Correlation Between Muscle Thickness and Inflammation With Ventilator Use in Critically Ill Patients

Study Overview
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Brief Summary
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Decrease thickness of diaphragm muscle, cross-sectional area of rectus femoris and biceps brachii muscle, and increase in CRP would affect ventilator length of use in critically ill patients in ICU

Official Title
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Correlation Between Muscle Thickness and Inflammation With Ventilator Length of Use in Critically Ill Patients: Study on Diaphragm Thickness, Rectus Femoris and Biceps Brachii Cross-sectional Area, and C-reactive Protein Level

Conditions
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Ventilation Therapy; Complications

Intervention / Treatment
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* Other: Diaphragm thickness
* Other: Cross-sectional area of rectus femoris muscle
* Other: Cross-sectional area of biceps brachii
* Diagnostic Test: C-Reactive Protein (CRP) Level


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients who had Modified Rankin Score < 4 in 1 month before admitted into ICU Exclusion Criteria: Pregnant women Patients who had intubation more than 24 hours before admitted at ICU Cipto Mangunkusumo Hospital Patients who had a history or prior to thoracic or heart surgery 14 days before admission Patients who had severe peripheral muscle dysfunction Patients who had a history of admission in hospital for more than 2 weeks on the last 3 months Patients who predicted will be using ventilator for less than 4 days Patients who suffered acute respiratory distress syndrome (ARDS) with a ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) less than 200 Patients who declined to participate in this study

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Ventilator length of use<br>measured in days | Other: Diaphragm thickness<br>* measured at apposition zone using ultrasonography in mm<br>Other: Cross-sectional area of rectus femoris muscle<br>* measured at lower one-third line between Spina iliaca anterior inferior (SIAI) and upper border femur patella using ultrasonography in cm^2<br>Other: Cross-sectional area of biceps brachii<br>* measured at biceps brachii muscle using ultrasonography in cm^2<br>Diagnostic Test: C-Reactive Protein (CRP) Level<br>* quantitative CRP using ELISA method in mcg/mL<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Correlation between changes in diaphragm thickness with ventilator length of use | Correlation between changes in diaphragm thickness with ventilator length of use: < 7 days or >7 days | 30 days from admission | 
| Correlation between changes in cross-sectional area of rectus femoris muscle with ventilator length of use | Correlation between changes in cross-sectional area of rectus femoris muscle with ventilator length of use: < 7 days or >7 days | 30 days from admission | 
| Correlation between changes in cross-sectional area of biceps brachii muscle with ventilator length of use | Correlation between changes in cross-sectional area of biceps brachii muscle with ventilator length of use: < 7 days or >7 days | 30 days from admission | 
| Correlation between changes in quantitative C-reactive protein (CRP) level with ventilator length of use | Correlation between changes in quantitative C-reactive protein (CRP) level with ventilator length of use: < 7 days or >7 days | 30 days from admission | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Ventilator length of use | duration of first ventilator use until patient is extubated or deceased: <7 days or >7 days | 30 days from admission | 
| Changes in diaphragm thickness | Measurement of diaphragm thickness from day 1 admission to ICU using ventilator to day 5 in mm Score for changes in diaphragm thickness: 0 : no changes : decrease thickness of <20% : decrease thickness of >20% | 5 days from admission | 
| Changes in cross-sectional area of rectus femoris muscle | Measurement of cross-sectional area of rectus femoris muscle from day 1 admission to ICU using ventilator to day 5 in cm^2 Score for changes in diaphragm thickness: 0 : no changes : decrease cross-sectional area of <20% : decrease cross-sectional area of >20% | 5 days from admission | 
| Changes in cross-sectional area of biceps brachii muscle | Measurement of cross-sectional area of biceps brachii muscle from day 1 admission to ICU using ventilator to day 5 in cm^2 Score for changes in diaphragm thickness: 0 : no changes : decrease cross-sectional area of <20% : decrease cross-sectional area of >20% | 5 days from admission | 
| Changes in quantitative C-reactive protein (CRP) levels | Measurement of quantitative CRP from day 1 admission to ICU using ventilator to day 5 in mcg/mL Score for changes in diaphragm thickness: 0 : no changes : increase in quantitative CRP <50% : increase in quantitative CRP >50% | 5 days from admission |