Muscle ultrasound for early assessment of critical illness neuromyopathy in severe sepsis.
BACKGROUND
Muscle ultrasound is emerging as a promising tool in the diagnosis of neuromuscular diseases. The current observational study evaluates the usefulness of muscle ultrasound in patients with severe sepsis for assessment of critical illness polyneuropathy and myopathy (CINM) in the intensive care unit.


METHODS
28 patients with either septic shock or severe sepsis underwent clinical neurological examinations, muscle ultrasound, and nerve conduction studies on days 4 and 14 after onset of sepsis. 26 healthy controls of comparable age underwent clinical neurological evaluation and muscle ultrasound only.


RESULTS
26 of the 28 patients exhibited classic electrophysiological characteristics of CINM, and all showed typical clinical signs. Ultrasonic echogenicity of muscles was graded semiquantitatively and fasciculations were evaluated in muscles of proximal and distal arms and legs. 75% of patients showed a mean echotexture greater than 1.5, which was the maximal value found in the control group. A significant difference in mean muscle echotexture between patients and controls was found at day 4 and day 14 (both p < 0.001). In addition, from day 4 to day 14, the mean grades of muscle echotexture increased in the patient group, although the values did not reach significance levels (p = 0.085). Controls revealed the lowest number of fasciculations. In the patients group, fasciculations were detected in more muscular regions (lower and upper arm and leg) in comparison to controls (p = 0.08 at day 4 and p = 0.002 at day 14).


CONCLUSIONS
Muscle ultrasound represents an easily applicable, non-invasive diagnostic tool which adds to neurophysiological testing information regarding morphological changes of muscles early in the course of sepsis. Muscle ultrasound could be useful for screening purposes prior to subjecting patients to more invasive techniques such as electromyography and/or muscle biopsy.


BACKGROUND
German Clinical Trials Register, DRKS-ID: DRKS00000642.
Alexander
A
Grimm
Ulrike
U
Teschner
Christine
C
Porzelius
Katrin
K
Ludewig
Jörg
J
Zielske
Otto W
OW
Witte
Frank M
FM
Brunkhorst
Hubertus
H
Axer
D000368:Aged; D016022:Case-Control Studies; D016638:Critical Illness; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009431:Neural Conduction; D009468:Neuromuscular Diseases / Q000000981:diagnostic imaging* / Q000209:etiology*; D010865:Pilot Projects; D011446:Prospective Studies; D018805:Sepsis / Q000150:complications* / Q000000981:diagnostic imaging*; D014463:Ultrasonography