Category Archives: Ultrasound

Can we measure muscle wasting in the ICU using Ultrasound?

Zudin Puthucheary (London, UK)

US can track changes in muscle mass of critically ill pts

Rectus femoris cross-sectional area (RF CSA) validated against Fibre CSA (gold standard – muscle biopsy of vastus lateralis) and Ratio of Protein:DNA in myocyte (biochemical gold standard in muscle mass measurement; UNAFFECTED by hydration status)

RF CSA and Fibre CSA both underestimate muscle wasting compared to myocyte Protein:DNA

–>> muscle wasting visualised on Ultrasound is likely to also be an underestimate


US sensitively discerns muscle loss between pts with different severity of illness – significantly greater in pts with higher number of failed organs


US + Bx of muscle, repeated 10d later –> smaller, brighter RF = cellular infiltrate + myonecrosis (present in up to 40% of critically ill pts)  — US is a non-invasive tool to detect changes in Muscle QUALITY and has been used in the paediatric population for over a decade

Limitations with using US to measure Muscle MASS – How to assess?


Changes in RF CSA are associated with changes in muscle strength (MRC score)

This change is not seen in MLT i.e. MLT is not associated with muscle function in critical illness

MLT also does not correlate with muscle mass (measured on CT)

–> MLT is not a good indicator of muscle mass in critically ill population

Lack of standardisation in examination technique and reporting are greatest barriers to external validity

–> reliability, reproducibility, accuracy should not be assumed

#ESICMtv webinar – Haemodynamic management in #COVID19 patients

This webinar presents how the COVID-19 crisis is impacting countries in Europe. Four experts provide an overview of the current WHO treatment guidelines and explore – using individual case reports – the patient benefits of advanced haemodynamic monitoring in the ICU.

The experts:

Co-Presenter: Prof. Jacques Duranteau is Professor and Head of Anaesthesiology and Intensive Care at Bicêtre University Hospital, Paris, and President of the Medical Committee of Paris-Saclay University Hospitals.

Co-Presenter: Antonio Messina isa Researcher andSenior Consultant in the Intensive Care Unit of the Humanitas Research Hospital, Milan.  His fields of interest include haemodynamic monitoring, heart-lung interaction and perioperative medicine.

Co-Presenter: Dr Manuel Ignacio Monge García of the Intensive Care Unit, Hospital Universitario del SAS, Jerez de la Frontera, Spain is an ICU doctor mainly dedicated to haemodynamic monitoring and cardiovascular physiology applied to bedside monitoring.

Moderator: Prof. Michael (Monty) G. Mythen is the Smiths Medical Professor of Anaesthesia & Critical Care at University College London.  He is also an Elected Council Member of the Royal College of Anaesthetists and leads their perioperative medicine programme.

The Video:

The presentations

This one on the current status in Italy, UK, Spain and France is particularly interesting….