Objective assessment of the Changes in body composition of critically ill patients is very valuable. Ultrasound stands as a solution due to its portability, bedside availability, and radiation-free technology. Those criteria are crucial for critically ill obstetrics and gynecological cases.
females with age 16 with no upper limit
American Society of Anesthesiologists (ASA) class I, II or III,
admitted to the obstetrics and Gynecology critical care unit
Patient refusal
Critically ill women whether pregnant, peripartum, postoperative, or admitted for any critical illness.
Cohort
Prospective
ultrasound detection of body composition
Diagnostic testMuscle mass and fat thickness The examiner will use a five-site protocol. The protocol includes the examination of quadriceps on four sides and one bicep will be used The technique is reported by USVALID (Arabella, 2020) GRADING OF QUALITY OF ULTRASOUND SCANS - Muscle quality (fat and fibrotic infiltration) grading for each scan 1. = Muscle fascia and bone surface visible 2. = muscle fascia and bone surface still possible to spot 3. = muscle fascia and bone surface not distinguishable; no evaluation possible The FLUID protocol for edema will be done as follows: MEASURING POINTS 36 points, GRADING OF QUALITY: The examiner will use a 5-point scale of ultrasonic subcutaneous edema grade (USEG) to evaluate subcutaneous edema at each site based on echo intensity, tissue transparency, and fluid properties. Day zero, day 2 then Every 2 days if extended length.
change in body composition-muscular element
Decreased muscle thickness measured by mm or change in quality by visual frey-white detection by ultrasound. The grading for each scan 1. = Muscle fascia and bone surface visible 2. = muscle fascia and bone surface still possible to spot 3. = muscle fascia and bone surface not distinguishable; no evaluation possible
change in body composition-fat element
change in thickness of subcutaneous fat measured in mm.
change in body composition-extreacellular oedema element
The examiner will use a 5-point scale of ultrasonic subcutaneous edema grade (USEG) to evaluate subcutaneous edema at each site based on echo intensity, tissue transparency, and fluid properties. the total Degree of edema measurement is: The final ultrasonic subcutaneous edema score (USES) will be calculated by adding scores from 36 subcutaneous sites (0-144). Each regional score will be estimated by summing the site scores of the hands (0-8), arms (0-16), thoracic wall (0-32), abdominal wall (0-32), thigh (0-24), calves (0-24), and feet (0-8). The total regional score will be divided by the number of sites in each region to the average score (0-4). the lower the score = the lower level of edema.
co-relation of the change of any elements of body composition with poor outcomes suchs such as death, need for ventilatory or circulatory support or increase the length of stay in icu.
Positive co-relation or negative correlation between both. That will be measured by the frequency of occurrence of poor clinical outcomes-mortality cardiorespiratory support or prolonged length of stay- in patients with positive change in any element (muscular-fat-extracellular edema).
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