QUALITATIVE AND QUANTITATIVE MUSCLE ULTRASOUND CHANGES IN COVID-19 RELATED ARDS PATIENTS

Umbrello, Michele; Guglielmetti, Luigi; Formenti, Paolo; Antonucci, Edoardo; Cereghini, Sergio; Filardo, Clelia; Montanari, Giulia; Muttini, Stefano

BACKGROUND & AIMS: Severe forms of COVID-19 are associated with systemic inflammation and hypercatabolism. We compared the time course of the size and quality of both rectus femoris and diaphragm muscles between critically-ill, COVID-19 survivors and non-survivors, and explored the correlation between the change in muscles size and quality with the amount of nutritional support delivered and the cumulative fluid balance. METHODS: Prospective observational study in the general ICU of a tertiary care hospital for COVID-19. The right rectus femoris cross-sectional area and the right diaphragm thickness, as well as their echodensities were assessed within 24 hours from ICU admission and on day 7. Anthropometric and biochemical data, respiratory mechanics and gas exchange, daily fluid balance and the amount of calories and proteins administered were recorded. RESULTS: 28 patients were analysed (age 65±10 years, 80% males, BMI 30.0±7.8). Rectus femoris and diaphragm sizes were significantly reduced at day 7 (-26.1 [-37.8;-15.2] and -29.2 [-37.8;-19.6]%, respectively) and this reduction was significantly higher in non-survivors. Both rectus femoris and diaphragm echodensity were significantly increased at day 7, with a significantly higher increase in non-survivors. The change in both rectus femoris and diaphragm size at day 7 was related to the cumulative protein deficit (R=0.664, p<0.001 and R=0.640, p<0.001, respectively), while the change in rectus femoris and diaphragm echodensity was related to the cumulative fluid balance (R=0.734, p<0.001 and R=0.646, p<0.001, respectively) CONCLUSIONS: Early changes in muscle size and quality seem related to the outcome of critically-ill, COVID-19 patients, and be influenced by nutritional and fluid management strategies.