Prevalence and magnitude of muscle loss in the pediatric intensive care unit assessed by ultrasound: a systematic review and meta-analysis.
Marcelo de Araújo Nazaré, Olga Naila Ayo Menezes Liberato Franz de Carvalho, Daniel Dominguez Ferraz et al.
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In 30 seconds
This systematic review and meta-analysis examined ultrasound-measured quadriceps thickness in children admitted to pediatric intensive care units. It included nine observational studies with 536 patients, each assessing muscle thickness at least twice during admission. Mean thickness declined by -7.89% at 7 days (95% CI, -11.36% to -4.41%; p < 0.001), while pooled prevalence of clinically significant atrophy (> 10%) was 49.4% (95% CI, 44.0% to 54.7%). Greater loss was associated with neuromuscular blocking agents, older age, and cumulative protein and caloric deficits.
Key findings
- Mean quadriceps thickness reduction at 7 days was -7.89% (95% CI, -11.36% to -4.41%; p < 0.001).
- Pooled prevalence of clinically significant atrophy (> 10%) was 49.4% (95% CI, 44.0% to 54.7%).
- Maximum observed muscle loss during admission was -10.77% (95% CI, -12.87% to -8.67%; p < 0.001).
- Greater loss was associated with neuromuscular blocking agents, older age, and cumulative protein and caloric deficits.
Why it matters
The findings indicate that measurable muscle loss is common and can occur early during pediatric intensive care. Recognising its frequency and reported associations may help clinicians consider muscle status alongside illness and nutritional factors when assessing critically ill children. The review also highlights bedside ultrasound as a means of tracking muscle thickness, although the evidence summarized does not establish that monitoring improves functional outcomes.
What to keep in mind
The synthesis included nine observational studies, so reported associations do not establish causation; the abstract does not report longer-term functional outcomes.