Quadriceps strength in intensive care unit survivors: Variability and influence of preadmission physical activity

Blanjean, Arielle; Kellens, Isabelle; Benoît, Michel; Joris, Jean; Croisier, Jean-Louis; Rousseau, Anne-Françoise

doi:10.1016/j.aucc.2020.10.007

Cited by 5 publications

(5 citation statements)

References 48 publications

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“…The highly standardized testing protocol is detailed in a previously published validation study [ 20 ]. Magnitude of the values that can be observed in healthy and critically ill patients are described elsewhere [ 21 ]. To reduce inter-individual variability and minimize the effect of subject weight on muscle strength, absolute strength was normalized according to actual body weight (expressed in N/kg).…”

Section: Methodsmentioning

confidence: 99%

Post-intensive care syndrome after a critical COVID-19: cohort study from a Belgian follow-up clinic

Rousseau¹,

Minguet²,

Colson³

et al. 2021

Ann. Intensive Care

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Purpose Many patients with coronavirus disease 2019 (COVID-19) required critical care. Mid-term outcomes of the survivors need to be assessed. The objective of this single-center cohort study was to describe their physical, cognitive, psychological, and biological outcomes at 3 months following intensive care unit (ICU)-discharge (M3). Patients and methods All COVID-19 adults who survived an ICU stay ≥ 7 days and attended the M3 consultation at our multidisciplinary follow-up clinic were involved. They benefited from a standardized assessment, addressing health-related quality of life (EQ-5D-3L), sleep disorders (PSQI), and the three principal components of post-intensive care syndrome (PICS): physical status (Barthel index, handgrip and quadriceps strength), mental health disorders (HADS and IES-R), and cognitive impairment (MoCA). Biological parameters referred to C-reactive protein and creatinine. Results Among the 92 patients admitted to our ICU for COVID-19, 42 survived a prolonged ICU stay and 32 (80%) attended the M3 follow-up visit. Their median age was 62 [49–68] years, 72% were male, and nearly half received inpatient rehabilitation following ICU discharge. At M3, 87.5% (28/32) had not regained their baseline level of daily activities. Only 6.2% (2/32) fully recovered, and had normal scores for the three MoCA, IES-R and Barthel scores. The main observed disorders were PSQI > 5 (75%, 24/32), MoCA < 26 (44%, 14/32), Barthel < 100 (31%, 10/32) and IES-R ≥ 33 (28%, 9/32). Combined disorders were observed in 13/32 (40.6%) of the patients. The EQ-5D-3L visual scale was rated at 71 [61–80]. A quarter of patients (8/32) demonstrated a persistent inflammation based on CRP blood level (9.3 [6.8–17.7] mg/L). Conclusion The burden of severe COVID-19 and prolonged ICU stay was considerable in the present cohort after 3 months, affecting both functional status and biological parameters. These data are an argument on the need for closed follow-up for critically ill COVID-19 survivors.

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Section: Methodsmentioning

confidence: 99%

Post-intensive care syndrome after a critical COVID-19: cohort study from a Belgian follow-up clinic

Rousseau¹,

Minguet²,

Colson³

et al. 2021

Ann. Intensive Care

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“…A huge heterogeneity in quadriceps strength has been observed among ICU survivors: some patients are extremely weak, whereas others are stronger than healthy patients [ 9 , 18 ]. This observation reinforces the concept of “one size does not fit all” and assumes a need for individualized rehabilitation.…”

Section: Discussionmentioning

confidence: 99%

“…A highly standardised protocol of quadriceps strength (QS) measurement in a modified supine position with the tested leg in 45° hip flexion and 40° knee flexion has been previously validated [ 8 , 9 ]. It can be advantageously performed as soon as the patient is cooperative, in the ICU setting.…”

Section: Introductionmentioning

confidence: 99%

Quadriceps handheld dynamometry during the post-ICU trajectory: using strictly the same body position is mandatory for repeated measures

Rousseau

Dardenne

Kellens

et al. 2023

ICMx

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Background The level of quadriceps strength (QS) generated in the supine or seated position is not similar. For QS follow-up from intensive care unit (ICU) stay to recovery, getting comparable measures is essential. This study aimed to develop and validate new equations for estimating QS in a given position based on the measurement taken in another one. Methods and results Isometric QS was measured using a handheld dynamometer and a standardized protocol in a supine and in a seated position. In a first cohort of 77 healthy adults, two QS conversion equations were developed using a multivariate model integrating independent parameters such as age, sex, body mass index (BMI) and baseline QS. These equations were tested in two cohorts for external validation, using the interclass correlation coefficient (ICC) and Bland–Altman graphical method. Only one was validated in the second cohort (62 different healthy adults): the ICC was 0.87 (95% CI 0.59–0.94) and the bias was − 0.49 N/Kg (limits of agreement: − 1.76–0.78 N/kg). However, this equation did not perform well in the third cohort (50 ICU survivors): the ICC was 0.60 (95% CI 0.24–0.78), and the bias was − 0.53 N/Kg (limits of agreement: − 1.01–2.07 N/kg). Conclusions As no conversion equation has been validated in the present study, repeated QS measurements should be performed strictly in the same standardized and documented position.

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“…Nevertheless, the observed bias was greater in patients who generated greater quadriceps strength. In critically ill patients who are generally weaker than healthy subjects [ 20 ], such bias could thus be less important. However, it remains to be explored in this population.…”

Section: Discussionmentioning

confidence: 99%

“…On the contrary, the supine position is easily feasible during ICU stay. We recently proposed and validated a highly standardised protocol of quadriceps strength measurement in a modified supine position with the tested leg at 45° of hip flexion and 40° of knee flexion [ 19 , 20 ]. However, due to the required equipment, it is more difficult to use this protocol outside of the ICU, such as in a post-ICU follow-up consultation.…”

Section: Introductionmentioning

confidence: 99%

Experimental Approach of Quadriceps Strength Measurement: Implications for Assessments in Critically Ill Survivors

et al. 2022

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(1) Background: The supine testing position is suitable for early quadriceps strength (QS) assessment in intensive care unit, while a seated position is more appropriate for survivors who have regained mobility. Acquiring consistent measurements is essential for longitudinal follow-up. We compared the QS generated in different settings in healthy volunteers. (2) Methods: Isometric QS was assessed using a MicroFet2 and standardised protocols comparing different modalities. Hip and knee flexion angles were, respectively, 45° and 40° (H45-K40) in the supine position, and both at 90° (H90-K90) in the seated position. Dynamometer was either handheld (non-fixed configuration, NFC), or fixed (FC) in a cubicle. (3) Results: QS in H90–K90 and H45-K40 positions were strongly correlated, but QS was higher in the later position regardless of the configuration. Compared to H45-K40, biases of 108.2N (or 28.05%) and 110.3N (27.13%) were observed in H90-K90 position, respectively, in the NFC and FC. These biases were independently and positively associated with QS (p < 0.001). For both position, there were no significant differences between QS measured in NFC or FC. (4) Conclusions: The quadriceps was less efficient in the seated position, compared to the supine position, in healthy volunteers. These findings have practical implications for further assessments and research in critically ill patients.

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Quadriceps strength in intensive care unit survivors: Variability and influence of preadmission physical activity

Cited by 5 publications

References 48 publications

Post-intensive care syndrome after a critical COVID-19: cohort study from a Belgian follow-up clinic

Post-intensive care syndrome after a critical COVID-19: cohort study from a Belgian follow-up clinic

Quadriceps handheld dynamometry during the post-ICU trajectory: using strictly the same body position is mandatory for repeated measures

Experimental Approach of Quadriceps Strength Measurement: Implications for Assessments in Critically Ill Survivors

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