الفهرس 
Skeletal muscle mass changes in ICUOnly 14 pages are availabe for public view
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Abstract
Intensive Care Unit-acquired weakness (ICUAW) represents a very common problem for the critically ill patient with implications in morbidity, mortality, and quality of life.
A simple, clinically applicable, reproducible, and noninvasive method is required To assess muscle atrophy. Ultrasonographic measurements in ICU patients have been used in both upper and lower limb muscles and have reliably shown reduced muscle size and increased echogenicity signifying muscle quality decline. Ultrasonography has been tested against the gold standards of CT and MRI, for measuring muscle dimensions, and is found to be adequately precise for the evaluation of muscle volume changes.
It is well known that rectus femoris cross-sectional area has a strong association with muscle volume and strength. As direct strength assessment may not be possible in the critically ill, the established association between muscle strength and muscle thickness of the quadriceps femoris muscle has been used.
The aim of this work was to assess the utility of ultrasonography in monitoring changes in skeletal muscle mass in patients with prolonged stay in respiratory ICU. Due to novelty of the subject few previous work could be found in literature.
This study was prospectively conducted during the period from January 2017 to April 2017 upon 20 ICU patients admitted to Respiratory ICU of Abbassia Chest Hospital with expected ICU stay more than 5 days, according to APACHE IV calculation.
In this study mean age was 64.2±12.1, mean of APACHE-4 score on admission was 74.1±21.2, male sex predominance 85 %, current smokers were 40 % of the study population.
Most of cases were COPD, AE, and RF2 (40 %) then pneumonia and RF1 (20 %) then pneumonia and RF2 (10 %) and old TB with RF2 (10 %) then bronchectasis and RF2, ILD and RF1 , mesothelioma and RF2 and NSTEMI had equal percentage (5 % each).
Most of studied cases had HTN 35 % then cardiac problem 25 % then diabetic or cerbrovascular 20% then CLD 10 %.
Most of studied cases had combined COPD & HTN then COPD & cardiac problem and 80 % of studied cases were mechanically ventilated.
In this study mean muscle CSA at day 1 was 1.7±0.6 cm and mean muscle CSA at day 5 was 1.4±0.7 cm so muscle CSA significantly decreased at day 5 after ICU admission but 15% of cases developed lower limb edema at day 5.
In this study no significant correlation between change of muscle CSA and APACHE-4 score on admission and development of lower limb edema did not correlate with admission APACHE-4 score. The development of edema , however, was associated with increase of dimensions of the muscle.
In this study no significant difference between different comorbidities regarding change of muscle CSA.
At day 12 (day of second assessment), 12 patients 60% of studied population died, 6 patients (30%) had been discharged, one patient (5%) showed more decrease in muscle CSA (0.9 cm compared to 1.3 cm on day 5) and one patient (5%) had developed edema with increase in measured CSA (2.5 cm compared to 1.8 cm on day 5).