ANÁLISE ULTRASSONOGRÁFICA MUSCULAR PERIFÉRICA EM PACIENTES COM LESÃO CEREBRAL AGUDA INTERNADOS EM UMA UNIDADE DE TERAPIA INTENSIVA NEUROLÓGICA

Abstract

Advances in intensive care have led to increased survival rates; however, the hospitalization process can result in architectural changes and muscle loss. Peripheral muscle ultrasound is a viable tool to facilitate monitoring of muscle morphology, but there is a lack of evidence in the profile of critically ill neurological patients. Therefore, this study aimed to evaluate peripheral muscle ultrasound analysis in patients with acute brain injury and monitor the evolution over time of ICU hospitalization until the final outcome (ICU discharge or death). This is a longitudinal and observational study carried out in a Neurological Intensive Care Unit, where quantitative and qualitative ultrasound variables were collected, such as: muscle thickness of the biceps brachii, quadriceps femoris and rectus femoris, cross-sectional area and echo intensity of the rectus femoris. We used statistical inference in comparison tests to monitor the moments of the entire sample (n=57) and in the fragmentation of two groups (discharge x death). We also explored the correlation (Spearman test) between sociodemographic and clinical quantitative data with the findings of the first USG at ICU admission. As a result, the total sample had a mean age of 53±17 years, a predominance of the neurosurgical profile and a mean hospital stay of 10±5 days. There was a difference between the two groups (discharge from the ICU versus death in the ICU) regarding the IMS score (p=0.024) and sedation time (p=0.030). We observed changes in muscle architecture related to the reduction of the cross-sectional area of the rectus femoris, thickness of the biceps brachii and improvement of the echo intensity of the rectus femoris. Age, weight, BMI, severity of the disease and length of hospital stay were correlated especially with the quantitative parameters of muscle USG. We conclude that further studies are needed in order to better understand which neurocritical individuals are most suitable for immediate monitoring of the serial assessment by the tool. Furthermore, validated and widely used intervention protocols based on such measurements are needed to monitor the occurrence of muscle wasting or to guide therapy. Further studies are therefore of essential importance to better establish the role and position of these instruments in the context of the diagnostic-therapeutic pathway of critically ill patients.