• Frederic V Valla, David K Young, Muriel Rabilloud, Uvaraj Periasami, Manoj John, Florent Baudin, Carole Vuillerot, Aurélie Portefaix, Deborah White, Jenna A Ridout, Rosan Meyer, Bénédicte Gaillard Le Roux, Etienne Javouhey, and Nazima Pathan.
• 1Pediatric Intensive Care, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France. 2Physiotherapy Department, Addenbrooke's Hospital, Cambridge, United Kingdom. 3Hospices Civils de Lyon, Service de Biostatistique et Bioinformatique, Lyon, France. 4Université Lyon 1, Villeurbanne, France. 5CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France. 6Paediatric Intensive Care Unit, Addenbrooke's Hospital, Cambridge, United Kingdom. 7Pediatric Neurology and Rehabilitation Unit, Hôpital Femme Mere Enfant, Hospices Civils de Lyon, Lyon, France. 8EPICIME-CIC 1407 de Lyon, Inserm, Service de Pharmacologie Clinique, CHU-Lyon, Bron, France. 9Department Paediatrics, Imperial College London, St. Mary's Campus, London, United Kingdom. 10Pediatric Intensive Care Unit, Réanimation Pédiatrique, Hôpital Mère enfants, CHU de Nantes, Nantes cedex, France. 11Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France. 12Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom.
• Pediatr Crit Care Me. 2017 Aug 1; 18 (8): e339-e347.

ObjectivesSignificant muscle wasting develops in critically ill adults, with subsequent worse outcomes. In the pediatric setting, occurrence and effects of muscle wasting are undescribed; this is in part due to a lack of validated, objective methods for assessing muscle wasting. A single measurement of quadriceps femoris thickness has failed to show consistent reproducibility. We hypothesized that averaging repeated measurements could afford good reproducibility to allow for quadriceps femoris thickness decline detection and monitoring.DesignA prospective bedside observational study.SettingTwo PICUs.PatientsMechanically ventilated critically ill children were 15 years and younger.InterventionsTransverse and longitudinal axis measurements of quadriceps femoris anterior thickness were undertaken using bedside ultrasound. The average of four measurement values was recorded. The location of measurement was marked for consistency within subsequent measurements by the same or another trained operator, to assess intra- and interoperator repeatability and reproducibility of the technique. Where feasible, serial measurements were undertaken until the time of extubation in a group of children with prolonged PICU stay (> 5 d).Measurements And Main ResultsSeventy-three children were enrolled to assess intra- and interoperator ultrasound reliability. Their median (25-75 interquartile range) age and weight were 30 months (4.5-96) and 10 kg (5-23.5). In the intraoperator repeatability study, mean relative difference in quadriceps femoris muscle thickness was 0.36% ± 2.5% (lower and upper limits of agreement: -4.5/+5.2%). In the interoperator reproducibility study, intraclass correlation coefficient was 0.998. In the 17 children monitored over their PICU stay, quadriceps femoris thickness significantly decreased at day 5 by 9.8% (p = 0.006) and by 13.3% (< 0.001) at the last performed measurement.ConclusionsQuadriceps femoris thickness decrease, proposed as a surrogate for muscle mass, is an early, frequent, and intense phenomenon in PICU. Quadriceps femoris ultrasonography is a reliable technique to monitor this process and in future could help to guide rehabilitation and nutrition interventions.

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