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Is sarcopenia a risk factor for reduced diaphragm function following hepatic resection? A study protocol for a prospective observational study

INTRODUCTION: Sarcopenia is associated with reduced pulmonary function in healthy adults, as well as with increased risk of pneumonia following abdominal surgery. Consequentially, postoperative pneumonia prolongs hospital admission, and increases in-hospital mortality following a range of surgical i...

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Autores principales: van der Kroft, Gregory, Fritsch, Sebastian Johannes Johannes, Rensen, S S, Wigger, Steffen, Stoppe, Christian, Lambertz, Andreas, Neumann, Ulf Peter, Damink, S W M Olde, Bruells, Christian S
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8596026/
https://www.ncbi.nlm.nih.gov/pubmed/34785555
http://dx.doi.org/10.1136/bmjopen-2021-053148
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author van der Kroft, Gregory
Fritsch, Sebastian Johannes Johannes
Rensen, S S
Wigger, Steffen
Stoppe, Christian
Lambertz, Andreas
Neumann, Ulf Peter
Damink, S W M Olde
Bruells, Christian S
author_facet van der Kroft, Gregory
Fritsch, Sebastian Johannes Johannes
Rensen, S S
Wigger, Steffen
Stoppe, Christian
Lambertz, Andreas
Neumann, Ulf Peter
Damink, S W M Olde
Bruells, Christian S
author_sort van der Kroft, Gregory
collection PubMed
description INTRODUCTION: Sarcopenia is associated with reduced pulmonary function in healthy adults, as well as with increased risk of pneumonia following abdominal surgery. Consequentially, postoperative pneumonia prolongs hospital admission, and increases in-hospital mortality following a range of surgical interventions. Little is known about the function of the diaphragm in the context of sarcopenia and wasting disorders or how its function is influenced by abdominal surgery. Liver surgery induces reactive pleural effusion in most patients, compromising postoperative pulmonary function. We hypothesise that both major hepatic resection and sarcopenia have a measurable impact on diaphragm function. Furthermore, we hypothesise that sarcopenia is associated with reduced preoperative diaphragm function, and that patients with reduced preoperative diaphragm function show a greater decline and reduced recovery of diaphragm function following major hepatic resection. The primary goal of this study is to evaluate whether sarcopenic patients have a reduced diaphragm function prior to major liver resection compared with non-sarcopenic patients, and to evaluate whether sarcopenic patients show a greater reduction in respiratory muscle function following major liver resection when compared with non-sarcopenic patients. METHODS AND ANALYSIS: Transcostal B-mode, M-mode ultrasound and speckle tracking imaging will be used to assess diaphragm function perioperatively in 33 sarcopenic and 33 non-sarcopenic patients undergoing right-sided hemihepatectomy starting 1 day prior to surgery and up to 30 days after surgery. In addition, rectus abdominis and quadriceps femoris muscles thickness will be measured using ultrasound to measure sarcopenia, and pulmonary function will be measured using a hand-held bedside spirometer. Muscle mass will be determined preoperatively using CT-muscle volumetry of abdominal muscle and adipose tissue at the third lumbar vertebra level (L3). Muscle function will be assessed using handgrip strength and physical condition will be measured with a short physical performance battery. A rectus abdominis muscle biopsy will be taken intraoperatively to measure proteolytic and mitochondrial activity as well as inflammation and redox status. Systemic inflammation and sarcopenia biomarkers will be assessed in serum acquired perioperatively. ETHICS AND DISSEMINATION: This trial is open for recruitment. The protocol was approved by the official Independent Medical Ethical Committee at Uniklinik (Rheinish Westphälische Technische Hochschule (RWTH) Aachen (reference EK309-18) in July 2019. Results will be published via international peer-reviewed journals and the findings of the study will be communicated using a comprehensive dissemination strategy aimed at healthcare professionals and patients. TRIAL REGISTRATION NUMBER: ClinicalTrials. gov (EK309-18); Pre-results.
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spelling pubmed-85960262021-11-24 Is sarcopenia a risk factor for reduced diaphragm function following hepatic resection? A study protocol for a prospective observational study van der Kroft, Gregory Fritsch, Sebastian Johannes Johannes Rensen, S S Wigger, Steffen Stoppe, Christian Lambertz, Andreas Neumann, Ulf Peter Damink, S W M Olde Bruells, Christian S BMJ Open Surgery INTRODUCTION: Sarcopenia is associated with reduced pulmonary function in healthy adults, as well as with increased risk of pneumonia following abdominal surgery. Consequentially, postoperative pneumonia prolongs hospital admission, and increases in-hospital mortality following a range of surgical interventions. Little is known about the function of the diaphragm in the context of sarcopenia and wasting disorders or how its function is influenced by abdominal surgery. Liver surgery induces reactive pleural effusion in most patients, compromising postoperative pulmonary function. We hypothesise that both major hepatic resection and sarcopenia have a measurable impact on diaphragm function. Furthermore, we hypothesise that sarcopenia is associated with reduced preoperative diaphragm function, and that patients with reduced preoperative diaphragm function show a greater decline and reduced recovery of diaphragm function following major hepatic resection. The primary goal of this study is to evaluate whether sarcopenic patients have a reduced diaphragm function prior to major liver resection compared with non-sarcopenic patients, and to evaluate whether sarcopenic patients show a greater reduction in respiratory muscle function following major liver resection when compared with non-sarcopenic patients. METHODS AND ANALYSIS: Transcostal B-mode, M-mode ultrasound and speckle tracking imaging will be used to assess diaphragm function perioperatively in 33 sarcopenic and 33 non-sarcopenic patients undergoing right-sided hemihepatectomy starting 1 day prior to surgery and up to 30 days after surgery. In addition, rectus abdominis and quadriceps femoris muscles thickness will be measured using ultrasound to measure sarcopenia, and pulmonary function will be measured using a hand-held bedside spirometer. Muscle mass will be determined preoperatively using CT-muscle volumetry of abdominal muscle and adipose tissue at the third lumbar vertebra level (L3). Muscle function will be assessed using handgrip strength and physical condition will be measured with a short physical performance battery. A rectus abdominis muscle biopsy will be taken intraoperatively to measure proteolytic and mitochondrial activity as well as inflammation and redox status. Systemic inflammation and sarcopenia biomarkers will be assessed in serum acquired perioperatively. ETHICS AND DISSEMINATION: This trial is open for recruitment. The protocol was approved by the official Independent Medical Ethical Committee at Uniklinik (Rheinish Westphälische Technische Hochschule (RWTH) Aachen (reference EK309-18) in July 2019. Results will be published via international peer-reviewed journals and the findings of the study will be communicated using a comprehensive dissemination strategy aimed at healthcare professionals and patients. TRIAL REGISTRATION NUMBER: ClinicalTrials. gov (EK309-18); Pre-results. BMJ Publishing Group 2021-11-16 /pmc/articles/PMC8596026/ /pubmed/34785555 http://dx.doi.org/10.1136/bmjopen-2021-053148 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Surgery
van der Kroft, Gregory
Fritsch, Sebastian Johannes Johannes
Rensen, S S
Wigger, Steffen
Stoppe, Christian
Lambertz, Andreas
Neumann, Ulf Peter
Damink, S W M Olde
Bruells, Christian S
Is sarcopenia a risk factor for reduced diaphragm function following hepatic resection? A study protocol for a prospective observational study
title Is sarcopenia a risk factor for reduced diaphragm function following hepatic resection? A study protocol for a prospective observational study
title_full Is sarcopenia a risk factor for reduced diaphragm function following hepatic resection? A study protocol for a prospective observational study
title_fullStr Is sarcopenia a risk factor for reduced diaphragm function following hepatic resection? A study protocol for a prospective observational study
title_full_unstemmed Is sarcopenia a risk factor for reduced diaphragm function following hepatic resection? A study protocol for a prospective observational study
title_short Is sarcopenia a risk factor for reduced diaphragm function following hepatic resection? A study protocol for a prospective observational study
title_sort is sarcopenia a risk factor for reduced diaphragm function following hepatic resection? a study protocol for a prospective observational study
topic Surgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8596026/
https://www.ncbi.nlm.nih.gov/pubmed/34785555
http://dx.doi.org/10.1136/bmjopen-2021-053148
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