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Weakness in the critically ill patient

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https://www.readbyqxmd.com/read/27897405/premorbid-obesity-but-not-nutrition-prevents-critical-illness-induced-muscle-wasting-and-weakness
#1
Chloë Goossens, Mirna Bastos Marques, Sarah Derde, Sarah Vander Perre, Thomas Dufour, Steven E Thiessen, Fabian Güiza, Thomas Janssens, Greet Hermans, Ilse Vanhorebeek, Katrien De Bock, Greet Van den Berghe, Lies Langouche
BACKGROUND: The 'obesity paradox' of critical illness refers to better survival with a higher body mass index. We hypothesized that fat mobilized from excess adipose tissue during critical illness provides energy more efficiently than exogenous macronutrients and could prevent lean tissue wasting. METHODS: In lean and premorbidly obese mice, the effect of 5 days of sepsis-induced critical illness on body weight and composition, muscle wasting, and weakness was assessed, each with fasting and parenteral feeding...
July 20, 2016: Journal of Cachexia, Sarcopenia and Muscle
https://www.readbyqxmd.com/read/27894277/human-limb-skeletal-muscle-wasting-and-architectural-remodeling-during-five-to-ten-days-intubation-and-ventilation-in-critical-care-an-observational-study-using-ultrasound
#2
Peter Turton, Richard Hay, Jonathon Taylor, Jamie McPhee, Ingeborg Welters
BACKGROUND: Critically ill patients frequently suffer muscle weakness whilst in critical care. Ultrasound can reliably track loss of muscle size, but also quantifies the arrangement of the muscle fascicles, known as the muscle architecture. We sought to measure both pennation angle and fascicle length, as well as tracking changes in muscle thickness in a population of critically ill patients. METHODS: On days 1, 5 and 10 after admission to critical care, muscle thickness was measured in ventilated critically ill patients using bedside ultrasound...
November 29, 2016: BMC Anesthesiology
https://www.readbyqxmd.com/read/27891297/exercise-rehabilitation-following-intensive-care-unit-discharge-for-recovery-from-critical-illness-executive-summary-of-a-cochrane-collaboration-systematic-review
#3
REVIEW
Bronwen Connolly, Lisa Salisbury, Brenda O'Neill, Louise Geneen, Abdel Douiri, Michael P W Grocott, Nicholas Hart, Timothy S Walsh, Bronagh Blackwood
Skeletal muscle wasting and weakness are major complications of critical illness and underlie the profound physical and functional impairments experienced by survivors after discharge from the intensive care unit (ICU). Exercise-based rehabilitation has been shown to be beneficial when delivered during ICU admission. This review aimed to determine the effectiveness of exercise rehabilitation initiated after ICU discharge on primary outcomes of functional exercise capacity and health-related quality of life...
December 2016: Journal of Cachexia, Sarcopenia and Muscle
https://www.readbyqxmd.com/read/27881152/fitness-and-mobility-training-in-patients-with-intensive-care-unit-acquired-muscle-weakness-fitonicu-study-protocol-for-a-randomised-controlled-trial
#4
Jan Mehrholz, Simone Thomas, Jane H Burridge, André Schmidt, Bettina Scheffler, Ralph Schellin, Stefan Rückriem, Daniel Meißner, Katja Mehrholz, Wolfgang Sauter, Ulf Bodechtel, Bernhard Elsner
BACKGROUND: Critical illness myopathy (CIM) and polyneuropathy (CIP) are a common complication of critical illness. Both cause intensive-care-unit-acquired (ICU-acquired) muscle weakness (ICUAW) which increases morbidity and delays rehabilitation and recovery of activities of daily living such as walking ability. Focused physical rehabilitation of people with ICUAW is, therefore, of great importance at both an individual and a societal level. A recent systematic Cochrane review found no randomised controlled trials (RCT), and thus no supporting evidence, for physical rehabilitation interventions for people with defined CIP and CIM to improve activities of daily living...
November 24, 2016: Trials
https://www.readbyqxmd.com/read/27852427/monitoring-the-hospital-management-of-acute-asthma-the-italian-pediatric-network-experience
#5
A G Martelli, R Bianchi, B Boldrighini, M Bosoni, A De Vuono, A Flores D'Arcais, G Gargantini, R Longhi, M T Ortisi, E Racchi, L Parola
BACKGROUND: The Study Group on Accreditation and Quality Improvement of the Italian Society of Pediatrics has developed an observational study about the hospital management of pediatric patients affected by severe asthma, in order to evaluate how the Guidelines for severe asthma in childhood are applied in the daily practice. METHODS: This study included patients between 2 and 17 years, hospitalized or under short intensive observation for acute asthma. The data collection was carried out through the compilation of on-line forms...
November 2016: European Annals of Allergy and Clinical Immunology
https://www.readbyqxmd.com/read/27825364/mid-regional-pro-adrenomedullin-mr-proadm-a-marker-of-positive-fluid-balance-in-critically-ill-patients-results-of-the-envol-study
#6
Bernard Vigué, Pierre-Etienne Leblanc, Frédérique Moati, Eric Pussard, Hussam Foufa, Aurore Rodrigues, Samy Figueiredo, Anatole Harrois, Jean-Xavier Mazoit, Homa Rafi, Jacques Duranteau
BACKGROUND: The optimal control of blood volume without fluid overload is a main challenge in the daily care of intensive care unit (ICU) patients. Accordingly this study focused on the identification of biomarkers to help characterize fluid overload status. METHODS: Sixty-seven patients were studied from ICU admission to day 7 (D7). Blood and urine samples were taken daily and sodium and water balance strictly calculated resulting in a total cumulative assessment of ∆Na(+) and ∆H2O...
November 9, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27818334/neuromuscular-blockade-in-the-21-st-century-management-of-the-critically-ill-patient
#7
REVIEW
Julian deBacker, Nicholas Hart, Eddy Fan
Neuromuscular blockings agents (NMBAs) have a controversial role in the ventilatory and medical management of critical illness. The clinical concern surrounding NMBA-induced complications stems from evidence presented in the 2002 clinical practice guidelines, but new evidence from subsequent randomized trials and studies provides a more optimistic outlook about the application of NMBAs in the intensive care unit (ICU). Furthermore, changes in the delivery of critical care such as protocolized care pathways, minimizing or interrupting sedation, increased monitoring techniques, and overall improvements in reducing immobility have created a modern, 21st century ICU environment whereby NMBAs may be administered safely...
November 3, 2016: Chest
https://www.readbyqxmd.com/read/27782830/patient-outcomes-after-critical-illness-a-systematic-review-of-qualitative-studies-following-hospital-discharge
#8
Mohamed D Hashem, Aparna Nallagangula, Swaroopa Nalamalapu, Krishidhar Nunna, Utkarsh Nausran, Karen A Robinson, Victor D Dinglas, Dale M Needham, Michelle N Eakin
BACKGROUND: There is growing interest in patient outcomes following critical illness, with an increasing number and different types of studies conducted, and a need for synthesis of existing findings to help inform the field. For this purpose we conducted a systematic review of qualitative studies evaluating patient outcomes after hospital discharge for survivors of critical illness. METHODS: We searched the PubMed, EMBASE, CINAHL, PsycINFO, and CENTRAL databases from inception to June 2015...
October 26, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27778318/oral-hygiene-care-for-critically-ill-patients-to-prevent-ventilator-associated-pneumonia
#9
REVIEW
Fang Hua, Huixu Xie, Helen V Worthington, Susan Furness, Qi Zhang, Chunjie Li
BACKGROUND: Ventilator-associated pneumonia (VAP) is defined as pneumonia developing in people who have received mechanical ventilation for at least 48 hours. VAP is a potentially serious complication in these patients who are already critically ill. Oral hygiene care (OHC), using either a mouthrinse, gel, toothbrush, or combination, together with aspiration of secretions, may reduce the risk of VAP in these patients. OBJECTIVES: To assess the effects of oral hygiene care on incidence of ventilator-associated pneumonia in critically ill patients receiving mechanical ventilation in hospital intensive care units (ICUs)...
October 25, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27755068/clinical-practice-guidelines-for-sustained-neuromuscular-blockade-in-the-adult-critically-ill-patient
#10
Michael J Murray, Heidi DeBlock, Brian Erstad, Anthony Gray, Judi Jacobi, Che Jordan, William McGee, Claire McManus, Maureen Meade, Sean Nix, Andrew Patterson, M Karen Sands, Richard Pino, Ann Tescher, Richard Arbour, Bram Rochwerg, Catherine Friederich Murray, Sangeeta Mehta
OBJECTIVE: To update the 2002 version of "Clinical practice guidelines for sustained neuromuscular blockade in the adult critically ill patient." DESIGN: A Task Force comprising 17 members of the Society of Critical Medicine with particular expertise in the use of neuromuscular-blocking agents; a Grading of Recommendations Assessment, Development, and Evaluation expert; and a medical writer met via teleconference and three face-to-face meetings and communicated via e-mail to examine the evidence and develop these practice guidelines...
November 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27748304/cleistanthus-collinus-poisoning-experience-at-a-medical-intensive-care-unit-in-a-tertiary-care-hospital-in-south-india
#11
Alladi Mohan, G Sivaram Naik, J Harikrishna, D Prabath Kumar, M H Rao, Kvs Sarma, K K Guntupalli
BACKGROUND & OBJECTIVES: Ingestion of Cleistanthus collinus causes hypokalemia and cardiac arrhythmias leading to mortality in most cases. We undertook this retrospective study to evaluate the clinical presentation and predictors of outcome in critically ill patients admitted with C. collinus poisoning. METHODS: The case records of 56 patients admitted to the medical intensive care unit (MICU) of a tertiary care teaching hospital in south India (2000-2014) with C...
June 2016: Indian Journal of Medical Research
https://www.readbyqxmd.com/read/27745753/the-sara-combilizer-%C3%A2-as-an-early-mobilisation-aid-for-critically-ill-patients-a-prospective-before-and-after-study
#12
David McWilliams, Gemma Atkins, James Hodson, Catherine Snelson
BACKGROUND: Early mobility within the ICU is associated with a number of positive outcomes including reductions in ICU and hospital length of stay and better functional recovery. The exact definition of 'early' mobility is still not defined, with the actual ability to mobilise limited by a number of perceived factors. The Sara Combilizer is a combined tilt table and stretcher chair, which allows passive transfer of patients out of bed. This study aimed to assess whether the introduction of the Sara Combilizer reduced time taken to first mobilise for patients mechanically ventilated for at least five days and at risk of ICU acquired weakness...
October 10, 2016: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
https://www.readbyqxmd.com/read/27736708/corticosteroids-and-neuromuscular-blockers-in-development-of-critical-illness-neuromuscular-abnormalities-a-historical-review
#13
Susan R Wilcox
Weakness is common in critically ill patients, associated with prolonged mechanical ventilation and increased mortality. Corticosteroids and neuromuscular blockade (NMB) administration have been implicated as etiologies of acquired weakness in the intensive care unit. Medical literature since the 1970s is replete with case reports and small case series of patients with weakness after receiving high-dose corticosteroids, prolonged NMB, or both. Several risk factors for weakness appear in the early literature, including large doses of steroids, the dose and duration of NMB, hyperglycemia, and the duration of mechanical ventilation...
September 26, 2016: Journal of Critical Care
https://www.readbyqxmd.com/read/27730109/early-mobilization-of-critically-ill-adults-a-survey-of-knowledge-perceptions-and-practices-of-canadian-physicians-and-physiotherapists
#14
Karen K Y Koo, Karen Choong, Deborah J Cook, Margaret Herridge, Anastasia Newman, Vincent Lo, Gordon Guyatt, Fran Priestap, Eileen Campbell, Karen E A Burns, FranÇois Lamontagne, Maureen O Meade
BACKGROUND: The promotion of early mobilization following critical illness is tempered by national reports of patient and institutional barriers to this approach. We carried out a survey to assess current knowledge, perceptions and practices of Canadian physicians and physiotherapists with respect to acquired weakness and early mobilization in adults in the intensive care unit (ICU). METHODS: We conducted a cross-sectional, self-administered postal survey among critical care physicians and physiotherapists in all 46 academic ICUs in Canada in 2011-2012...
July 2016: CMAJ Open
https://www.readbyqxmd.com/read/27716370/near-infrared-spectroscopy-for-assessing-tissue-oxygenation-and-microvascular-reactivity-in-critically-ill-patients-a-prospective-observational-study
#15
Abele Donati, Elisa Damiani, Roberta Domizi, Claudia Scorcella, Andrea Carsetti, Stefania Tondi, Valentina Monaldi, Erica Adrario, Rocco Romano, Paolo Pelaia, Mervyn Singer
BACKGROUND: Impaired microcirculatory perfusion and tissue oxygenation during critical illness are associated with adverse outcome. The aim of this study was to detect alterations in tissue oxygenation or microvascular reactivity and their ability to predict outcome in critically ill patients using thenar near-infrared spectroscopy (NIRS) with a vascular occlusion test (VOT). METHODS: Prospective observational study in critically ill adults admitted to a 12-bed intensive care unit (ICU) of a University Hospital...
October 1, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27703296/rhabdomyolysis-in-critically-ill-surgical-patients
#16
Biljana Kuzmanovska, Emilija Cvetkovska, Igor Kuzmanovski, Nikola Jankulovski, Mirjana Shosholcheva, Andrijan Kartalov, Tatjana Spirovska
INTRODUCTION: Rhabdomyolysis is a syndrome of injury of skeletal muscles associated with myoglobinuria, muscle weakness, electrolyte imbalance and often, acute kidney injury as severe complication. THE AIM: of this study is to detect the incidence of rhabdomyolysis in critically ill patients in the surgical intensive care unit (ICU), and to raise awareness of this medical condition and its treatment among the clinicians. MATERIAL AND METHODS: A retrospective review of all surgical and trauma patients admitted to surgical ICU of the University Surgical Clinic "Mother Teresa" in Skopje, Macedonia, from January 1(st) till December 31(st) 2015 was performed...
July 27, 2016: Medical Archives
https://www.readbyqxmd.com/read/27676204/time-to-decannulation-and-associated-risk-factors-in-the-post-acute-rehabilitation-of-critically-ill-patients-with-intensive-care-unit-acquired-weakness-a-cohort-study
#17
Simone Thomas, Wolfgang Sauter, Ulrike Starrost, Marcus Pohl, Jan Mehrholz
BACKGROUND: Treatment of critical illness on intensive-care-units (ICU) results often in persistent invasive endotracheal intubation which might delay rehabilitation and increases the risk of mortality. Recent longitudinal studies have described the recovery of critically ill people, but the detailed time course of decannulation in patients with chronic critical illness with ICU- acquired muscle weakness (ICUAW) is not well known. AIM: The aim of our study was therefore to describe the decannulation times and associated risk factors in patients who are chronic critically ill with ICU acquired weakness...
September 27, 2016: European Journal of Physical and Rehabilitation Medicine
https://www.readbyqxmd.com/read/27670853/recovery-of-sit-to-stand-function-in-patients-with-intensive-care-unit-acquired-muscle-weakness-results-from-the-general-weakness-syndrome-therapy-cohort-study
#18
Simone Thomas, Jane H Burridge, Marcus Pohl, Frank Oehmichen, Jan Mehrholz
OBJECTIVES: To describe the time course of recovery of sit-to-stand function in patients with intensive-care-unit-acquired muscle weakness and the impact of recovery. METHODS: A cohort study in post-acute intensive care unit and rehabilitation units. Patients with chronic critical illness and intensive-care-unit-acquired muscle weakness were included. Sit-to-stand function was measured daily, using a standardized chair height, defined as 120% of the individual's knee height...
October 12, 2016: Journal of Rehabilitation Medicine
https://www.readbyqxmd.com/read/27665572/evaluation-of-perfusion-index-as-a-tool-for-pain-assessment-in-critically-ill-patients
#19
Ahmed Hasanin, Sabah Abdel Raouf Mohamed, Akram El-Adawy
Pain is a common and undertreated problem in critically ill patients. Pain assessment in critically ill patients is challenging and relies on complex scoring systems. The aim of this work was to find out the possible role of the perfusion index (PI) measured by a pulse oximeter (Masimo Radical 7; Masimo Corp., Irvine, CA, USA) in pain assessment in critically ill patients. A prospective observational study was carried out on 87 sedated non-intubated patients in a surgical intensive care unit. In addition to routine monitoring, a Masimo pulse oximeter probe was used for PI measurement...
September 24, 2016: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/27661566/secreted-frizzled-related-protein-2-and-inflammation-induced-skeletal-muscle-atrophy
#20
Xiaoxi Zhu, Melanie Kny, Franziska Schmidt, Alexander Hahn, Tobias Wollersheim, Christian Kleber, Steffen Weber-Carstens, Jens Fielitz
OBJECTIVE: In sepsis, the disease course of critically ill patients is often complicated by muscle failure leading to ICU-acquired weakness. The myokine transforming growth factor-β1 increases during inflammation and mediates muscle atrophy in vivo. We observed that the transforming growth factor-β1 inhibitor, secreted frizzled-related protein 2, was down-regulated in skeletal muscle of ICU-acquired weakness patients. We hypothesized that secreted frizzled-related protein 2 reduction enhances transforming growth factor-β1-mediated effects and investigated the interrelationship between transforming growth factor-β1 and secreted frizzled-related protein 2 in inflammation-induced atrophy...
September 21, 2016: Critical Care Medicine
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