WIP 43 - Ultrasonographic Assessment of Thigh Muscle Thickness and Its Correlation with Nutritional Status and Fluid Overload in Critically Ill, Mechanically Ventilated Children

Publication Number: WIP 43.7452

Hodaka Takaiso, Children's National Health System, Washington, DC, United States; Esther J. Kim, Children’s National Hospital, Washington, DC, United States; Eduardo A. Trujillo Rivera, Children's National Health System, Washington, DC, United States; Sonali Basu, Children's National Health System, Washington, DC, United States

Background: Muscle wasting in adult ICU patients has been associated with poor outcomes, including prolonged hospitalization, functional impairment, and increased healthcare costs, but limited research exists for pediatric ICU populations. As a non-invasive and cost-effective bedside tool, ultrasound (US) is valuable for detecting muscle wasting related to malnutrition and physical inactivity in these patients. Although previous studies have investigated the association between muscle thickness and nutritional status, clear evidence is still lacking in children. Assessing quadriceps femoris muscle thickness (QFMT) in critically ill pediatric patients could offer insights that inform factors relating to muscle wasting among severely ill pediatric patients.

Objective: This study aims to determine the relationship between muscle thickness loss and various clinical factors, including nutritional adequacy, physical therapy and occupational therapy interventions, steroid and paralytic usage, and illness severity in critically ill, mechanically ventilated children. Additionally, it seeks to explore the correlation between muscle thickness loss and the degree of fluid overload (FO) experienced by patients before their admission to the PICU.

Design/Methods: This retrospective observational study took place at a single center and involved 103 critically ill children, aged 34 days to 17 years, who were admitted to the PICU between February 2021 and March 2022. US measurements of the quadriceps femoris muscle were taken every 1-4 days while patients were sedated and on mechanical ventilation. Institutional Review Board approval was obtained, and informed consent was provided by legal guardians. Using generalized mixed-effect models, the study analyzes daily changes in US-measured QFMT about several clinical factors. This statistical approach allows for assessing how several predictors impact the rate of muscle thickness loss over time. The study aims to complete this analysis by December 2024, with findings expected to improve understanding of factors influencing muscle wasting.