James Bradley, MD
Fellow
University of Louisville, United States
Disclosure information not submitted.
Quang Nguyen, MD
Fellow
University of Louisville, United States
Disclosure information not submitted.
Gina Ratterman, PT
Physical Therapy
University of Louisville, United States
Disclosure information not submitted.
Mohamed Saad, MD
Chair of Pulmonary and Critical Care Medicine
University of Louisville, United States
Disclosure information not submitted.
Title: Sarcopenia in ARDS: The Importance of Nutrition in ICU Patients with ARDS
Introduction: Acute Respiratory Distress Syndrome (ARDS) is a common but disabling syndrome with high mortality. An international study involving 29,144 patients estimated that ARDS was found in 10% of patients admitted to the ICU. The subgroup with severe ARDS had mortality rate of 46%.
Early nutrition in the ICU has been shown to reduce mortality. In addition to adequate nutrition, early mobility can aide in the prevention of sarcopenia and maintain muscle mass while in the ICU.
Sarcopenia is an independent risk factor for poor clinical outcomes. Studies looking at mortality in all ICU patients exist, but a literature search did not yield a study looking into mortality rate of ARDS in sarcopenia.
Methods: Dr. Derstine’s study measured skeletal muscle area (SMA) a CT scan and identified sarcopenia as 2 standard deviations below the mean SMA. The study identified sarcopenia as SMA < 92.2cm2 for females and SMA < 144.3cm2 for males at L3 and SMA < 54.6cm2 for females and SMA < 91.4cm2 for males at T10.
Retrospective chart review of ARDS patients in ICU with CT of chest/abdomen within 5 days of admission. A disc of their scan was obtained and SMA was measured by two independent researchers using an image software.
Results: For our primary end-point of in-hospital mortality, 3 (30%) sarcopenic and 25 (50%) non-sarcopenic patients died within a 60-day timeframe (p=.418). Our secondary endpoints were length of ICU stay, total LOS, and intubation days. For total LOS, sarcopenic patients averaged18.3 days vs 18.1 days for non-sacropenic patients (p=.964). For ICU LOS, sarcopenic patients averaged 12.2 days vs 13.9 in non-sacropenic patients (p=.687). Finally, for intubation days, sarcopenic patients averaged 10.8 days vs. 10.2 days for non-sacropenic patients (p=.882).
Discussion: Our data did not show a statistically significant difference in any of our endpoints. This is likely due to a small sample size of 60 patients and only 10 were sarcopenic. Our project lays the framework for a larger study to be designed. The method for which we measured sarcopenia has been validated. The importance of nutrition and early mobility have also been validated. Thus, more studies in these sarcopenic patients are warranted to further emphasize the importance of nutrition.