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In this project, we aim to use ultrasound of the quadriceps to evaluate the effect of the nutritional practices of the EFFORT parent trial on muscle mass. 

Our Research Question: 

In critically ill patients with nutrition ‘risk factors’, what is the effect of prescribing a higher dose (2.2 grams/kg/day) of protein/amino acid administration compared to patients prescribed a usual protein dose (1.2 gram/kg/day) on muscle quality and quantity measured by US of quadriceps?


Site who have signed up and registered for participation in the parent EFFORT trial have the opportunity to participate in this substudy. 

In order to participate in this trial, sites must have access to ultrasound equipment and undergo specialized training conducted by CERU Staff or local experts who have been trained on our ultrasound procedures.



Ultrasonography is an accessible, non-invasive, portable and user-friendly tool that is gaining popularity in the ICU and can be used to quantify structural and physical characteristics of skeletal muscle at the bedside. Diverse ultrasound protocols have been developed and applied in an ICU setting to quantify muscle thickness, cross sectional area of the rectus femoris, and other measures of muscle quality such as echogenicity. These measures have largely been shown to be reliable in critically ill patient populations and have some degree of validity as they predict for total body skeletal muscle and more distal functional outcomes. 


In this trial, we will use an US protocol that we have developed and are using in our other research projects. These measures will be taken locally at baseline (within 24 hrs of randomization), 10 days post randomization and just prior to hospital discharge and sent securely via the internet to a central storage facility where they will be read by experts.


EFFORT Ultrasound Protocol: 

Clean Version

Tracked Changes Version

Ultrasound Procedure Manual:

EFFORT Ultrasound Procedure Manual


Launch and Training:

We have partnered with Dr Rosa Larreategui who is organizing the Panamanian Conference on Clinical Nutrition, October 2-4th in Panama City. Here we will have experts on hand to offer hands-on training for the ultrasound procedures to be used in EFFORT US.

Dr Daren Heyland will also be present to answer questions about the study.

More details will be announced closer to the the conference.


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