Muscular mass assessed by ultrasonography after administration of low-dose corticosteroids and muscle relaxants in critically ill hemiplegic patients.
OBJECTIVE
The present study investigates the influence of low-dose and short- term administration of corticosteroids and muscle relaxants on the muscular mass (MM) in hemiplegic ICU patients, with the aid of ultrasonography (U/S).


METHODS
Thirty-seven patients hospitalised in the ICU for 18.6+/-3.6 days, were included in the study. Sixteen patients did not receive either drug (group A), five patients received dexamethasone (24 mg/day) for 4 days (group B), eight patients received dexamethasone (24 mg/day) for 4 days and atracurium (0.3-0.6 mg/kg/h) for 2.8+/-0.4 days (group C), whereas eight other non-hemiplegic ICU patients comprised the control group. MM was measured in cm by U/S and serum Albumin (ALB, g/l) at the first and the tenth ICU hospitalisation day. The corresponding differences (DeltaMM, DeltaALB) were compared between the four groups of patients.


RESULTS
MM and ALB decreased significantly in all groups. DeltaMM was significantly higher in group C in comparison to all other groups, while DeltaMM was also higher in group B, when compared to the control and A groups. DeltaALB did not show significant inter-group differences. DeltaMM was significantly related to patients' age (r=0.41,P =0.001).


CONCLUSIONS
Muscular atrophy of the ICU hemiplegic patients is significantly influenced by the synchronous treatment with muscle relaxants and corticosteroids at low doses and for short term. This myopathy should be taken into account for the better prognosis and the safer outcome of the patient and U/S is suitable for accurate and non-invasive monitoring of MM.
The Intensive Care Unit, Hellenic Red Cross Hospital, Athens, Greece.
Markos
M
Moukas
Mitliades P
MP
Vassiliou
Argyro
A
Amygdalou
Costas
C
Mandragos
Fotis
F
Takis
Panagiotis K
PK
Behrakis
D018806:APACHE; D000367:Age Factors; D001279:Atracurium / Q000009:adverse effects*; D016638:Critical Illness; D003907:Dexamethasone / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects*; D006429:Hemiplegia / Q000150:complications / Q000503:physiopathology; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging* / Q000187:drug effects / Q000473:pathology; D009133:Muscular Atrophy / Q000139:chemically induced / Q000000981:diagnostic imaging* / Q000473:pathology; D003473:Neuromuscular Nondepolarizing Agents / Q000009:adverse effects*; D012709:Serum Albumin / Q000032:analysis; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography
D005938:Glucocorticoids; D003473:Neuromuscular Nondepolarizing Agents; D012709:Serum Albumin; D001279:Atracurium; D003907:Dexamethasone