著者

Kohei Tanaka Sho Katayama Kazuki Okura Masatsugu Okamura Keishi Nawata Nobuto Nakanishi Ayato Shinohara

出版者

The Japanese Society of Strategies for Cancer Research and Therapy

雑誌

Annals of Cancer Research and Therapy (ISSN:13446835)

巻号頁・発行日

vol.30, no.2, pp.93-99, 2022-07-21 (Released:2022-08-23)

参考文献数

53

被引用文献数

5

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The skeletal muscle has a significant role on physical functions, and the assessment of the skeletal muscle is important in critically ill patients. Computed tomography (CT), ultrasound examination, bioelectrical impedance analysis (BIA) device, and biomarkers can all be used to assess skeletal muscle mass. CT is useful for accurately measuring skeletal muscle mass, and the measurement is conducted at the third lumbar vertebra level as the gold standard. However, the assessment using CT is done retrospectively because CT involves radiation exposure and requires patients to be transported to the examination room. On the other hand, ultrasound and BIA are noninvasive and can be used at the bedside to assess longitudinal skeletal muscle mass. However, accurate assessment requires knowledge and skills. Assessments using BIA should be carefully interpreted because critically ill patients are under dynamic fluid change and edema. Furthermore, various biomarkers for the assessment of skeletal muscle mass have been recently reported. Appropriate skeletal muscle assessment will contribute to the nutrition and rehabilitation intervention of critically ill patients so that they can return to society.

著者

Nobuto Nakanishi Takuya Takashima Jun Oto

出版者

The University of Tokushima Faculty of Medicine

雑誌

The Journal of Medical Investigation (ISSN:13431420)

巻号頁・発行日

vol.67, no.1.2, pp.1-10, 2020 (Released:2020-05-02)

参考文献数

114

被引用文献数

19

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Critically ill patients exhibit prominent muscle atrophy, which occurs rapidly after ICU admission and leads to poor clinical outcomes. The extent of atrophy differs among muscles as follows: upper limb: 0.7%–2.4% per day, lower limb: 1.2%–3.0% per day, and diaphragm 1.1%–10.9% per day. This atrophy is caused by numerous risk factors such as inflammation, immobilization, nutrition, hyperglycemia, medication, and mechanical ventilation. Muscle atrophy should be monitored noninvasively by ultrasound at the bedside. Ultrasound can assess muscle mass in most patients, although physical assessment is limited to almost half of all critically ill patients due to impaired consciousness. Important strategies to prevent muscle atrophy are physical therapy and electrical muscular stimulation. Electrical muscular stimulation is especially effective for patients with limited physical therapy. Regarding diaphragm atrophy, mechanical ventilation should be adjusted to maintain spontaneous breathing and titrate inspiratory pressure. However, the sufficient timing and amount of nutritional intervention remain unclear. Further investigation is necessary to prevent muscle atrophy and improve long-term outcomes. J. Med. Invest. 67 : 1-10, February, 2020