Evaluation of Peripheral Muscle With Ultrassonografic of Critical Patients With Covid-19
Condition: COVID-19 Respiratory Infection
MeSH terms: COVID-19; Respiratory Tract Infections
Study type: Observational

Summary: 
      Currently, the tools available for assessing peripheral muscle dysfunction in the intensive
      care setting require patient collaboration. Several studies have shown that peripheral muscle
      ultrasound is capable of reliably detecting morphological changes in critically ill patients,
      in addition to contributing to the identification of patients at higher risk of prolonged
      complications, especially when performed daily. In this sense, a valid, non-volitional
      alternative capable of determining muscle mass is through ultrasound assessment. However,
      current studies are characterized by a lack of standardization in their protocols, which
      include proper positioning of limbs, transducer, clear reference points and techniques for
      better visualization of the assessed muscle, in addition to significant methodological
      defects and inadequate sample sizes. We believe that, together with a tool capable of
      determining muscle mass and being a safe and non-invasive method, we can contribute to a more
      complete assessment of these patients, exploring outcomes such as survival, length of stay in
      the ICU, extubation success and functional capacity. In addition to having the potential to
      serve as a biomarker of muscle strength during rehabilitation, given little knowledge about
      the long-term physical consequences of COVID-19, thus promoting a more complete assessment,
      exploring morphological characteristics of the peripheral muscles resulting from the
      hospitalization process. and assisting the physiotherapist in clinical decision making in
      rehabilitation.
    

Detailed description: 
      Introduction: the length of hospital stay may be associated with factors such as the need for
      mechanical ventilation, severity of the underlying disease, infections, use of sedation and
      neuromuscular blockers. In this context, the new coronavirus (SARS-CoV-2) presents itself as
      a group of viruses that can cause acute respiratory syndromes with mild and severe symptoms,
      contributing to increased hospital stays and periods of immobility. Peripheral muscle
      measurement through ultrasound is a topic of growing interest in the assessment of critically
      ill patients. Currently, this tool has been shown to be able to assess muscle dimensions and
      morphology during hospitalization in the intensive care unit (ICU) and can be performed at
      the bedside, presenting itself as a reliable inter and intraobserver method. As this tool
      does not depend on patient collaboration and is a non-invasive method available in most ICUs,
      it can provide additional information to the physical examination and clinical impression.

      Objective: to evaluate the evolution of ultrasound pattern measurements in mechanically
      ventilated patients admitted to the ICU.

      Methods: prospective cohort study that will be carried out in the ICU of the Recife Women's
      Hospital, located in Recife - PE, with individuals of both genders, over 18 years old, under
      mechanical ventilation due to suspicion or confirmation of COVID- 19. To carry out this
      study, the measurement of the ultrasound pattern of peripheral muscles will be performed from
      admission to the ICU, with follow-up on the 3rd, 5th and 7th days under mechanical
      ventilation. The length of stay in the ICU and mechanical ventilation, mortality in this
      population will also be evaluated. Clinical, laboratory, oxygenation, ventilation,
      respiratory system mechanics data will also be analyzed. Data will be collected and archived
      for analysis, which considers differences between groups with p<0.05. All ethical principles
      will be respected with either written Free and Consent Term by the patient or relatives at
      the intensive care phase or at the post ICU discharge phase.

      Expected results: to contribute to a more complete assessment of these patients, exploring
      outcomes such as survival, length of stay in the ICU and effects of immobility on peripheral
      muscle mass.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        The sample consisted of volunteers with COVID - 19 admitted to the SRAG ICU on mechanical
        ventilation due to acute respiratory failure.
      
Keywords: SARS-CoV-2; Intensive care unit; Coronavirus; Peripheral muscle; Atrophy muscular; Uultrasound evaluation; Critically ill