Effects of Frailty, Sarcopenia and Muscle Wasting on Outcomes of Patients in the Surgical Intensive Care Unit

Study Overview
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Brief Summary
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The primary aim of the study is to evaluate consequences of frailty in critically ill patients. We hypothesize that a higher frailty index (based on published questionnaires) predicts a longer surgical intensive care unit and hospital length of stay, less ventilator-free days and a higher likelihood of an adverse discharge disposition. Our secondary aim is to identify muscle-size derived variables that can be used to predict frailty. We hypothesize that a low skeletal muscle mass measured by ultrasound can be used to quantify frailty, and to also predict the outcome of SICU patients, expressed as longer stay in the surgical intensive care unit and longer stay in the hospital, less ventilator-free days and a higher likelihood of an adverse discharge disposition. Our third aim is to examine potential triggers of muscle wasting in critically ill patients. Muscle wasting will be assessed by repetitive ultrasound measurements of muscle mass. We hypothesize that a significant decrease in skeletal muscle mass predicts longer stay at the surgical intensive care unit and longer hospital length of stay, less ventilator-free days and adverse discharge disposition.

Detailed Description
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Frailty is defined as status of decreased physiological reserve which leads to a higher vulnerability to stressors. It is associated with a higher risk of morbidity and mortality. Within the geriatric population, frailty is common and a known predictor of adverse outcomes. The usefulness of a frailty assessment as an outcome measure in critically ill patients of all ages needs to be evaluated. This study evaluates whether frailty has an effect on outcome of critically ill patients. Muscle weakness predicts outcome of ICU patients but is hard to determine in the ICU since the measurement is volition dependent. Muscle mass correlates with muscle weakness and can be assessed objectively. This study evaluates the consequences of reduced muscle mass or sarcopenia on the outcome of critically ill patients. In addition, muscle wasting in the ICU may predict persistent functional disability. This study aims to examine muscle wasting of critically ill patients on the surgical ICU.

Official Title
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Ultrasound Assessment of Muscle to Quantify Frailty.

Conditions
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Critical Illness, Sarcopenia, Muscle Wasting

Intervention / Treatment
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* Device: Ultrasound Philips CX50
* Other: Frailty Index Questionnaire
* Other: Muscle strength tests


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients admitted to the SICU (within 72 hours of admission) Age over 18 years Stay on the SICU for at least 24 hours Exclusion Criteria: Ongoing discussions about goals of care Motor component of Glasgow Coma Scale <5 Unstable fractures Preexisting paralysis Pregnancy Absence of both lower limbs

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 |
| --- | --- |
| Adult patients on the SICU<br>Adult patients on the surgical intensive care unit (SICU), within 72 hours of admission to the SICU and until SICU discharge. Ultrasound Philips CX50, Frailty Index questionnaire and muscle strength tests. | Device: Ultrasound Philips CX50<br>* The Philips CX50 ultrasound system is used to measure muscle size of the patients. We will measure the area and diameter of the rectus femoris muscle via ultrasound.<br>Other: Frailty Index Questionnaire<br>* Frailty Index Questionnaire is a clinical tool to assess frailty in patients. We will ask patients to answer the questionnaire, including clarification that the questionnaire assesses the patient's pre-admission condition. The presence of a frail characteristic will be scored as 1 point. Most variables will be dichotomized (e.g. 1 point when a frail characteristic will be present and 0 points when frail characteristic will be not present).The Frailty Index will be calculated as the total number of frail characteristics of the patient divided by the total number of variables (n=50).<br>Other: Muscle strength tests<br>* MRC score is a clinical assessment of muscle power on abduction of the arm, flexion of the forearm, extension of the wrist, flexion of the leg, extension of the knee and dorsal flexion of the foot with the score of (0-5) on each measurement.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Surgical intensive care unit length of stay | Time from study inclusion to SICU discharge, an expected time of 2 days to 2 weeks. | Patients will be followed until SICU discharge, an expected 2 days to 2 weeks. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hospital length of stay | Time from study inclusion to hospital discharge, an expected time of 4 days to 4 weeks | Patients will be followed until hospital discharge, an expected 4 days to 4 weeks | 
| Discharge Disposition | Discharge disposition of the patient expressed as home, rehabilitation, nursing facility or in-hospital mortality. | Patient will be followed until hospital discharge, an expected 4 days to 4 weeks | 
| Ventilator-free days | Days spent on the SICU that patient is not receiving mechanical ventilation | Patients will be followed until SICU discharge, an expected 2 days to 2 weeks. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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outcome, critically illness, intensive care unit, frailty