title: Sepsis is associated with a preferential diaphragmatic atrophy: a critically ill patient study using tridimensional computed tomography.
abstract: BACKGROUND
  Diaphragm and psoas are affected during sepsis in animal models. Whether diaphragm or limb muscle is preferentially affected during sepsis in the critically ill remains unclear.
  
  
  METHODS
  Retrospective secondary analysis study including 40 patients, comparing control (n = 17) and critically ill patients, with (n = 14) or without sepsis (n = 9). Diaphragm volume, psoas volume, and cross-sectional area of the skeletal muscles at the third lumbar vertebra were measured during intensive care unit (ICU) stay using tridimensional computed tomography scan volumetry. Diaphragm strength was evaluated using magnetic phrenic nerve stimulation. The primary endpoint was the comparison between diaphragm and peripheral muscle volume kinetics during the ICU stay among critically ill patients, with or without sepsis.
  
  
  RESULTS
  Upon ICU admission, neither diaphragm nor psoas muscle volumes were significantly different between critically ill and control patients (163 ± 53 cm vs. 197 ± 82 cm for the diaphragm, P = 0.36, and 272 ± 116 cm vs. to 329 ± 166 cm for the psoas, P = 0.31). Twenty-five (15 to 36) days after admission, diaphragm volume decreased by 11 ± 13% in nonseptic and by 27 ± 12% in septic patients, P = 0.01. Psoas volume decreased by 11 ± 10% in nonseptic and by 19 ± 13% in septic patients, P = 0.09. Upon ICU admission, diaphragm strength was correlated with diaphragm volume and was lower in septic (6.2 cm H2O [5.6 to 9.3]) than that in nonseptic patients (13.2 cm H2O [12.3 to 15.6]), P = 0.01.
  
  
  CONCLUSIONS
  During the ICU stay, both diaphragm and psoas volumes decreased. In septic patients, the authors report for the first time in humans preferential diaphragm atrophy compared with peripheral muscles.
authors.affiliation: From the Department of Critical Care Medicine and Anesthesiology, Saint Eloi Teaching Hospital, Montpellier, France, and Institut National de la Santé et de la Recherche Médicale (INSERM U-1046), University Montpellier I, Montpellier II, Montpellier, France (B.J., M.C., Y.C., G.C., S.J.); Department of Abdominal Imaging, Saint Eloi Teaching Hospital, Montpellier, France (S.N.); Department of Anesthesiology and Critical Care, Clermont-Ferrand University Hospital, Clermont-Ferrand, France (E.F.); Department of Medical Statistics, Arnaud de Villeneuve Saint Eloi Teaching Hospital; Montpellier, France (N.M.); Department of Physiology, Arnaud de Villeneuve Teaching Hospital and Institut National de la Santé et de la Recherche Médicale (INSERM U-1046), University Montpellier I, Montpellier II, Montpellier, France (S.M.); and Institut National de la Santé et de la Recherche Médicale (INSERM U-1046), University Montpellier 1, University Montpellier 2, Montpellier, France (A.L.).
authors.forename: Boris
authors.initials: B
authors.lastname: Jung
authors.forename: Stephanie
authors.initials: S
authors.lastname: Nougaret
authors.forename: Matthieu
authors.initials: M
authors.lastname: Conseil
authors.forename: Yannaël
authors.initials: Y
authors.lastname: Coisel
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Futier
authors.forename: Gerald
authors.initials: G
authors.lastname: Chanques
authors.forename: Nicolas
authors.initials: N
authors.lastname: Molinari
authors.forename: Alain
authors.initials: A
authors.lastname: Lacampagne
authors.forename: Stefan
authors.initials: S
authors.lastname: Matecki
authors.forename: Samir
authors.initials: S
authors.lastname: Jaber
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D054893:Cone-Beam Computed Tomography / Q000379:methods*; D016638:Critical Illness / Q000453:epidemiology; D003964:Diaphragm / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009133:Muscular Atrophy / Q000000981:diagnostic imaging* / Q000453:epidemiology; D012189:Retrospective Studies; D018805:Sepsis / Q000000981:diagnostic imaging* / Q000453:epidemiology