Muscle Function and Muscle Ultrasound in ICU
Muscle Function and Muscle Ultrasound in ICU
The objective of intensive care therapists is to be able to detect as early as possible the
 muscle weakness acquired in intensive care, in order to implement curative strategies such as
 adapted nutrition and early rehabilitation. Various diagnostic tools are available for this
 purpose. To evaluate muscle mass, CT and MRI remain the gold standard but are difficult to
 implement in routine practice in ICU and are extremely expensive and can generate radiation
 for the patient.

 Functional muscle evaluation is based on different voluntary tests which are not all able to
 predict muscle weakness acquired in ICU. In addition, some of the voluntary tests are
 expensive and require expert staff for practice and interpretation of results.

 In addition, a muscle test such as MRC, although having an intraclass coefficient of 0.94,
 has little predictive value on clinical parameters such as mechanical ventilation duration
 and is not associated with mortality in the ward. However, it remains the test of choice to
 define a ICUAW with a threshold value of 48/60 points.

 Dynamometry is a tool for measuring muscle strength. The patient is asked to perform a short
 and intense maximal muscular effort against manual or instrumental resistance. The limb
 segments must not move, it is an isometric effort. The most common measurement in intensive
 care units is the dynamometric grip force, called "handgrip".

 In ICU, the patient may have touble with awareness, arousal or even comprehension, which will
 lead to biases in the evaluation of the motor force.

 Ultrasound is a tool available in ICU and the muscle component can be assessed qualitatively
 or quantitatively without the patient's participation. Several studies have also demonstrated
 that muscle ultrasound is capable of reliably detecting pathological changes, particularly
 when repeated. Muscle ultrasound could thus help identify patients at higher risk of
 prolonged complications. Nevertheless, this technique lacks standardization and normative
 criteria (patient position, probe position, type and number of measurements, target muscle,
 etc.).

 The main objective is to show that the dynamometric force relative to ultrasound thickness of
 several muscle groups (arm flexors/knee extensors/foot lifters) is correlated with manual MRC
 testing in intensive care unit (ICU) patients
When the patient will be under invasive ventilatory support and coma, and will present the
 inclusion criteria, the investigator will perform ultrasound measurements of muscle thickness
 on four muscle groups:

 -  Shoulder Side muscular compartment

 -  Anterior Arm muscular compartment

 -  Anterior thigh muscular compartment

 -  Antero-lateral leg muscular compartment The ultrasound measurements will be made once a
 day each weekday, until the discharge from ICU.

 Ultrasound measurements will be stopped if the patient's condition deteriorates and the ICU
 team chooses to limit active therapy.

 If the patient condition get better, the investigator will perform the first volitional
 muscle function assessment, as soon as the patient Glasgow scale will score 15/15:

 1. Medical Research Council sum score (MRC-ss)

 2. Dynamometric strength assessment with the muscular groups used for the MRC-ss Then the
 volitional muscle assessment will be made once every 3 days, until patient discharges
 from ICU.
Inclusion Criteria:

 -  Major patient > 18 years old

 -  Admission for more than 24 hours in the ICU ward

 -  Stay must be at least 72 hours

 Exclusion Criteria:

 -  Person with a neuromuscular pathology

 -  Person presenting an osteoarticular contraindication to mobilization

 -  Amputee

 -  Person under guardianship or curatorship

 -  Person not affiliated to a social security system

 -  Pregnant Women