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Evaluation of Bedside Methods to Measure Muscularity in Critically Ill Patients

25. marts 2019 opdateret af: Kate Lambell, La Trobe University

Evaluation of Bedside Methods to Measure Muscularity in Critically Ill Patients: A Prospective Observational Study

Muscle wasting is a significant problem in critically ill patients, with reported losses of a half to three percent per day over the first ten days (for an average 70kg person this equates to 3 to 20kg of muscle loss). Low skeletal muscle mass at admission to the intensive care unit (ICU) and the loss of lean tissue have been associated with negative clinical outcomes, including increased incidence of infections, length of stay, mortality and muscle weakness. It is therefore crucial that technology is utilised to: 1) identify ICU patients with low muscularity on admission, 2) to help understand the factors impacting muscle loss and to 3) assess the effectiveness of interventions aimed at maintaining skeletal muscle mass in this population.

The measurement of lean body mass in patients admitted to the ICU is challenging however, due to the large fluid shifts that occur in this population and logistical issues in moving patients to specialised machinery for body composition analysis. Currently, there is no validated method for accurately assessing a patient's muscle mass at the bedside in the intensive care setting. It is therefore important to investigate the accuracy, feasibility and reliability of bedside methods such as subjective physical assessment of muscle mass, mid arm muscle circumference, ultrasound and bioimpedance analysis to assess muscularity in this population who are primarily bedbound. In order to do this, a critical comparison is required between these methods and muscularity assessed by a "reference" body composition method, such computed tomography (CT) image analysis. Briefly, quantification of skeletal muscle at the abdomen area utilising abdominal CT images has been shown to be highly representative of whole body skeletal muscle volume.

We wish to conduct a pilot, feasibility study (n= 50), which will recruit patients who have a CT scan (containing abdomen area), performed for clinical purposes. Our primary aim will be to investigate whether muscularity assessed with non-invasive bedside methods (ultrasound, bioimpedance analysis, SGA physical assessment, mid arm muscle circumference) are correlated with skeletal muscle mass quantified by a "reference method" (CT image analysis).

Studieoversigt

Status

Afsluttet

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

Aim Our primary aim is to investigate whether muscularity assessed via bedside ultrasound is correlated with a reference method for estimating whole body skeletal muscle mass (CT image analysis) in the first few days of critical illness.

Our secondary aims are

  • To investigate whether muscularity assessed via other bedside methods (bioimpedance spectroscopy, subjective physical assessment and mid arm muscle circumference) are correlated with a reference method for estimating whole body skeletal muscle mass (CT image analysis) in critically ill patients.
  • To better understand the association between measured resting energy expenditure and muscularity in the critically ill.
  • To observe changes in skeletal muscle mass (in a sub set of patients who have two CT scans) and the impact various factors, including energy and protein delivery has on these changes.

Undersøgelsestype

Observationel

Tilmelding (Faktiske)

50

Kontakter og lokationer

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Studiesteder

    • Victoria
      • Melbourne, Victoria, Australien, 3004
        • The Alfred Hospital

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

18 år og ældre (Voksen, Ældre voksen)

Tager imod sunde frivillige

Ingen

Køn, der er berettiget til at studere

Alle

Prøveudtagningsmetode

Ikke-sandsynlighedsprøve

Studiebefolkning

Critically ill adults

Beskrivelse

Inclusion Criteria:

  • Have had a CT scan of the L3 vertebra performed for clinical reasons ≤24 hours before or ≤72 hours after ICU admission

Exclusion Criteria:

  • CT scan performed >48hrs ago
  • Death is imminent or deemed highly likely in the next 96 hours
  • Are known to be pregnant
  • Treating clinician does not believe the study to be in the best interest of the patient
  • It is not possible to image two or more muscle groups via ultrasound (i.e. due to trauma, burns, wounds)

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Tidsramme
Mean skeletal muscle mass measured by CT scan analysis at L3 area (cm2)
Tidsramme: CT performed for clinical reasons ≤24 hours before or ≤72 hours after ICU admission
CT performed for clinical reasons ≤24 hours before or ≤72 hours after ICU admission
Mean skeletal muscle mass measured by ultrasound (muscle thickness at each site, cm and rectus femoris CSA, cm2)
Tidsramme: <48 hours after CT scan containing L3 area
<48 hours after CT scan containing L3 area

Sekundære resultatmål

Resultatmål
Tidsramme
Fat free mass (kg), phase angle and impedance ratio measured by bioimpedance spectroscopy
Tidsramme: <48 hours after CT scan containing L3 area
<48 hours after CT scan containing L3 area
Subjective assessment of muscle and fat wasting via SGA (normal, mild-moderate or severe)
Tidsramme: <48 hours after CT scan containing L3 area
<48 hours after CT scan containing L3 area
Mid arm muscle circumference (cm)
Tidsramme: <48 hours after CT scan containing L3 area
<48 hours after CT scan containing L3 area
Mean skeletal muscle mass measured by CT scan analysis at femoral area (cm2)
Tidsramme: CT performed for clinical reasons ≤24 hours before or ≤72 hours after ICU admission
CT performed for clinical reasons ≤24 hours before or ≤72 hours after ICU admission
Measured resting energy expenditure (kilojoules)
Tidsramme: <48 hours after CT scan containing L3 area
<48 hours after CT scan containing L3 area
Intramuscular, subcutaneous and visceral adipose tissue CSA at L3 area (cm2)
Tidsramme: CT performed for clinical reasons ≤24 hours before or ≤72 hours after ICU admission
CT performed for clinical reasons ≤24 hours before or ≤72 hours after ICU admission

Samarbejdspartnere og efterforskere

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Sponsor

Samarbejdspartnere

Efterforskere

  • Ledende efterforsker: Kate Lambell, MNutrDiet, La Trobe University and Alfred Health

Publikationer og nyttige links

Den person, der er ansvarlig for at indtaste oplysninger om undersøgelsen, leverer frivilligt disse publikationer. Disse kan handle om alt relateret til undersøgelsen.

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart

1. januar 2017

Primær færdiggørelse (Faktiske)

1. marts 2019

Studieafslutning (Faktiske)

1. marts 2019

Datoer for studieregistrering

Først indsendt

11. januar 2017

Først indsendt, der opfyldte QC-kriterier

11. januar 2017

Først opslået (Skøn)

13. januar 2017

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

27. marts 2019

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

25. marts 2019

Sidst verificeret

1. marts 2019

Mere information

Begreber relateret til denne undersøgelse

Nøgleord

Yderligere relevante MeSH-vilkår

Andre undersøgelses-id-numre

  • 523/16

Plan for individuelle deltagerdata (IPD)

Planlægger du at dele individuelle deltagerdata (IPD)?

UBESLUTET

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