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Weakness acquired in ICU

Diana Greene-Chandos, Michel Torbey
PURPOSE OF REVIEW: Weakness is a common reason patients are seen in neurologic consultation. This article reviews the differential diagnosis of neuromuscular disorders in the intensive care unit (ICU), discusses the intensive care needs and evaluation of respiratory failure in patients with neuromuscular disorders, and provides a practical guide for management. RECENT FINDINGS: Although primary neuromuscular disorders used to be the most common cause for weakness from peripheral nervous system disease in the ICU, a shift toward ICU-acquired weakness is observed in today's clinical practice...
December 2018: Continuum: Lifelong Learning in Neurology
Maya N Elías, Cindy L Munro, Zhan Liang, Karel Calero, Ming Ji
BACKGROUND: Older adults in the intensive care unit (ICU) often experience sleep disturbances, which may stem from life-threatening illness, the ICU environment, medications/sedation, or psychological stress. Two complementary endocrinological responses occur as a result of compromised sleep and consequently could exacerbate ICU-acquired weakness: a decrease in anabolic hormones leading to decreased protein synthesis and an increase in catabolic hormones leading to increased protein degradation...
January 2019: Dimensions of Critical Care Nursing: DCCN
Ying Liu, Wei Zhao, Wenxiu Chen, Xiao Shen, Run Fu, Yi Zhao, Han Liu
OBJECTIVE: To explore the therapeutic effects of early enteral nutrition (EEN) on patients with sepsis on mechanical ventilation. METHODS: Patients with sepsis on mechanical ventilation in the medical intensive care unit (ICU) from January 2013 to March 2016 were treated with enteral nutrition. Patients treated within 48 hours of initiation of mechanical ventilation were assigned to the EEN group, and the rest were assigned to the delayed enteral nutrition (DEN) group...
November 1, 2018: Journal of Intensive Care Medicine
Deonni P Stolldorf, Mary S Dietrich, Tiffani Chidume, Marie McIntosh, Cathy A Maxwell
BACKGROUND: Critical-care nurses play a vital role in promoting safe early mobilization in intensive care unit (ICU) settings to reduce the risks associated with immobility in ICUs, including the risk of delirium, ICU-acquired weakness, and functional decline. OBJECTIVE: The purposes of this study were to describe nurse-led mobilization practices in 2 community hospital ICUs and to report differences and similarities between the 2 settings. METHODS: This was a cross-sectional exploratory study of 18 nurses (ICU A: n = 12, ICU B: n = 6) and 124 patients (ICU A: n = 50, ICU B: n = 74)...
November 2018: Dimensions of Critical Care Nursing: DCCN
Krysta S Wolfe, Bhakti K Patel, Erica L MacKenzie, Shewit P Giovanni, Anne S Pohlman, Matthew M Churpek, Jesse B Hall, John P Kress
BACKGROUND: Vasoactive medications are commonly used in the treatment of critically ill patients, but their impact on the development of ICU-acquired weakness is not well described. The objective of this study is to evaluate the relationship between vasoactive medication use and the outcome of ICU-acquired weakness. METHODS: This is a secondary analysis of mechanically ventilated patients (N = 172) enrolled in a randomized clinical trial of early occupational and physical therapy vs conventional therapy, which evaluated the end point of ICU-acquired weakness on hospital discharge...
October 2018: Chest
Tao Yang, Zhiqiang Li, Li Jiang, Xiuming Xi
BACKGROUND: The association between corticosteroid use and intensive care unit (ICU)-acquired weakness remains unclear. We evaluated the relationship between corticosteroid use and ICU-acquired weakness in critically ill adult patients. METHODS: The PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and Cumulative Index of Nursing and Allied Health Literature databases were searched from database inception until October 10, 2017. Two authors independently screened the titles/abstracts and reviewed full-text articles...
August 3, 2018: Critical Care: the Official Journal of the Critical Care Forum
Avelino C Verceles, Chris L Wells, John D Sorkin, Michael L Terrin, Jeffrey Beans, Toye Jenkins, Andrew P Goldberg
PURPOSE: To compare the effects of adding a progressive multimodal rehabilitation program to usual care (MRP + UC) versus UC alone on 1) functional mobility, strength, endurance and 2) ventilator weaning and discharge status of patients with ICU-acquired weakness (ICUAW) receiving prolonged mechanical ventilation (PMV). METHODS: Randomized pilot trial of an individualized MRP + UC versus UC in middle-aged and older ICU survivors with ICUAW receiving PMV...
October 2018: Journal of Critical Care
Chunyan Zhu, Bao Liu, Tianjun Yang, Qing Mei, Aijun Pan, Dongsheng Zhao
OBJECTIVE: To investigate the effect of early rehabilitation physiotherapy on muscle quality and function in critical patients. METHODS: A prospective randomized controlled study was performed. Adult critically ill patients admitted to intensive care unit (ICU) of Anhui Provincial Hospital from October 1st, 2016 to August 31st, 2017 who had been hospitalized for more than 7 days and had acute physiology and chronic health evaluation II (APACHE II) > 8 were enrolled, and they were divided into treatment group and control group according to random number table method...
June 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Simone Thomas, Jan Mehrholz
OBJECTIVE: To describe predictors for health-related quality of life, participation, physical activity and cognitive function in patients with intensive care unit (ICU)-acquired muscle weakness 1 year after discharge from rehabilitation. DESIGN: This is a cohort study. PARTICIPANTS: We included 150 chronic critically ill individuals with ICU-acquired muscle weakness. SETTING: Postacute ICU and rehabilitation units in Germany...
July 13, 2018: BMJ Open
Yosuke Morimoto, Motohiro Sekino, Kiyoyuki Eishi, Ryo Kozu
Although ICU-AW is a common condition in critically ill, it is unclear which intervention is best to treat. We applied combined exercise training and nutritional supplementation, and these were effective to recover the skeletal muscle function and exercise capacity. We should recognize necessity of nutritional support in ICU-AW patients.
July 2018: Clinical Case Reports
M Raurell-Torredà, S Arias-Rivera, J D Martí, M J Frade-Mera, I Zaragoza-García, E Gallart, T R Velasco-Sanz, A San José-Arribas, E Blázquez-Martínez
AIM: To evaluate the degree of implementation of protocols associated with the prevention of intensive-care-unit (ICU) acquired muscle weakness, and the presence of the physiotherapist in various ICU in Spain. METHOD: A descriptive, cross-sectional study performed in 86 adult ICU in Spain between March and June 2017. Neurosurgical and major burns ICU were excluded. A multiple-choice survey was used that included questions on protocols for glycaemia control, sedation, pain assessment, delirium prevention, delirium management and early mobilisation...
June 28, 2018: Enfermería Intensiva
L Sánchez Solana, I Goñi Bilbao, P Ruiz García, J L Díaz Agea, C Leal Costa
INTRODUCTION: Polyneuropathy and myopathy, grouped under the term «intensive care unit-acquired weakness» (ICUAW), are neuromuscular pathologies to which patients in the intensive care unit (ICU) are susceptible. They are multifactorial pathologies, prolonged connection to a ventilator is one of the most common. The objective of this review was to identify the efficacy of different rehabilitative treatments in patients with ICUAW, and the relationship between ICUAW and a series of indicators...
July 2018: Enfermería Intensiva
Esther Witteveen, Luuk Wieske, Friso M de Beer, Nicole P Juffermans, Camiel Verhamme, Marcus J Schultz, Ivo N van Schaik, Janneke Horn
Background: The main risk factors for intensive care unit-acquired weakness (ICU-AW) are sepsis, the systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction. These risk factors are associated with systemic complement activation. We hypothesized that critically ill patients who develop ICU-AW have increased systemic complement activation compared to critically ill patients who do not develop ICU-AW. Methods: Complement activation products C3b/c, C4b/c and C5a were measured in plasma of ICU patients with mechanical ventilation for ≥48 hours...
April 2018: Annals of Translational Medicine
Tao Yang, Zhiqiang Li, Li Jiang, Yinhua Wang, Xiuming Xi
Intensive care unit-acquired weakness (ICUAW) occurs frequently in the context of critical illness without alternative plausible cause and specific treatment options, and it is important to identify and summarize the independent risk factors for ICUAW. PubMed, Embase, Central, China Biological Medicine, China National Knowledge Infrastructure, VIP and Wanfang databases were searched from database inception until 10 July 2017. Prospective cohort studies on adult ICU patients who were diagnosed with ICUAW using either clinical or electrophysiological criteria were selected...
August 2018: Acta Neurologica Scandinavica
Philip A Efron, Alicia M Mohr, Azra Bihorac, Hiroyuki Horiguchi, McKenzie K Hollen, Mark S Segal, Henry V Baker, Christiaan Leeuwenburgh, Lyle L Moldawer, Frederick A Moore, Scott C Brakenridge
As early as the 1990s, chronic critical illness, a distinct syndrome of persistent high-acuity illness requiring management in the ICU, was reported under a variety of descriptive terms including the "neuropathy of critical illness," "myopathy of critical illness," "ICU-acquired weakness," and most recently "post-intensive care unit syndrome." The widespread implementation of targeted shock resuscitation, improved organ support modalities, and evidence-based protocolized ICU care has resulted in significantly decreased in-hospital mortality within surgical ICUs, specifically by reducing early multiple organ failure deaths...
August 2018: Surgery
Christopher Brock, Vince Marzano, Margot Green, Jiali Wang, Teresa Neeman, Imogen Mitchell, Bernie Bissett
BACKGROUND: Mobilisation of intensive care (ICU) patients attenuates ICU-acquired weakness, but the prevalence is low (12-54%). Better understanding of barriers and enablers may inform practice. OBJECTIVES: To identify barriers to mobilisation and factors associated with successful mobilisation in our medical /surgical /trauma ICU where mobilisation is well-established. METHODS: 4-week prospective study of frequency and intensity of mobilisation, clinical factors and barriers (extracted from electronic database)...
July 2018: Heart & Lung: the Journal of Critical Care
Syed Omar Shah, Jacqueline Kraft, Nethra Ankam, Paula Bu, Kristen Stout, Sara Melnyk, Fred Rincon, M Kamran Athar
INTRODUCTION: Prolonged immobility in patients in the intensive care unit (ICU) can lead to muscle wasting and weakness, longer hospital stays, increased number of days in restraints, and hospital-acquired infections. Increasing evidence demonstrates the safety and feasibility of early mobilization in the ICU. However, there is a lack of evidence in the safety and feasibility of mobilizing patients with external ventricular drains (EVDs). The purpose of this study was to determine the safety and feasibility of early mobility in this patient population...
June 2018: Journal of Intensive Care Medicine
Esther Witteveen, Luuk Wieske, Juultje Sommers, Jan-Jaap Spijkstra, Monique C de Waard, Henrik Endeman, Saskia Rijkenberg, Wouter de Ruijter, Mengalvio Sleeswijk, Camiel Verhamme, Marcus J Schultz, Ivo N van Schaik, Janneke Horn
OBJECTIVES: An early diagnosis of intensive care unit-acquired weakness (ICU-AW) is often not possible due to impaired consciousness. To avoid a diagnostic delay, we previously developed a prediction model, based on single-center data from 212 patients (development cohort), to predict ICU-AW at 2 days after ICU admission. The objective of this study was to investigate the external validity of the original prediction model in a new, multicenter cohort and, if necessary, to update the model...
January 1, 2018: Journal of Intensive Care Medicine
Anneke Rebel, Vince Marzano, Margot Green, Karlee Johnston, Jiali Wang, Teresa Neeman, Imogen Mitchell, Bernie Bissett
BACKGROUND: Mobilisation of intensive care unit (ICU) patients reduces ICU-acquired weakness and is associated with better functional outcomes. However, the prevalence of mobilisation of ICU patients remains low. A known barrier to mobilisation is haemodynamic instability, frequently with patients requiring vasoactive therapy. There is a lack of published data to guide clinicians about the safety and feasibility of mobilising patients receiving vasoactive therapy. OBJECTIVES: To describe our mobilisation practice in ICU patients receiving vasoactive therapy and identify factors associated with mobilisation and adverse events...
April 24, 2018: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
Xiaofan Yu, Xiaohong Wan, Linjun Wan, Qingqing Huang
OBJECTIVE: To investigate high risk factors of intensive care unit-acquired weakness (ICUAW) in patients with sepsis. METHODS: A retrospective study was conducted. 164 patients with mechanical ventilation (MV) who were diagnosed sepsis and multiple organ dysfunction syndrome (MODS), admitted to intensive care unit (ICU) of the Second Affiliated Hospital of Kunming Medical University from January 1st, 2015 to September 30th, 2017 were enrolled. The general situation, the basic diseases (hypertension, diabetes), body mass index (BMI), protopathy diseases, the level of albumin before ICU admission, the MV time, whether to use glucocorticoid and continuous renal replacement therapy (CRRT) or not, nutrition supply (nutritional way, nutrition initiation time, amino acid/protein supply, nutritional status on ICU 3 days and 7 days), myoglobin, the length of ICU stay, the length of hospital stay, and acute physiology and chronic health evaluation II (APACHE II) score were collected...
April 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
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