Introduction:

in recent years, the impact of the state has been well recognized and defined nutritional influence on the clinical outcomes of critically ill patients and malnutrition has been related to prolonged hospital stay, mortality, and increased hospital costs in healthcare system. Evaluation of skeletal muscle has proven to be a reliable parameter for determining the nutritional status of the patient and its relationship with clinical events adverse. Measurement of the thickness of the quadriceps femoris can be evaluated by ultrasonography at the bedside of the patient in the Adult Intensive Care Unit (ICU), without requiring transfer, and subject you to unnecessary risks associated with imaging techniques. The above makes it a promising tool to be used in the context of nutritional evaluation of critically ill patient.

Objective:

determine the association between conventional biochemical nutrition parameters with the thickness of the quadriceps femoris measured by ultrasonography and the phase angle by bioimpedance in critically ill patients.

Material and methods:

prospective, observational, comparative, longitudinal (analytical), cohort study. Patients were included upon admission to the adult intensive care unit. Quadriceps femoris thickness measurement was performed by ultrasound in each patient’s extremity at the bedside, as well as phase angle by electrical bioimpedance. These measurements were repeated on days 1 and 7.

Results:

21 patients were included, with a median age of 75 (55-81.5), of which 10 (47.6%) were women and 11 (52.4%) men. Patients had a median APACHE II, SOFA, and NUTRIC score of 12, 4, and 4 points, respectively. The median AP and LL quadriceps thickness on day 1 was 0.64 cm and 2.5 cm, respectively. On day 7, it was 0.58 cm and 2.1 cm, respectively. The median phase angle on day 1 and 7 was 3o and 2.9o, respectively. At day 1, a moderate negative association was found between AP quadriceps thickness and SOFA score (r = -0.436, p = 0.048) and nitrogen balance (r = -0.536, p = 0.018), as well as an association moderate positive between transferrin (r=0.409, p = 0.074) and prealbumin (r = 0.466, p = 0.038) with quadriceps AP thickness. On the seventh day of stay in the ICU, we found only a moderate negative correlation between the thickness of the AP quadriceps femoris and the overall hospital stay. Of all patients, the median hospital stay was 9 (8-19) days. 10 patients (47.6%) required mechanical ventilation. Sepsis occurred in 9 (42.9%) and acute kidney injury in 3 (14.3%). Mortality was 1 patient (4.8%).

Conclusions:

in our study, we concluded that on the first day of evaluation the SOFA score and nitrogen balance had a moderate negative correlation with the AP thickness of the quadriceps muscle, while this same diameter was moderately positively associated with transferrin levels. and patient prealbumin. Furthermore, on the seventh day, there was a moderate negative correlation between the thickness of the quadriceps femoris in its AP diameter and the days of hospital stay.

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