Diagnosis of Muscular Weakness Syndrome After a Stay in Intensive Care : Measurement by Ultrasound

Terminated

• Conditions: Amyotrophia; Weakness, Muscle

• Registration Number: NCT03735693
• Lead Sponsor: Association Pro-arte

Brief Summary

The objective is to diagnose earlier and more precisely the occurrence of a weakness neuromuscular syndrome at the end of intensive care, or within 28 days if the stay is longer than 28 days. The amyotrophy has been shown to be proportional to muscle strength in healthy subjects. The amyotrophy can be reliably evaluated by measuring the cross-sectional area of the right femoral muscle. The hypothesis is that amyotrophy measured by muscle ultrasound can allow an early and reliable diagnosis of neuromuscular weakness syndrome (NMWS), even though the measurement of the MRC score (the Gold Standard), has shown its limitations in intensive care in terms of reliability and delayed diagnosis.

Moreover, this syndrome is associated with a loss of functionality and a deterioration of long-term quality of life. One of the objectives is thus to determine if the muscular ultrasound allows a prediction of the occurrence of these alterations far from the intensive care.

Early rehabilitation has shown a benefit on mortality, duration of stay, mechanical ventilation and on functional alteration after intensive care. This is why an earlier and more precise means of diagnostic of this pathology is searched.

The target population is therefore patients from 18 to 80 years hospitalized in intensive care for prolonged stay (\> 5 days), and prolonged ventilation (\> 48H).

Detailed Description

Neuromuscular weakness syndrome post intensive care is a generalized muscular weakness with amyotrophy caused by the stay in the intensive care unit. This pathology is frequent, under diagnosed, increases the length of stay and mortality in intensive care and alters the functional status in the long term (mobility, autonomy, cognitive abilities). The gold standard is the MRC score. It must be under 48/60. But this means of diagnostic is unreliable and tardive (problem of voluntary cooperation, confusion, sedation).

This study allows the earlier diagnosis of neuromuscular weakness syndrome, by muscular ultrasound. Ultrasound of the right femoral muscle allows evaluation of the amyotrophy, which is related to the maximum muscular strength.

The early rehabilitation enable improved prognosis. This is an observational, prospective, single-center, blinded, observational study.

The objective is to determine the day of ultrasound examination with the highest diagnostic performance to predict with a maximum of specificity the occurrence of post-intensive care neuromuscular weakness syndrome, defined by an MRC score \<48/60 at the end of intensive care or if the duration of stay exceeds 28 days on the 28th day of hospitalization in intensive care unit.

Study Timeline

• Study Start: 2018-09-14
• Study First Submitted: 2018-10-30
• Study First Submitted QC: 2018-11-07
• Study First Posted: 2018-11-08
• Primary Completion: 2021-12-14
• Study Completion: 2022-02-02
• Status Verified: 2022-11
• Last Update Submitted: 2023-02-02
• Last Update Posted: 2023-02-03

Recruitment & Eligibility

• Status: TERMINATED
• Sex: All
• Target Recruitment: 60

Inclusion Criteria

• Predictable mechanical ventilation time of at least 48 hours
• Patient intubated for less than 48 hours
• Social security
• Not opposing, or whose family does not object to this research

Exclusion Criteria

• Neuromuscular pathology
• Amputation of one of the limbs
• Central or peripheral neurological impairment impacting the realization of the MRC score
• Orthopaedic trauma of the limbs or the pelvis preventing the achievement of an MRC score at the exit of resuscitation or by default at J28
• Subject in exclusion period of another study
• Persons referred to in Articles L1121-5 to L1121-8 of the CSP

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Determination of the day of ultrasound examination having the highest diagnostic performance to predict with a maximum of specificity the occurrence of a neuromuscular weakness syndrome post-intensive care unit	through study completion, an average of 1 year	Two-to-two comparison of the AUCs of 3 ROC curves corresponding to 3 measurements by ultrasound of decreasing muscles between J1-J5, J1-J7 and J1-J10

Secondary Outcome Measures

Name	Time	Method
Comparison of length of stay in intensive care unit and hospital into 2 cohorts of patients (probably not affected by the syndrome, and probably affected)	through study completion, an average of 1 year	calculation of the length of stay
Determination of the perfect threshold of muscular decrease allowing the prediction with the maximum of specificity of a post-intensive care neuromuscular weakness syndrome	through study completion, an average of 1 year	Look for the 3 ROC curves corresponding to 3 measurements of ultrasound muscle reduction between J1-J5, J1-J7 and J1-J10, the optimal threshold for measuring the cross sectional area of the right femoral muscle
Comparison of malnutrition into 2 cohorts of patients (probably not affected by the syndrome, and probably affected)	at intensive care discharge, within a limit of 28 days, at 3 months	Variation NUTRIC score ; ranging from 0 (low malnutrition risk) to 10 (the most likely to benefit from aggressive nutrition therapy).
Comparison of drug intake into 2 cohorts of patients (probably not affected by the syndrome, and probably affected)	through study completion, an average of 1 year	the administration of corticosteroids in intensive care
comparison of the persistence of neuromuscular weakness into 2 cohorts of patients (probably not affected by the syndrome, and probably affected)	3 months after discharge from hospital	MRC score : Medical Research Council (muscular testing), from 0 to 5 for each muscular group, and from 0 (complete tetraplegia) to 60 (normal muscular strength) for the total. The 6 subscales are summed.
comparison of functional alteration into 2 cohorts of patients (probably not affected by the syndrome, and probably affected)	3 months after discharge from hospital	the Karnofsky index (description of the general condition of the patient) : from 0% (dead) to 100% (normal state)
comparison of mortality at discharge of intensive care unit into 2 cohorts of patients (probably not affected by the syndrome, and probably affected)	during hospitalization in intensive care, at hospital discharge, and 3 months after hospital discharge	mortality rate
Comparison of calorie intake into 2 cohorts of patients (probably not affected by the syndrome, and probably affected)	through study completion, an average of 1 year	Daily calorie intake
Comparison of duration of mechanical ventilation, Optiflow, NIV, and number of days without ventilation into 2 cohorts of patients (probably not affected by the syndrome, and probably affected)	through study completion, an average of 1 year	calculation of the duration of ventilation and no-ventilation

Trial Locations

Locations (1)

CHU Grenoble Alpes; 🇫🇷 Grenoble, France