Correlação entre a avaliação ultrassonográfica de estímulo em pacientes internados na unidade de terapia intensiva.

Abstract

Introduction: Acquired muscle weakness (AMS) in the intensive care unit (ICU) refers to the deficit in strength and loss of muscle mass diagnosed in critically ill patients, whose etiology is multifactorial and is associated with impairment of physical function and patient health status. The literature provides little evidence on the relationship between changes in structure, quality and function using different muscle groups in patients admitted to the ICU. The results of this study may provide support for clinical practice in the ICU, expanding the possibilities of evaluating these changes. Objective: Correlate muscle changes and neuromuscular excitability in patients admitted to the intensive care unit. Method: This is a correlational study conducted in the ICU of HUL- UFS, including patients of both sexes, aged over 18 years. The thickness and echogenicity were assessed using kinesiological ultrasonography (CUS), and the chronaxia and accommodation index were assessed using the electrodiagnostic stimulus test (TEDE) in the anterior tibial, quadriceps femoris, forearm flexors and biceps brachii muscles at three time points. The outcome variable was the presence of correlation between the test values for the three time points in individuals who remained hospitalized for at least fourteen days. In the statistical analysis, the Shapiro-Wilk test was used to verify the normality of the data. The Kruskal-Wallis test was used to compare medians of two independent samples. To assess differences in the proportions of different time points, the Cochran's Q test was applied. Finally, Spearman's correlation was applied to assess the strength and direction between two variables. Results: Of the 68 patients selected for the study, 18 were evaluated with CUS and 20 with TEDE at the three time points over 14 days. Significant correlations were found between muscle thickness and the presence of neuromuscular dysfunction verified by chronaxia for the biceps brachii (r=-0.480, p=0.005), for the forearm flexors (r=-0.580, p=0.01; r=-0.620, p=0.006) and for the tibialis anterior (r=0.370, p=0.042). Regarding echogenicity, we observed significant correlations with the Accommodation Index in the forearm flexor muscles (r=0.500, p=0.039), quadriceps femoris (r=0.540, p=0.021; r=0.560, p=0.020) and tibialis anterior (r=0.480, p=0.050; r=0.580, p=0.015) and with chronaxia only in the tibialis anterior muscle (r=0.480, p=0.050; r=0.510, p=0.038). Conclusion: It can be concluded that there is a relationship between some muscle changes in thickness and echogenicity with neuromuscular excitability for the tibialis anterior, quadriceps femoris, forearm flexors and biceps brachii muscles.