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Nonvolitional assessment of tibialis anterior force and architecture during critical illness

Introduction: Contemporaneous measures of muscle architecture and force have not previously been conducted during critical illness to examine their relationship with intensive care unit (ICU)‐acquired weakness. Methods: Ankle dorsiflexor muscle force (ADMF) with high‐frequency electrical peroneal nerve stimulation and skeletal muscle architecture via ultrasound were measured in 21 adult, critically ill patients, 16 at ICU admission. Results: Thirteen patients were measured on 2 occasions. Among these, 10 who were measured at ICU admission demonstrated muscle weakness. Despite significant reductions in tibialis anterior (Δ = −88.5 ± 78.8 mm2, P = 0.002) and rectus femoris (Δ = −126.1 ± 129.1 mm2, P = 0.006) cross‐sectional areas between occasions, ADMF did not change (100‐HZ ankle dorsiflexor force 9.8 [IQR, 8.0–14.4] kg vs. 8.6 (IQR, 6.7–19.2) kg, P = 0.9). Discussion: Muscle weakness was evident at ICU admission. No additional decrements were observed 7 days later despite significant reductions in muscle size. These data suggest that not all ICU weakness is truly “acquired” and questions our understanding of muscle function during critical illness. Muscle Nerve 57: 964–972, 2018