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Weakness acquired in ICU

Jean Deschamps, Jordan Webber, Robin Featherstone, Meghan Sebastianski, Ben Vandermeer, Janek Senaratne, Sean M Bagshaw
INTRODUCTION: Predicting successful liberation from mechanical ventilation (MV) among critically ill patients receiving MV can be challenging. The current parameters used to predict successful extubation have shown variable predictive value. Brain natriuretic peptide (BNP) has been proposed as a novel biomarker to help guide decision-making in readiness for liberation of MV following a spontaneous breathing trial (SBT). Current evidence on the predictive ability of BNP has been uncertain, and BNP has not been integrated into clinical practice guidelines...
February 12, 2019: BMJ Open
Robert Patejdl, Uwe Walter, Sarah Rosener, Martin Sauer, Daniel A Reuter, Johannes Ehler
BACKGROUND: Intensive care unit-acquired weakness (ICU-AW) is associated with poorer outcome of critically ill patients. Microcirculatory changes and altered vascular permeability of skeletal muscles might contribute to the pathogenesis of ICU-AW. Muscular ultrasound (MUS) displays increased muscle echogenicity, although its pathogenesis is uncertain. OBJECTIVE: We investigated the combined measurement of serum and ultrasound markers to assess ICU-AW and clinical patient outcome...
February 11, 2019: Canadian Journal of Neurological Sciences. le Journal Canadien des Sciences Neurologiques
Han Sang Lee, Jangsup Moon, Hye-Rim Shin, Seon Jae Ahn, Tae-Joon Kim, Jin-Sun Jun, Soon-Tae Lee, Keun-Hwa Jung, Kyung-Il Park, Ki-Young Jung, Manho Kim, Sang Kun Lee, Kon Chu
Background: Bed-ridden state, dysphagia, altered mental state, or respiratory muscle weakness are common in neurologic patients and increase the risk of pneumonia. The major causes of pneumonia in neurologic patients may differ from those in the general population, resulting in a different pathogen distribution. We investigated the trends of pathogen distribution in culture-positive pneumonia in hospitalized neurologic patients and the related antibiotic resistance in those with hospital-acquired pneumonia (HAP)...
2019: Antimicrobial Resistance and Infection Control
Andrea Perren, Patrick Zürcher, Joerg C Schefold
Swallowing disorders and respective consequences (including aspiration-induced pneumonia) are often observed in extubated ICU patients with data indicating that a large number of patients are affected. We recently demonstrated in a large-scale analysis that the incidence of post-extubation dysphagia (PED) is 12.4% in a general ICU population and about 18% in emergency admissions to the ICU. Importantly, PED was mostly sustained until hospital discharge and independently predicted 28- and 90-day mortality. Although oropharyngeal/laryngeal trauma, neuromuscular ICU-acquired weakness, reduced sensation/sensorium, dyssynchronous breathing, and gastrointestinal reflux, are all considered to contribute to PED, little is known about the underlying pathomechanisms and risk factors leading to PED in critically ill patients...
January 25, 2019: Dysphagia
Massimiliano Polastri, Stefano Oldani, Lara Pisani, Stefano Nava
Intensive care unit-acquired weakness is characterised by severe impairment of muscle function that often arises after prolonged mechanical ventilation, difficult weaning, and severe sepsis. Elastic band exercises constitute an inexpensive and simple technique that is quite appealing for implementation in a "protected environment" such as the intensive care unit; however, elastic band application in the intensive care unit and in critical patients has not yet been described. A 72-year-old male was referred to the respiratory intensive care unit for hypoxemic respiratory failure due to acute respiratory distress syndrome...
February 2018: Tanaffos
Joerg C Schefold, Anna S Messmer, Stefanie Wenger, Lionel Müller, Stephan von Haehling, Wolfram Doehner, Jamie S McPhee, Michaela Fux, Kai M Rösler, Olivier Scheidegger, Radu Olariu, Werner Z'Graggen, Serge Rezzi, Dominik Grathwohl, Tobias Konz, Jukka Takala, Bernard Cuenoud, Stephan M Jakob
INTRODUCTION: Intensive care unit-acquired weakness (ICU-AW) is often observed in critically ill patients with prolonged intensive care unit (ICU) stay. We hypothesized that evolving metabolic abnormalities during prolonged ICU stay are reflected by changing nutrient patterns in blood, urine and skeletal muscle, and that these patterns differ in patients with/without ICU-AW and between patients with/without sepsis. METHODS: In a prospective single-center observational trial, we aim to recruit 100 critically ill patients (ICU length of stay ≥ 5 days) with severe sepsis/septic shock ("sepsis group", n = 50) or severe head trauma/intracerebral hemorrhage ("CNS group", n = 50)...
January 2019: Medicine (Baltimore)
J H Eagan, G Ramdharry, S T Smailes
INTRODUCTION: Intensive Care Unit Acquired Weakness challenges the clinical care of critically ill patients. Despite a surge in validated ICU functional outcome measures following the publication of Clinical Guideline 83 'Rehabilitation After Critical Illness' by the National Institute for Health and Care Excellence (2009), there are none composed specifically for use in the Burns ICU. We therefore developed and tested the inter-rater reliability of a burn specific novel functional outcome measure; The Functional Assessment for Burns-Critical Care (FAB-CC)...
December 27, 2018: Burns: Journal of the International Society for Burn Injuries
Yuchen Wu, Nannan Ding, Biantong Jiang, Zhigang Zhang, Caiyun Zhang, Bin Li
OBJECTIVE: To explore effective and objective diagnostic tools for evaluating intensive care unit acquired weakness (ICUAW). METHODS: The studies about evaluation and diagnosis of adult ICUAW in PubMed, Embase, Web of Science, the Cochrane Library, CNKI, CBM, VIP and Wanfang databases from the date of their foundation to July 1st in 2018 were retrieved by computer. The literatures in Chinese and English were searched. Two investigators independently screened literature and evaluated the literature quality ratings, and extracted the research design, sample size, research object, evaluation item, reliability, validity, clinical application and other indicators, and then systematically analyzed the reliability and validity of ICUAW diagnostic tools, and evaluated diagnostic tools' advantages, disadvantages and application status...
December 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
M H Jang, M H Yoon, S J Ahn, J W Lee, M J Shin
BACKGROUND: Intensive care unit-acquired weakness (ICUAW) can occur after liver transplantation. Early diagnosis of ICUAW and monitoring of muscle condition during rehabilitation are helpful in improving functional recovery. METHODS AND MATERIALS: A 47-year-old man with liver cirrhosis developed limb weakness after liver transplantation. The patient had a Medical Research Council sum score of 2 weeks post-liver transplantation with marked proximal limb weakness...
December 2018: Transplantation Proceedings
Chao-Nan Jin, Ling-Ling Tang
BACKGROUND: The emerging avian influenza A (H7N9) virus, a subtype of influenza viruses, was first discovered in March 2013 in China. Infected patients frequently present with pneumonia and acute respiratory disorder syndrome with high rates of intensive care unit admission and death. Neurological complications, such as Guillain-Barré syndrome(GBS), and intensive care unit-acquired weakness, including critical illness polyneuropathy and myopathy, have only rarely been reported previously...
December 20, 2018: BMC Infectious Diseases
Vijay Hadda, Rohit Kumar, Gopi Chand Khilnani, Mani Kalaivani, Karan Madan, Pawan Tiwari, Saurabh Mittal, Anant Mohan, Ashu Seith Bhalla, Randeep Guleria
Background and aims: Data regarding trends of muscle loss on ultrasonography (USG) and its relationship with various outcomes among critically ill patients is limited. This study aimed to describe the trends of loss of muscle thickness of the arm and thigh (assessed using USG) and to determine the relationship between loss of muscle thickness and in-hospital and post-discharge outcomes. Methods: Muscle thickness of 70 patients with sepsis was measured at the level of the mid-arm and mid-thigh using bedside USG on days 1, 3, 5, 7, 10 and 14 and then weekly till discharge or death...
2018: Journal of Intensive Care
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
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