Paresis Acquired in the Intensive Care Unit<SUBTITLE>A Prospective Multicenter Study</SUBTITLE>

Abstract

Identified using simple bedside clinical criteria, ICUAP was frequent during recovery from critical illness and was associated with a prolonged duration of mechanical ventilation. Our findings suggest an important role of corticosteroids in the development of ICUAP.

The incidence of intensive care unit-acquired weakness syndromes: A systematic review

“…Eleven out of the 29 (38%) 25,28,29,32,[36][37][38][39][40][41][42] observational studies were graded of low quality, 17 out of 29 (59%) 12,[14][15][16]20,24,26,27,30,[43][44][45][46][47][48][49][50] as medium and one (3%) 51 as high quality. There were four RCTs included; two studies were deemed of low risk, 22,23 one unclear risk 8 and one with high risk 31 of bias.…”

Mechanisms of Neuromuscular Dysfunction in Critical Illness

“…These studies, however, did not adjust for confounding variables that might associate with the development of NMD and, in fact, many of these same patients with ICU weakness had sepsis, multi-organ dysfunction (MOD), or organ rejection. Further prospective studies subsequently found no association between NMD and either steroids or neuromuscular blockade [9,10,24], although in one report corticosteroid administration was associated with NMD in multivariate analysis (OR 14.9, 95% CI 3.2-69.8, p <0.001) [21].…”

“…Increased risk of acquired NMD related to elevated plasma glucose levels has been reported by a number of prospective studies [21,25,26]. Interestingly, recent reports from randomized controlled studies document that intensive insulin therapy can decrease the incidence of NMD [26,27].…”

“…Sepsis and SIRS has been associated with NMD in a number of prospective studies [14,15,[21][22][23]. Severity of critical illness and organ dysfunction scores predicts NMD in multivariable analyses.…”

“…In that study, the probability of developing NMD by thirty days was 72% for those with APACHE III scores >85 and SIRS, whereas those with an APACHE III score of ≤70 and no SIRS had a risk of only 8%. A prospective multicenter study of 95 patients mechanically ventilated for 7 or more days reported that the number of days with organ dysfunction of ≥2 organs significantly predicted NMD in multivariable analysis [21]. Duration of SIRS and severity of organ dysfunction also predict NMD: approximately 86% of NMD subjects had >3days days with SIRS) and cumulative 1-weeks SOFA score >45 [9].…”