Bedside Ultrasound Assessment to Detect Muscle Loss in Critically Ill Children

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OBJECTIVES: To evaluate the feasibility and inter-rater reliability of bedside muscle ultrasonography for detecting muscle loss in critically ill pediatric patients. DESIGN: A single-center prospective cohort study was conducted (January 2024-January 2025). METHODS: Critically ill children frequently experience rapid muscle loss, a complication associated with intensive care unit (ICU)-acquired weakness, prolonged mechanical ventilation, and increased morbidity. Early detection of muscle wasting may enable targeted interventions to mitigate these adverse outcomes. PATIENTS: Critically ill children (aged 2-18 years) requiring invasive mechanical ventilation for >24 hours. INTERVENTIONS: Serial ultrasound assessments of the quadriceps femoris muscle thickness and cross-sectional area were performed at baseline and during ICU stay. Potential risk factors (eg, corticosteroid use, neuromuscular blockade, hyperglycemia, and nutritional status) were recorded. RESULTS: Of the 35 patients enrolled in the study, 14 (40%) had significant muscle loss (defined as loss of ≥10% of muscle mass compared to the baseline assessment) detected by decreased muscle thickness, and 20 (57%) had muscle loss detected by reduced cross-sectional area. Muscle loss occurred 3-10 days into their critical illness and invasive mechanical ventilation. Stepwise multivariable logistic associations showed that patients with a lower ratio of actual-to-goal protein intake at the time of scan had higher odds of muscle loss, as it was associated with >10% decrease in cross-sectional area (adjusted OR 3.2, CI 1.22, 3.56) and that a higher mean level of C-reactive protein was associated with a significant decrease in muscle thickness (adjusted OR 1.7, CI 1.23, 3.34). CONCLUSION: Bedside muscle ultrasonography is a feasible, and practical tool for early detection of muscle loss in critically ill children. Its noninvasive nature, portability, and cost-effectiveness support its potential integration into routine ICU monitoring to guide early rehabilitative or nutritional interventions. Further multicenter studies are warranted to validate these findings.

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