine in our country.