Person: González Seguel, Felipe
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González Seguel
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Felipe
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Felipe Andrés González Seguel
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Publication Trajectories of Recovery after ACutE and cRitical illness (TRACER): a prospective observational study protocol(González-Seguel F, Summers LA, Fresenko LE, Long DE, Scott LN, Slone SA, Shankara Bhaktula S, Wen Y, Miller BF, Morris PE, Salyer AL, Kalema AG, Montgomery-Yates AA, Dupont-Versteegden EE, Mayer KP; TRACER study group Collaborators. Trajectories of Recovery after ACutE and cRitical illness (TRACER): a prospective observational study protocol, 2025) González Seguel, Felipe; Summers, Louisa; Fresenko, Lindsey; Long, Douglas; Scott, Logan; Slone, Stacey; Shankara, Srushan; Wen, Yuan; Miller, Benjamin; Morris, Peter; Salyer, Amy; Kalema, Anna; Montgomery, Ashley; Dupont, Esther; Mayer, KirbyIntroduction: Patients who survive admission to intensive care unit (ICU) for critical illness are at high risk of developing muscle atrophy and weakness, commonly diagnosed as ICU-acquired weakness (ICUAW). The development of ICUAW is closely linked to long-term symptoms and impairments known as post-intensive care syndrome (PICS). Despite heightened recognition of impairments, there is limited research supporting effective interventions to improve muscle and physical outcomes after hospital discharge. Prior to developing and testing interventions for ICU survivors, it is imperative to understand the trajectory of muscle and physical function recovery following an ICU stay. The purpose of this study is to longitudinally investigate skeletal muscle health and physical function outcomes after ICU admission. Methods and analysis: This protocol describes a single site, prospective, observational study in adult patients who have survived a critical illness (ie, sepsis or acute respiratory failure). Patients will participate in a battery of testing including primary outcomes: muscle power and physical function; and secondary outcomes: muscle strength, muscle size, endurance and physical activity (by accelerometry) at hospital discharge and 3, 6, and 12 months post-discharge. A subset of patients will participate in muscle biopsy and venipuncture. To examine if the trajectory of recovery predicts primary outcomes, we will perform multivariate linear regression models in 150 evaluable patients. To examine differences in molecular and cellular outcomes in plasma and muscle tissue, a control group of community-dwelling adults without history of an ICU stay will be enrolled as a comparator group. Enrolment started on 18 October 2022 with an estimated completion date of 1 August 2027. Ethics and dissemination: This protocol was approved by the University of Kentucky Office of Research Integrity Medical Internal Review Board (# 77407), with patients providing informed written consent. We anticipate our findings to establish recovery trajectories, improving the classification of patients who experience sustained physical disability. Improved identification of recovery trajectories of muscle and physical function enables future studies to employ an individually targeted rehabilitation approach, that is, precision medicine, with the goal of improving patient outcomes. The cellular findings will support the development of novel interventions specifically designed for detecting underlying mechanisms. We intend to disseminate findings to patients, healthcare professionals, the public and other relevant groups via conference presentations and manuscripts without publication restrictions.Publication Development of an artificial intelligence powered software for automated analysis of skeletal muscle ultrasonography(2025) Calulo, Zoe; González Seguel, Felipe; Horikawa, Arimitsu; Granger, Catherine; Sarwal, Aarti; Dha, Sanjay; Ntoumenopoulos, George; Chen, Jin; Bumgardner, V K; Parry, Selina; Mayer, Kirby; Wen, YuanMuscle ultrasound has high utility in clinical practice and research; however, the main challenges are the training and time required for manual analysis to achieve objective quantification of muscle size and quality. We aimed to develop and validate a software tool powered by artificial intelligence (AI) by measuring its consistency and comparability of expert manual analysis quantifying lower limb muscle ultrasound images. Quadriceps complex (QC) and tibialis anterior (TA) muscle images of healthy, intensive care unit, and/or lung cancer participants were captured with portable devices. Manual analyses of muscle size and quality were performed by experienced physiotherapists taking approximately 24 h to analyze all 180 images, while automated analyses were performed using a custom-built deep-learning model (MyoVision-US), taking 247 s (saving time = 99.8%). Consistency between the manual and automated analyses was good to excellent for all QC (ICC = 0.85-0.99) and TA (ICC = 0.93-0.99) measurements, even for critically ill (ICC = 0.91-0.98) and lung cancer (ICC = 0.85-0.99) images. The comparability of MyoVision-US was moderate to strong for QC (adj. R2 = 0.56-0.94) and TA parameters (adj. R2 = 0.81-0.97). The application of AI automating lower limb muscle ultrasound analyses showed excellent consistency and strong comparability compared with human analysis across healthy, acute, and chronic population.Publication Acute skeletal muscle wasting in patients with acute kidney injury requiring continuous kidney replacement therapy: A prospective multicenter study(2026) Mayer, Kirby; Teixeira, Pedro; González Seguel, Felipe; Tran, Vinh; Gross, Jessica; Horikawa, Arimitsu; Anil, Chaitanya; Shareef, Zan; Puffer, Hayley; Wen, Yuan; Griffin, Benjamin; Neyra, JavierPurpose: Acute kidney injury (AKI) requiring continuous kidney replacement therapy (CKRT) has been hypothesized to increase the risk of developing intensive care unit-associated weakness (ICU-AW), but prospective data are lacking. Materials and methods: This prospective observational study evaluated critically ill adults with AKI requiring CKRT at two U.S. academic hospitals. Using ultrasonography (US), we quantified changes in rectus femoris (RF) muscle mass and quality in the first week after CKRT initiation. At hospital discharge, we assessed for ICU-AW, physical function, and frailty. Results: Twenty-three patients with median age 56 [IQR 47-60] years, BMI 29 [26-36] kg/m2, and Charlson Comorbidity Index 3 [1.5-5] were enrolled. The baseline Sequential Organ Failure Assessment (SOFA) score was 9 [7.5-11.5] and CKRT duration was 4 [1-7] days. Six (26 %) patients died in the ICU and one (4 %) transitioned to comfort measures before study completion. Substantial muscle wasting occurred between Day 1 and Day 7: RF muscle thickness (mT) decreased by 10 % [3 %-20 %]; RF cross-sectional area (CSA) decreased by 19 % [12 %-22 %]; and echo intensity (EI) increased (implying worse muscle quality) by 14 % [5 %-25 %]. A significant effect of time within subjects was observed for all three ultrasound measures (CSA: F = 66.2, p < 0.001; mT: F = 27.1, p < 0.001; EI: F = 22.5, p < 0.001). At hospital discharge, 67 % of survivors (n = 10/15) met criteria for ICU-AW. Conclusions: Patients with AKI requiring CKRT experienced significant muscle wasting in the first week following CKRT initiation and had high rate of ICU-AW at hospital discharge. Trial registration: NCT05287204, Registered 20 October 2021.