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hospital acquired weakness

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
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
Emilio Dirlikov, Chelsea G Major, Marrielle Mayshack, Nicole Medina, Desiree Matos, Kyle R Ryff, Jomil Torres-Aponte, Rebecca Alkis, Jorge Munoz-Jordan, Candimar Colon-Sanchez, Jorge L Salinas, Daniel M Pastula, Myriam Garcia, Marangely Olivero Segarra, Graciela Malave, Dana L Thomas, Gloria M Rodríguez-Vega, Carlos A Luciano, James Sejvar, Tyler M Sharp, Brenda Rivera-Garcia
Guillain-Barré syndrome (GBS) is a postinfectious autoimmune disorder characterized by bilateral flaccid limb weakness attributable to peripheral nerve damage (1). Increased GBS incidence has been reported in countries with local transmission of Zika virus, a flavivirus transmitted primarily by certain Aedes species mosquitoes (2). In Puerto Rico, three arthropod-borne viruses (arboviruses) are currently circulating: Zika, dengue, and chikungunya. The first locally acquired Zika virus infection in Puerto Rico was reported in December 2015 (3)...
2016: MMWR. Morbidity and Mortality Weekly Report
Shahad Abbas
AIM: The paediatric triage tool was previously developed within the hospital to allow delegation to less experienced pharmacists to provide clinical pharmacist cover and allow identification and prioritisation of patients depending on pharmaceutical care requirement within a paediatric population. The paediatric triage tool triages patients via a traffic light system and identifies patients who are at high risk and who need to be reviewed first each day, rather than trying to see every patient and every drug chart...
September 2016: Archives of Disease in Childhood
Sabrina Eggmann, Martin L Verra, Gere Luder, Jukka Takala, Stephan M Jakob
BACKGROUND: Prolonged need for intensive care is associated with neuromuscular weakness, termed Intensive Care Unit Acquired Weakness. Those affected suffer from severe functional impairment that can persist for years. First studies suggest a positive effect of physiotherapy and early mobilisation. However, the ideal intervention for a preferential functional outcome is not known. So far no randomised controlled trial has been conducted to specifically evaluate an early endurance and resistance training in the mechanically ventilated, critically ill patient...
2016: Trials
Christiane G Stäuble, Marc Helming, J A Jeevendra Martyn, Manfred Blobner, Heidrun Fink
OBJECTIVES: Recovery from ICU-acquired muscle weakness extends beyond hospital stay. We hypothesized that immobilization, more than inflammation, plays a prominent role in the delayed recovery from critical illness. DESIGN: Prospective, randomized, controlled, experimental study. SETTING: Animal laboratory, university hospital. SUBJECTS: Male Sprague-Dawley rats. INTERVENTIONS: Animals were divided to have one hind limb immobilized (n = 129) or sham-immobilized (n = 129) on day -12...
November 2016: Critical Care Medicine
Henry H Cheng, Satish Rajagopal, Erica McDavitt, Daniel Wigmore, Kathryn Williams, Ravi Thiagarajan, P Ellen Grant, Amy Danehy, Michael J Rivkin
OBJECTIVE: To describe strokes in patients with acquired or congenital heart disease and investigate risk factors for in-hospital mortality and ongoing neurologic deficits. DESIGN: Single-center, retrospective review of cardiac, neurologic, and radiologic patient databases. SETTING: Tertiary care children's hospital. PATIENTS: All patients with acquired or congenital heart disease admitted from January 2010 to October 2014 identified with stroke...
October 2016: Pediatric Critical Care Medicine
Minxuan Huang, Kitty S Chan, Jennifer M Zanni, Selina M Parry, Saint-Clair G B Neto, Jose A A Neto, Vinicius Z M da Silva, Michelle E Kho, Dale M Needham
OBJECTIVES: To evaluate the internal consistency, validity, responsiveness, and minimal important difference of the Functional Status Score for the ICU, a physical function measure designed for the ICU. DESIGN: Clinimetric analysis. SETTINGS: Five international datasets from the United States, Australia, and Brazil. PATIENTS: Eight hundred nineteen ICU patients. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: Clinimetric analyses were initially conducted separately for each data source and time point to examine generalizability of findings, with pooled analyses performed thereafter to increase power of analyses...
August 3, 2016: Critical Care Medicine
Xin Li, Man Shen, Wan-Jun Sun, Zhong-Xia Huang, Na An, Jia-Jia Zhang
Adefovir dipivoxil is commonly used for treatment of chronic hepatitis B patients. We present a case of acquired Fanconi syndrome and hypophosphatemic osteomalacia in a patient with chronic hepatitis B who had been treated with ADV for 8 years. A 41-year-old man complained of severe bilateral hypochondrium pain and lower limb weakness, and he had the diagnosis of bone metastasis cancer or multiple myeloma. Laboratory results and radiologic findings suggested Fanconi syndrome with osteomalacia after hospitalized...
June 2016: Indian Journal of Hematology & Blood Transfusion
(no author information available yet)
No abstract text is available yet for this article.
June 2016: Annals of Intensive Care
Richard D Zorowitz
ICU-acquired weakness (ICUAW) occurs with reported incidence rates from 25% to 100%. Risk factors include immobility, sepsis, persistent systemic inflammation, multiorgan system failure, hyperglycemia, glucocorticoids, and neuromuscular blocking agents. The pathophysiology remains unknown. Clinical features may be neuropathic, myopathic, or a combination of both. Although manual muscle testing is more practical in diagnosing ICUAW, the "gold standard" for the diagnosis of ICUAW remains electromyography and nerve conduction studies...
October 2016: Chest
Martin Dres, Bruno-Pierre Dubé, Julien Mayaux, Julie Delemazure, Danielle Reuter, Laurent Brochard, Thomas Similowski, Alexandre Demoule
BACKGROUND: Intensive care unit (ICU) and mechanical ventilation (MV) acquired limb muscle and diaphragm dysfunction may both be associated with longer length of stay and worse outcome. Whether they are two aspects of the same entity or whether they have a different prevalence and prognostic impact remains unclear. This study was designed to quantify the prevalence and coexistence of these two forms of ICU-acquired weakness and their impact on outcome. METHODS: In patients undergoing a first spontaneous breathing trial (SBT) after at least 24 h of MV, diaphragm dysfunction was evaluated using twitch tracheal pressure in response to bilateral anterior magnetic phrenic nerve stimulation (a pressure <11 cmH2O defined dysfunction) and ultrasonography (thickening fraction (TFdi) and excursion)...
June 16, 2016: American Journal of Respiratory and Critical Care Medicine
Tetsuro Tominaga, Takashi Nonaka, Hiroaki Takeshita, Yuichiro Honda, Hiroki Nagura, Toshio Shiraishi, Masaki Kunizaki, Yorihisa Sumida, Shigekazu Hidaka, Terumitsu Sawai, Takeshi Nagayasu
INTRODUCTION: Surgeons often perform surgery for patients who are critically ill. Intensive care unit (ICU)-acquired weakness (ICUAW) is a condition in which systemic and prolonged muscle weakness occurs and causes worse short-term and long-term outcomes. PRESENTATION OF CASE: A 60-year-old woman with sudden nausea and vomiting presented to our hospital and developed shock. Abdominal CT showed thickness of the descending colon and ascites. She was diagnosed with sepsis due to descending colon cancer...
2016: International Journal of Surgery Case Reports
Scott K Powers, Gordon S Lynch, Kate T Murphy, Michael B Reid, Inge Zijdewind
Numerous health problems, including acute critical illness, cancer, diseases associated with chronic inflammation, and neurological disorders, often result in skeletal muscle weakness and fatigue. Disease-related muscle atrophy and fatigue is an important clinical problem because acquired skeletal muscle weakness can increase the duration of hospitalization, result in exercise limitation, and contribute to a poor quality of life. Importantly, skeletal muscle atrophy is also associated with increased morbidity and mortality of patients...
November 2016: Medicine and Science in Sports and Exercise
Marc Nickels, Leanne M Aitken, James Walsham, Lisa Watson, Steven McPhail
BACKGROUND: Rehabilitative exercise for critically ill patients may have many benefits; however, it is unknown what intensive care unit (ICU) clinicians perceive to be important rationale for the implementation of rehabilitative exercise in critical care settings. OBJECTIVE: To identify which rationales for rehabilitative exercise interventions were perceived by ICU clinicians to be important and determine whether perceptions were consistent across nursing, medical and physiotherapy clinicians...
April 19, 2016: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
Mohamed D Hashem, Archana Nelliot, Dale M Needham
Despite the historical precedent of mobilizing critically ill patients, bed rest is common practice in ICUs worldwide, especially for mechanically ventilated patients. ICU-acquired weakness is an increasingly recognized problem, with sequelae that may last for months and years following ICU discharge. The combination of critical illness and bed rest results in substantial muscle wasting during an ICU stay. When initiated shortly after the start of mechanical ventilation, mobilization and rehabilitation can play an important role in decreasing the duration of mechanical ventilation and hospital stay and improving patients' return to functional independence...
July 2016: Respiratory Care
Sarah E Jolley, Aaron E Bunnell, Catherine L Hough
Survivorship after critical illness is an increasingly important health-care concern as ICU use continues to increase while ICU mortality is decreasing. Survivors of critical illness experience marked disability and impairments in physical and cognitive function that persist for years after their initial ICU stay. Newfound impairment is associated with increased health-care costs and use, reductions in health-related quality of life, and prolonged unemployment. Weakness, critical illness neuropathy and/or myopathy, and muscle atrophy are common in patients who are critically ill, with up to 80% of patients admitted to the ICU developing some form of neuromuscular dysfunction...
November 2016: Chest
Margaret S Herridge, Marc Moss, Catherine L Hough, Ramona O Hopkins, Todd W Rice, O Joseph Bienvenu, Elie Azoulay
Outcomes after acute respiratory distress syndrome (ARDS) are similar to those of other survivors of critical illness and largely affect the nerve, muscle, and central nervous system but also include a constellation of varied physical devastations ranging from contractures and frozen joints to tooth loss and cosmesis. Compromised quality of life is related to a spectrum of impairment of physical, social, emotional, and neurocognitive function and to a much lesser extent discrete pulmonary disability. Intensive care unit-acquired weakness (ICUAW) is ubiquitous and includes contributions from both critical illness polyneuropathy and myopathy, and recovery from these lesions may be incomplete at 5 years after ICU discharge...
May 2016: Intensive Care Medicine
M Busico, D Intile, M Sívori, N Irastorza, A L Alvarez, J Quintana, L Vazquez, G Plotnikow, F Villarejo, P Desmery
OBJECTIVE: To identify risk factors for worsened quality of life (QoL) and activities of daily living (ADL) at 3 and 12 months after discharge from the Intensive Care Unit (ICU) in patients on mechanical ventilation (MV). DESIGN: A prospective, multicentric observational study was made. SETTING: Three ICUs in Argentina. PATIENTS: The study included a total of 84 out of 129 mainly clinical patients admitted between 2011-2012 and requiring over 24hours of MV...
October 2016: Medicina Intensiva
Namrata Raman, Karen Marchillo, Myung-Ryul Lee, Angélica de L Rodríguez López, David R Andes, Sean P Palecek, David M Lynn
Candida albicans is the most prevalent cause of hospital-acquired fungal infections and forms biofilms on indwelling medical devices that are notoriously difficult to treat or remove. We recently demonstrated that the colonization of C. albicans on the surfaces of catheter tube segments can be reduced in vitro by coating them with polyelectrolyte multilayers (PEMs) that release a potent antifungal β-peptide. Here, we report on the impact of polymer structure and film composition on both the inherent and β-peptide-mediated ability of PEM-coated catheters to prevent or reduce the formation of C...
January 11, 2016: ACS Biomaterials Science & Engineering
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