title: Qualitative Ultrasound in Acute Critical Illness Muscle Wasting.
abstract: OBJECTIVE
  A rapid and early loss of skeletal muscle mass underlies the physical disability common amongst survivors of critical illness. However, skeletal muscle function depends not only on its quantity but its quality, which may be adversely affected. We set out to characterise the changes in macroscopic muscle echogenicity and fascial characteristics that occur early in critical illness, and to relate these to microscopic histologically defined myofibre necrosis and fascial pathology.
  
  
  METHODS
  Prospective two center observational study.
  
  
  METHODS
  Thirty subjects comprising a subgroup of patients recruited to the Musculoskeletal Ultrasound in Critical Illness: Longitudinal Evaluation (MUSCLE) study.
  
  
  RESULTS
  Comparisons were made between sequential Vastus Lateralis histological specimens and ultrasound assessment of Rectus Femoris echogenicity. Change in muscle echogenicity was greater in patients who developed muscle necrosis (n = 15) than in those who did not (8.2% [95% CI, -5.3 to 21.7] vs -15.0% [95% CI, -28.9 to -1.09]; p = 0.016). The area under receiver operator curve for ultrasound echogenicity's prediction of myofiber necrosis was 0.74 (95% CI, 0.565 to 0.919; p = 0.024) increasing to 0.85 (95% CI, 0.703 to -0.995; p = 0.003) with the removal of those with potential iatrogenic muscle damage. Fasciitis was observed in 18 of 30 biopsies (60%).
  
  
  CONCLUSIONS
  Myofiber necrosis and fascial inflammation can be detected noninvasively using ultrasound in the critically ill. Fasciitis precedes and frequently accompanies muscle necrosis. These findings may have functional implications for survivors of critical illness.
authors.affiliation: 1Institute of Health and Human Performance, University College London, London, United Kingdom. 2Centre of Human and Aerospace Physiological Sciences, Kings College London, London, United Kingdom. 3Division of Respiratory and Critical Care, University Medicine Cluster, National University Health System, Singapore, Singapore. 4University College London Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, United Kingdom. 5Hepatology and Gastroenterology, St Mary's Hospital, Imperial College London, London, United Kingdom. 6Institute of Liver Studies, Kings College Hospital NHS Foundation Trust, London, United Kingdom. 7Kings College Hospital NHS Foundation Trust, London, United Kingdom. 8King's College London School of Medicine, London, United Kingdom. 9Guy's and St Thomas' and King's College London, NIHR Comprehensive Biomedical Research Centre, London, United Kingdom.
authors.forename: Zudin A
authors.initials: ZA
authors.lastname: Puthucheary
authors.forename: Rahul
authors.initials: R
authors.lastname: Phadke
authors.forename: Jaikitry
authors.initials: J
authors.lastname: Rawal
authors.forename: Mark J W
authors.initials: MJ
authors.lastname: McPhail
authors.forename: Paul S
authors.initials: PS
authors.lastname: Sidhu
authors.forename: Anthea
authors.initials: A
authors.lastname: Rowlerson
authors.forename: John
authors.initials: J
authors.lastname: Moxham
authors.forename: Stephen
authors.initials: S
authors.lastname: Harridge
authors.forename: Nicholas
authors.initials: N
authors.lastname: Hart
authors.forename: Hugh E
authors.initials: HE
authors.lastname: Montgomery
mesh_terms: D000208:Acute Disease; D000328:Adult; D016638:Critical Illness; D005208:Fasciitis / Q000000981:diagnostic imaging* / Q000473:pathology*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D018485:Muscle Fibers, Skeletal / Q000473:pathology*; D009133:Muscular Atrophy / Q000000981:diagnostic imaging* / Q000473:pathology*; D011446:Prospective Studies; D052097:Quadriceps Muscle / Q000000981:diagnostic imaging / Q000473:pathology; D014463:Ultrasonography