Acute and long-term outcomes of ICU-acquired weakness: a cohort study and propensity matched analysis

Prediction and Outcome of Intensive Care Unit-Acquired Paresis

“…3,19 However, there is no clear mechanism to explain a causal relationship between ICUAP and mortality and this conjecture remains controversial. 5 Despite attempts to adjust for confounders in these studies, the data are not conclusive regarding the possibility that the worse outcomes may simply reflect the type and/or severity of the patient's underlying condition. The challenge is how to incorporate the existence of complex feedback relations between ICUAP, underlying critical illness, and evolving organ failure over time.…”

“…Intensive care unit-acquired paresis has been associated with prolonged mechanical ventilation, difficult weaning, increased hospital mortality, 3 functional limitations, and higher costs. 4,5 An early diagnosis of ICUAP could help to identify candidates for early rehabilitation to potentially minimize the deleterious consequences of ICUAP. Usually, the diagnosis of ICUAP using volitional muscle strength testing is not possible in most critically ill patients due to impaired consciousness from sedation and/or delirium.…”

“…(4)(5)(6)(7)(8)(9)(10)(11) 23(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29) (4-12) <.001Abbreviations: ICUAP, intensive care unit-acquired paresis; SD, standard deviation. aIn the group of ICUAP the data are corresponding to register before diagnosis of ICUAP.…”

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“…Heparin started within 48 hours after an ischaemic stroke of presumed cardioembolic origin significantly increased the risk of symptomatic intracerebral haemorrhage over 7-14 days as was demonstrated in a meta-analysis of 7 randomized clinical trials. [8] Currently, there is no indication for early subcutaneous heparin or low molecular heparin for the prevention of recurrent stroke in patients with atrial fibrillation. The best time to start anticoagulant therapy with the aim to reduce the risk of recurrent cerebral ischaemia is unknown.…”

“…Immobility of limbs and of respiratory muscles with sedation and mechanical ventilation, ICU delirium, hyperglycemia, and administration of drugs such as corticosteroids or neuromuscular blocking agents are also considered risk factors (6). Prevalence is estimated to vary between 25% and 33%, but percentages as high as 100% are reported in selected patient populations and is associated with worse outcome (7,8). ICUAW is caused by critical illness polyneuropathy (CIP) or myopathy (CIM), which are frequently coexistent.…”