Article

Skeletal muscle wasting and weakness are common in patients with
sepsis in the intensive care unit, although less is known about deficits in
diaphragm and limb muscles when mechanical ventilation also is required.
The objective of this study was to concurrently investigate relative
differences in both thickness and strength of respiratory and peripheral muscles
during routine care. DESIGN: A prospective, cross-sectional study of 16 alert
patients with sepsis and 16 people who were healthy (control group) was used.
METHODS: Assessment was made of the diaphragm, upper arm, forearm, and thigh
muscle thicknesses with the use of ultrasound; respiratory muscle strength by
means of maximal inspiratory pressure; and isometric handgrip, elbow flexion, and
knee extension forces with the use of portable dynamometry. To describe relative
changes, data also were normalized to fat-free body mass (FFM) measured by
bioelectrical impedance spectroscopy. RESULTS: Patients (9 men, 7 women; mean
age=62 years, SD=17) were assessed after a median of 16 days (interquartile
range=11-29) of intensive care unit admission. Patients' diaphragm thickness did
not differ from that of the control group, even for a given FFM. When normalized
to FFM, only the difference in patients' mid-thigh muscle size significantly
deviated from that of the control group. Within the patient sample, all
peripheral muscle groups were thinner compared with the diaphragm. Patients were
significantly weaker than were the control group participants in all muscle
groups, including for a given FFM. Within the critically ill group, limb weakness
was greater than the already-significant respiratory muscle weakness.
LIMITATIONS: Volitional strength tests were applied such that successive
measurements from earlier in the course of illness could not be reliably
obtained. CONCLUSIONS: When measured at bedside, survivors of sepsis and a period
of mechanical ventilation may have respiratory muscle weakness without remarkable
diaphragm wasting. Furthermore, deficits in peripheral muscle strength and size
may exceed those in the diaphragm.

Langue : ANGLAIS