Peripheral muscular ultrasound as outcome assessment tool in critically ill patients on mechanical ventilation: An observational cohort study.

BACKGROUND & AIMS: Survivors of critical illness experience significant skeletal muscle wasting that may predict clinical outcome. Ultrasound (US) is a noninvasive method that can measure muscle quadriceps muscle layer thickness (QMLT) at the bedside. The aim of this study was to determine the muscle loss assessed by ultrasonography (US) of the quadriceps femoris muscle in critically ill patients on mechanical ventilation and its relationship with hospital outcomes. METHODS: This study involved patients ≥18 years admitted to the intensive care unit who needed mechanical ventilation for at least 48 h. The quadriceps muscle layer thickness (QMLT) in the two-thirds of the thigh was quantified using bedside US. The QMLT of the left and right legs on the first (D1), third (D3), and seventh (D7) days were measured. RESULTS: US quadriceps thickness measurements were performed in 74 critically ill patients. The mean age was 62.3 ± 19.5 years, 54.1% of the patients were men, with a BMI of 25.5 ± 4.6 kg/m2, SAPS 3 of 55.2 ± 17.2, and NRS of 3.2 ± 1.0. The percentage muscle thickness declined at the right leg in 15% (95%CI, 10.5%-19.4%), and 12.7% (95%CI, 9.1%-16.3%) at the left leg from the first to the seventh day. Receiver operating characteristic showed cutoff value in muscle thickness of ≤1.64 cm on day 7 could predict survival (area under then curve = 0.7; 95% CI, 0.582-0.801). In Cox regression after adjusting, the probability of patients remaining on mechanical ventilation was higher with ≤1.64 cm loss of thigh muscle thickness on day 7; HR = 2.1 (95% CI 1.1-3.8, P = 0.017). The same occurred about ICU survival probability; HR = 3.7 (95% CI 1.2 to 11.5) and hospital survival probability; HR = 4.5 (95% CI 1.5 to 13.7). CONCLUSIONS: The measurement of QMLT using US showed that critically ill patients on mechanical ventilation presented with muscle wasting and greater loss of muscle thickness was associated with worse outcomes.

Intensive care unit patients' opinion on enrollment in clinical research: A multicenter survey.

BACKGROUND: In most emergency situations or severe illness, patients are unable to consent for clinical trial enrollment. In such circumstances, the decision about whether to participate in a scientific study or not is made by a legally designated representative. OBJECTIVE: To address the willingness of patients admitted to the intensive care unit (ICU) to be enrolled in a scientific study as volunteers, and to assess the agreement between patients' and their legal representatives' opinion concerning enrollment in a scientific study. METHODS: This survey was conducted in two hospitals in São Paulo, Brazil. Patients (≥18 years) with preserved cognitive functions accompanied by a surrogate admitted to the ICU were eligible for this study. A survey containing 28 questions for patients and 8 questions for surrogates was applied within the first 48h from ICU admission. The survey for patients comprised three sections: demographic characteristics, opinion about participation in clinical research and knowledge about the importance of research. The survey for legal representatives contained two sections: demographic characteristics and assessment of legal representatives' opinion in authorizing patients to be enrolled in research. RESULTS: Between January 2017 and May 2018, 208 pairs of ICU patients and their respective legal representatives answered the survey. Out of 208 ICU patients answering the survey, 73.6% (153/208) were willing to be enrolled in the study as volunteers. Of those patients, 65.1% (97/149) would continue participating in a research even if their legal representative did not support their enrollment. Agreement between patients' and surrogates' opinion concerning participation was poor [Kappa = 0.11 (IC95% -0.02 to 0.25)]. If a consent for study participation had been obtained, 69.1% (103/149) of patients would continue participating in the study until its conclusion, and 23.5% (35/149) would allow researchers to use data collected to date, but would withdraw from the study on that occasion. CONCLUSION: The majority of patients admitted to the ICU were willing to be enrolled in a scientific study as volunteers, also after a deferred informed consent procedure has been used. Nevertheless, contradictory opinions between patients and their and their legal representatives' concerning enrollment in a scientific study were often observed.