The role of maximum compressed thickness of the quadriceps femoris muscle measured by ultrasonography in assessing nutritional risk in critically-ill patients with different volume statuses.

PURPOSE: In this prospective observational study, we aimed to investigate the role of the maximum compressed (MC) and uncompressed (UC) thickness of the quadriceps femoris muscle (QFMT) measured by ultrasonography (USG) in the detection of nutritional risk in intensive care patients (ICPs) with different volume status. METHODS: 55 patients were included. Right, left, and total ucQFMT and mcQFMT measurements were obtained by a standard USG device within the first 48 hours after ICU admission. Clinical examination and the USG device were used to determine the volume status of the patients. SOFA, APACHE II, modified NUTRIC scores, and demographic data were collected. RESULTS: There was a significant difference between the nutritional risk of patients in terms of left, right, and total mcQFMT measurements (p=0.025, p=0.039; p=0.028, respectively), mechanical ventilation requirement (p=0.014), presence of infection (p=0.019), and sepsis (p=0.006). There was no significant difference between different volume statuses in terms of mcQFMT measurements. In the multi-variance analysis, mcQFMT measurements were found to be independently associated with high nutritional risk (p=0.019, Exp(B)=0.256, 95%CI=0.082-0.800 for modified NUTRIC score ≥ 5), and higher nutritional risk (p=0.009, Exp(B)=0.144, 95%CI=0.033-0.620 for modified NUTRIC score ≥ 6). a Total mcQFMT value below 1.36 cm was a predictor for higher nutritional risk with 79% sensitivity and 70% specificity (AUC=0.749, p=0.002, likelihood ratio=2.04). CONCLUSION: Ultrasonographic measurement of total mcQFMT can be used as a novel nutritional risk assessment parameter in medical ICPs with different volume statuses. Thus, patients who could benefit from aggressive nutritional therapy can be easily identified in these patient groups.

Cases of Opsi syndrome still candidate for medical ICU

Splenectomized patients are likely to suffer from severe infections, such as sepsis and meningitis, which is called overwhelming postsplenectomy infection (OPSI) syndrome. It seems to be more common in children, but occurs at all ages. The risk is greatest in the early months and years after operation, but never disappears entirely. The course is rapid, the clinical symptoms are serious, and the prognosis is very poor. In this paper, three cases of OPSI syndrome are described, in which infection developed 8, 8 and 15 years after splenectomy; two of the patients died. With the help of these case reports, we want to again emphasize the importance of vaccination, antibiotic prophylaxis and seeking earlier medical attention in splenectomized patients.

Cases of OPSI syndrome still candidate for medical ICU.

Splenectomized patients are likely to suffer from severe infections, such as sepsis and meningitis, which is called overwhelming postsplenectomy infection (OPSI) syndrome. It seems to be more common in children, but occurs at all ages. The risk is greatest in the early months and years after operation, but never disappears entirely. The course is rapid, the clinical symptoms are serious, and the prognosis is very poor. In this paper, three cases of OPSI syndrome are described, in which infection developed 8, 8 and 15 years after splenectomy; two of the patients died. With the help of these case reports, we want to again emphasize the importance of vaccination, antibiotic prophylaxis and seeking earlier medical attention in splenectomized patients.