Peripheral Muscle Strength and Correlates of Muscle Weakness in Patients Receiving Mechanical Ventilation

Abstract

Background Intensive Care Unit Acquired Weakness (ICUAW) is a frequent complication of critical illness due to immobility and prolonged mechanical ventilatory support. Objectives To describe daily peripheral muscle strength measurement in ventilated patients and explore relationships among factors that influence ICUAW. Methods Peripheral muscle strength of 120 ventilated ICU patients (mean age 59.8 ± 15.1; 51% female; APACHE III 61.3 ± 20.7; ICU stay 10.6 ± 8.6 days) was measured daily using a standardized hand grip dynamometry protocol. Three grip measurements for each hand were recorded in pounds-force; the mean of these three assessments was used in the analysis. Correlates of ICUAW were analyzed with mixed models to explore their relationship to grip strength (age, gender, illness severity, length of ventilatory support, medications). Results Median baseline grip strength was variable yet diminished (7.7; 0-102) with either a pattern of diminishing grip strength or maintenance of the baseline low grip strength over time. Controlling for days on protocol, female gender [β = −10.4(2.5); p = <.001], age [= −.24(.08); p = .004], and days receiving ventilatory support [= −.34(.12); p = .005] explained a significant amount of variance in grip strength over time. Conclusions Patients receiving prolonged periods of mechanical ventilatory support in this sample show marked decrements in grip strength measured by hand dynamometry, a marker for peripheral muscle strength. Hand dynamometry is a reliable method to measure muscle strength in cooperative ICU patients and can be used in future research to ultimately develop interventions to prevent ICUAW.

Functional dependence at discharge from the intensive care unit: relevance for rehabilitation nursing

“…These were also patients who had, on average, long hospital stays (43 days on average), representing a subgroup where high health and, in particular, rehabilitation care requirements would be expected, during hospitalization and after hospital discharge. Most patients also required long-term (MV), the study showing, similarly to other studies (Chlan, Tracy, Guttormson, & Savik, 2015), correlation between the use of MV and sharp decline in peripheral muscle strength. This study assessed muscle strength using the MRC score, which ranges from 0 (complete paralysis) to 60 (normal muscle strength), considering according to De Jonghe et al 2002that a score ≤ 48 points indicates muscle weakness acquired in the ICU.…”

ICU-acquired weakness

“…A first group of risk factors are not modifiable The severity of critical illness is an important determinant. Thus, a higher severity of illness score, sepsis and inflammation, multiple organ failure, as well as a longer duration of mechanical ventilation and ICU stay, were found to be predictive [11,[43][44][45]. In fact, ICU-acquired weakness is most frequent in patients with persistent critical illness [46].…”

“…Another illness-related risk factor is a high lactate level [45]. Further, a higher risk of weakness may apply to women than to men, and to older as compared with younger patients [11,43,45]. Also, premorbid disability and frailty may predispose to the severity of weakness.…”

Testing Flexible Grippers for Geometric and Surface Grasping Conformity in Reconfigurable Assembly Systems

“…The force properties are detected in terms of the gripping performance and the criteria illustrated in Figure 2. The grip strength measurements were related to the grip fatigue of human hands over time, when grip force was measured [10]. A comparison of the grip strength of robotic grippers with human hands was established to serve as a comparable model.…”