Presence and severity of intensive care unit-acquired paresis at time of awakening are associated with increased intensive care unit and hospital mortality*

Abstract

Both the presence and severity of intensive care unit-acquired paresis at the time of awakening are associated with increased intensive care unit and hospital mortality; the mechanisms underlying this association need further study.

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

“…The major cause of this was a lack of patient compliance with clinical assessment. Patients unable to comply with clinical assessment tend to have a higher mortality rate 15,16,20,28 and potentially have greater encephalopathy, both of which are associated with increased incidences of ICUAW. 14,20,23,42,51 The lower incidence of ICUAW in the group diagnosed on clinical assessment is likely to be explained in part by higher rates of incomplete testing.…”

“…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.…”

“…These syndromes are now all included under the clinical diagnostic label of intensive care unit-acquired weakness (ICUAW). 10 The development of an ICUAW syndrome may have important consequences on patient outcomes; prolonged ventilatory weaning, 11,12 increased ICU 12 and hospital length of stay, 13 increased hospital mortality, 14,15 increased 180-day mortality 16 and persistent disabling weakness with reduced quality of life out to one year from ICU discharge. [17][18][19] There may also be a number of potentially modifiable risk factors for ICUAW; prolonged ICU stay/bed rest, 20,21 hyperglycaemia/insulin therapy, 13,[22][23][24] corticosteroids 20 and neuromuscular blockers.…”

Hormonal status in protracted critical illness and in-hospital mortality

“…Deaths attributed to infection were those in which an infection-related complication developed after initial awakening, including septic shock, multiple organ failure, acute respiratory distress syndrome and hypoxemic pneumonia. Cases in which death was associated with a decision to limit or withdraw care were also recorded [18]. …”

“…These endocrine markers were assessed in a study on ICU-acquired paresis [11] because they affect muscle metabolism. However, although the present study is based on the same population [8,12] and the same hormonal measurements [11] as previously published ones, its objective (that is, in-hospital mortality) is entirely original.…”