Interobserver agreement of medical research council sum‐score and handgrip strength in the intensive care unit

Hermans, Greet; Clerckx, Béatrix; Vanhullebusch, Tine; Segers, Johan; Vanpee, Goele; Robbeets, Christophe; Casaer, Michaël P; Wouters, Pieter; Gosselink, Rik; Berghe, Greet Van den

doi:10.1002/mus.22219

Cited by 258 publications

(230 citation statements)

References 25 publications

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“…22 Weakness in respiratory muscles, as indicated by low maximal inspiratory and expiratory pressure or diaphragmatic dysfunction on ultrasonography, is associated with delayed successful extubation as well as weaning failure. 25,26 The MRC sum score 33 has been used to comprehensively assess muscle strength 47,48 as well as to predict morbidity and mortality in critically ill subjects. 45 In our study, we used the muscle strength assessed by bedside nurses, and we validated this easily applicable scale with the MRC sum score in our cohort and found a fair agreement (46.0% agreement and 0.25 Cohen kappa coefficient).…”

Section: Discussionmentioning

confidence: 99%

Prospective Observational Study of Predictors of Re-Intubation Following Extubation in the Surgical ICU

et al. 2015

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BACKGROUND: Re-intubation is associated with high morbidity and mortality. There is limited information regarding the risk factors that predispose patients admitted to the surgical ICU to re-intubation. We hypothesized that preoperative comorbidities, acquired muscular weakness, and renal dysfunction would be predictors of re-intubation in the surgical ICU population. METHODS: This was a prospective observational study in 2 surgical ICUs of a large tertiary hospital. All patients who were extubated during their surgical ICU stay were included. Demographic and clinical data were collected before and after extubation. The primary outcome was re-intubation within 72 h. Using multivariate logistic regression analysis, independent risk factors of re-intubation were determined, and a prediction score was developed. RESULTS: Between December 1, 2012, and January 31, 2014, we included 764 consecutive subjects. Of these, 65 subjects (8.5%) required re-intubation. Independent risk factors of re-intubation were blood urea nitrogen level of >8.2 mmol/L (odds ratio [OR] 3.66, 95% CI 1.97-6.80), hemoglobin level of <75 g/L (OR 2.10, 95% CI 1.23-3.61), and muscle strength of <3 (OR 2.03, 95% CI 1.16 -3.55). The presence of all 3 risk factors was associated with an estimated probability for re-intubation of 26.8%. CONCLUSIONS: In noncardiac surgery, surgical ICU subjects, elevated blood urea nitrogen level, low hemoglobin level, and muscle weakness were identified as independent risk factors for re-intubation. The presence of these risk factors can potentially aid clinicians in making informed decisions regarding optimal airway management in patients considered for an extubation attempt. (ClinicalTrials.gov registration NCT01967056.)

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Section: Discussionmentioning

confidence: 99%

Prospective Observational Study of Predictors of Re-Intubation Following Extubation in the Surgical ICU

et al. 2015

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“…The MRC sum score was proposed as a routine and first line screening tool in the ICU for patients at risk for developing ICUAW (268,402,622,661). As reported in various clinical settings [mechanically ventilated patients with acute stroke (267), Guillain-Barré syndrome (369), stimulants (189), post ICU (40, 325)], inter-rater reproducibility was found to be good in a large study of critically ill patients (301), and one smaller series (10), but not in two other small studies (129,325). Methodological issues such as judging the adequate awakening and cooperation of the patient required to perform the test may be very important.…”

Section: B Aspects Of Clinical Evaluation and Diagnosticsmentioning

confidence: 92%

The Sick and the Weak: Neuropathies/Myopathies in the Critically Ill

Friedrich

Reid

Berghe

et al. 2015

Physiological Reviews

291

329

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Critical illness polyneuropathies (CIP) and myopathies (CIM) are common complications of critical illness. Several weakness syndromes are summarized under the term intensive care unit-acquired weakness (ICUAW). We propose a classification of different ICUAW forms (CIM, CIP, sepsis-induced, steroid-denervation myopathy) and pathophysiological mechanisms from clinical and animal model data. Triggers include sepsis, mechanical ventilation, muscle unloading, steroid treatment, or denervation. Some ICUAW forms require stringent diagnostic features; CIM is marked by membrane hypoexcitability, severe atrophy, preferential myosin loss, ultrastructural alterations, and inadequate autophagy activation while myopathies in pure sepsis do not reproduce marked myosin loss. Reduced membrane excitability results from depolarization and ion channel dysfunction. Mitochondrial dysfunction contributes to energy-dependent processes. Ubiquitin proteasome and calpain activation trigger muscle proteolysis and atrophy while protein synthesis is impaired. Myosin loss is more pronounced than actin loss in CIM. Protein quality control is altered by inadequate autophagy. Ca 2ϩ dysregulation is present through altered Ca 2ϩ homeostasis. We highlight clinical hallmarks, trigger factors, and potential mechanisms from human studies and animal models that allow separation of risk factors that may trigger distinct mechanisms contributing to weakness. During critical illness, altered inflammatory (cytokines) and metabolic pathways deteriorate muscle function. ICUAW prevention/treatment is limited, e.g., tight glycemic control, delaying nutrition, and early mobilization. Future challenges include identification of primary/secondary events during the time course of critical illness, the interplay between membrane excitability, bioenergetic failure and differential proteolysis, and finding new therapeutic targets by help of tailored animal models.

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“…An observer supported the device manually during measurements and care was taken to perform measurements with the elbow at 90° flexion. 30 …”

Section: Muscle Strength Evaluationmentioning

confidence: 99%

Muscle Weakness Predicts Pharyngeal Dysfunction and Symptomatic Aspiration in Long-term Ventilated Patients

et al. 2013

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Background: Prolonged mechanical ventilation is associated with muscle weakness, pharyngeal dysfunction, and symptomatic aspiration. The authors hypothesized that muscle strength measurements can be used to predict pharyngeal dysfunction (endoscopic evaluation-primary hypothesis), as well as symptomatic aspiration occurring during a 3-month follow-up period. Methods: Thirty long-term ventilated patients admitted in two intensive care units at Massachusetts General Hospital were included. The authors conducted a fiberoptic endoscopic evaluation of swallowing and measured muscle strength using medical research council score within 24 h of each fiberoptic endoscopic evaluation of swallowing. A medical research council score less than 48 was considered clinically meaningful muscle weakness. A retrospective chart review was conducted to identify symptomatic aspiration events.Results: Muscle weakness predicted pharyngeal dysfunction, defined as either valleculae and pyriform sinus residue scale of more than 1, or penetration aspiration scale of more than 1. Area under the curve of the receiver-operating curves for muscle strength (medical research council score) to predict pharyngeal, valleculae, and pyriform sinus residue scale of more than 1, penetration aspiration scale of more than 1, and symptomatic aspiration were 0.77 (95% CI, 0.63-0.97; P = 0.012), 0.79 (95% CI, 0.56-1; P = 0.02), and 0.74 (95% CI, 0.56-0.93; P = 0.02), respectively. Seventy percent of patients with muscle weakness showed symptomatic aspiration events. Muscle weakness was associated with an almost 10-fold increase in the symptomatic aspiration risk (odds ratio = 9.8; 95% CI, 1.6-60; P = 0.009). Conclusion: In critically ill patients, muscle weakness is an independent predictor of pharyngeal dysfunction and symptomatic aspiration. Manual muscle strength testing may help identify patients at risk of symptomatic aspiration.

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Interobserver agreement of medical research council sum‐score and handgrip strength in the intensive care unit

Cited by 258 publications

References 25 publications

Prospective Observational Study of Predictors of Re-Intubation Following Extubation in the Surgical ICU

Prospective Observational Study of Predictors of Re-Intubation Following Extubation in the Surgical ICU

The Sick and the Weak: Neuropathies/Myopathies in the Critically Ill

Muscle Weakness Predicts Pharyngeal Dysfunction and Symptomatic Aspiration in Long-term Ventilated Patients

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