Ultrassonografia na avaliação e no seguimento nutricional de pacientes críticos

Abstract

Ultrasonography (US) has emerged as a promising method for nutritional follow-up of patients admitted to intensive care units, however there are certain questions regarding its use with this population that should be considered. Thus, the objective of this study was to evaluate the use of ultrasound as an instrument to assess the quadricep muscle in patients admitted to the intensive care units. Methods: Patients admitted to the Intensive Care Unit (ICU) of the Hospital das Clínicas Federal University of Minas Gerais (HC-UFMG) were included. Demographic, clinical data and fluid balance were collected from medical records. Subjective global assessment was performed at baseline, as part of the nutrition diagnosis. Quadriceps muscle measurements were performed by US at the iliac crest and the superior line patella landmarks, adductor pollicis muscle thickness, arm, calf and thigh circumferences were carried out at admission and every 2 days within the first week, and every 7 days thereafter. Caloric and protein adequacy was evaluated daily. Outcomes (mechanical ventilation time, length of hospital and ICU stay) were recorded and follow-up of outcomes after 1 month and 3 months of ICU discharge were made by telephone contact. Results: A total of 60 patients were included. Reduction of quadriceps thickness (EQ) and transverse rectus femoris area (ATRF) were observed mainly for measurements at landmarks 2/3 at follow up (reduction of both measurements from days 1 and 3 to days 5 and 7; p = 0.017 and p = 0.000, respectively). The mid arm circumference was the other anthropometric measurements that more was reduced between days (From day 1 to day 3, 5 and 7; p = 0.000). Malnourished patients had lower initial muscle mass, however muscle mass loss was similar between nourished and malnourished individuals (p>0,005). Patients with greater fluid alterations between days 1 and 3 were those who presented smaller transverse area of the rectus femoris in both days, and surgical patients had more muscle loss between day 1 and 5, respectively. The percentage of deaths was higher among those who lost more than 2% of the ATRF between days 1 and 3. There was no difference between muscle loss and caloric and protein intake, as well as mechanical ventilation time, length of stay and follow-up after 1 and 3 months. Conclusions: Ultrasonography muscle mass assessment was able to detect short-term changes. Muscle mass measurements loss assessed by US was not associated with nutritional supply and most outcomes.