Muscle Atrophy Among Critically Ill Children Occurs Within 1 Week of Mechanical Ventilation

This is important for our readers that treat children in the OR and the ICU.

Children with life-threatening respiratory failure who require mechanical ventilation in a paediatric intensive care unit (ICU) commonly experience rapid muscle atrophy, according to a study published in PLOS ONE.

More than 80% of children enrolled in the study experienced atrophy in at least 1 muscle group, and almost half experienced atrophy in ≥2 muscle groups after just 1 week on the ventilator.

Older children and kids with traumatic brain injury appeared to experience even more pronounced muscle loss.

“Our study, so far the largest prospective assessment of wasting in multiple muscle groups in critically ill children, comes as the field of paediatric critical care medicine begins to focus on preventing long-term morbidity and on improving functional outcomes in children after a critical illness,” said senior author Michael Shoykhet, MD, Children’s National Health System, Washington, DC.

“It will be important for future multicentre studies to explore how skeletal muscle loss in critically ill kids impacts their recovery,” he added. “We know that adult patients with similarly weakened muscle tone take longer to wean from ventilators, have longer hospital stays, and face heightened mortality risk. Prospective interventions to prevent muscle loss, such as improved nutrition and early physical therapy, may be required to improve paediatric outcomes.”

The research team used beside ultrasound to serially measure thickness of the right diaphragm, biceps, quadriceps, and tibialis muscles in 30 critically ill children receiving mechanical ventilation for at least 48 hours. The children were enrolled from June 2015 to May 2016 and ranged in age from 1 week to 18 years. The most common diagnoses that triggered hospitalisation in the ICU were airway/respiratory (33%), central nervous system (24%), and trauma (15%).

The research team performed at least 2 ultrasound assessments at a median interval of 6 days. The findings showed that diaphragm thickness decreased by 11% between ultrasounds (2.2% per day), 47% of patients experienced diaphragm thinning, and quadriceps thickness decreased by 8.6% (1.5% per day).

Children aged older than 1 year experienced muscle atrophy in their arms and legs, a finding not seen in infants younger than 1.

The researchers noted that the imaging tools they leveraged are ubiquitous across the nation’s paediatric ICUs, so children’s muscle status can be monitored easily in real time during their illness and recovery.