Avaliação muscular pela ultrassonografia, força muscular e capacidade funcional do paciente crítico

Abstract

Ultrasonography(US) has been used to identify these structural, quantitative and qualitative changes. Therefore, it is necessary to identify in literature the relationship between changes in muscular characteristics evaluated in different muscles, strength and functionality of individuals post-discharge from the Intensive Care Unit(ICU), identifying the existing relationships and observed outcomes. Furthermore, weaknesses in muscle assessment methodologies using US have been reported, which can lead to difficulties in comparability, verification and generalization of results, making it necessary to propose a protocol that meets this demand, favoring research and applicability in clinical practice. Thus, for this thesis two separate studies were developed. Study 1 aimed to analyze whether there is a relationship between muscle changes assessed by ultrasonography and the disability of patients after ICU admission through a systematic review with meta-analysis, done according to the MOOSE guideline and registered in PROSPERO. Searches were done by two authors in the following databases: National Library of Medicine(MEDLINE-PubMed), Cinahl, Embase, Scopus, LILACS, Web of Science and Science Direct. A qualitative analysis of the studies was carried out using the NOS and AHRQ scales. Meta-analysis was carried out in “R”, “metafor” package. Heterogeneity was assessed by I2 and Cochran's Q test. Metaregression analyzes were performed to verify moderators, and funnel plots and Egger's regression intercept test were done to analyze publication bias. Eleven articles were included for the qualitative assessment and six for the quantitative. There is evidence of correlations between thickness (r=0.22[0.14;0.31];p<0.0001), echogenicity (r=-0.43[-0.61;-0.21];p<0.0001) and muscle strength. In subgroup analyses, correlations ware evidenced between thickness of the vastus intermedius (r=0.42[0.18;0.61];p=0.0009), thickness of vastus lateralis (r=0.33[0.07;0.55];p=0.013), echogenicity of rectus femoris (r=-0.40[-0.61;-0.13];p=0.0042) and strength assessed by MRC-SS. There is evidence of correlations between thickness (r=0.36[0.21;0.50];p<0.0001), cross-sectional area (r=0.35[0.16;0.51];p=0, 0005), echogenicity (r=-0.29[-0.53;-0.01];p=0.043) and mobility. In subgroup analyses, correlations were evidenced between MT of vastus lateralis (r=0.43[0.13;0.66];p=0.0065), cross-sectional area of rectus femoris (r=0.38[0.13;0.59];p=0.004), echogenicity of rectus femoris (r=-0.25[-0.48;-0.00];p=0.0499) and mobility. In the sensitivity analysis, correlation was observed between cross-sectional area and strength (r=0.24[0.06;0.40];p=0.0078) and not between echogenicity and mobility (r=-0. 21[0.45;0.06];p=0.1223). In conclusion, there is evidence for the relation between muscle characteristics assessed by US and functioning outcomes. Research 2 analyzed the inter-examiner and intra-examiner reliability of muscle assessment using ultrasound in critically ill patients. This study included 10 individuals aged≥18 years who were admitted to the ICU. Practical training of approximately eight hours was done for four health professionals from different backgrounds to perform muscle assessment with US. Each evaluator acquired three images to evaluate the thickness and echogenicity of the biceps brachii, flexors in forearm, quadriceps femoris, anterior tibialis and diaphragm muscle groups. To analyze reliability, the intraclass correlation coefficient (ICC) values were calculated. 600 US images were evaluated for thickness and 150 for echogenicity. Excellent intra-examiner reliability was found for echogenicity (ICC:0.867-0.973) and inter-examiner reliability for muscle thickness (ICC:0.778-0.942) for all muscle groups. For intra-examiner reliability of muscle thickness, excellent results were found in the vast majority of analyzes performed (ICC:0.718-0.988), with the exception of a “good” correlation from one examiner for the diaphragm (ICC:0.718). Thus, there was excellent agreement between the evaluations done by each examiner and between examineners of the measurement of muscle thickness, as well as the echogenicity evaluations of an examiner.