Erworbene Muskelschwäche beim kritisch Kranken

Judemann, K.; Lunz, Dirk; Zausig, York; Graf, Bernhard M.; Zink, Wolfgang

doi:10.1007/s00101-011-1951-7

Cited by 26 publications

(7 citation statements)

References 136 publications

(226 reference statements)

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“…The clinical risk factors that can facilitate the development of CIP/CIM are as follows: systemic inflammatory response syndrome (SIRS), sepsis, kidney failure, multiorgan failure, MV, age, sex, general burden of disease, hypotension, hyperosmolarity, parenteral nutrition, low serum albumin levels, immobilisation, hyperglycaemia, certain medications and hypoxia [53, 107, 110, 111].…”

Section: Pathophysiology Of Weaning Failurementioning

confidence: 99%

Prolonged Weaning: S2k Guideline Published by the German Respiratory Society

et al. 2020

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Mechanical ventilation (MV) is an essential part of modern intensive care medicine. MV is performed in patients with severe respiratory failure caused by respiratory muscle insufficiency and/or lung parenchymal disease; that is, when other treatments such as medication, oxygen administration, secretion management, continuous positive airway pressure (CPAP), or nasal high-flow therapy have failed. MV is required for maintaining gas exchange and allows more time to curatively treat the underlying cause of respiratory failure. In the majority of ventilated patients, liberation or “weaning” from MV is routine, without the occurrence of any major problems. However, approximately 20% of patients require ongoing MV, despite amelioration of the conditions that precipitated the need for it in the first place. Approximately 40–50% of the time spent on MV is required to liberate the patient from the ventilator, a process called “weaning”. In addition to acute respiratory failure, numerous factors can influence the duration and success rate of the weaning process; these include age, comorbidities, and conditions and complications acquired during the ICU stay. According to international consensus, “prolonged weaning” is defined as the weaning process in patients who have failed at least 3 weaning attempts, or require more than 7 days of weaning after the first spontaneous breathing trial (SBT). Given that prolonged weaning is a complex process, an interdisciplinary approach is essential for it to be successful. In specialised weaning centres, approximately 50% of patients with initial weaning failure can be liberated from MV after prolonged weaning. However, the heterogeneity of patients undergoing prolonged weaning precludes the direct comparison of individual centres. Patients with persistent weaning failure either die during the weaning process, or are discharged back to their home or to a long-term care facility with ongoing MV. Urged by the growing importance of prolonged weaning, this Sk2 Guideline was first published in 2014 as an initiative of the German Respiratory Society (DGP), in conjunction with other scientific societies involved in prolonged weaning. The emergence of new research, clinical study findings and registry data, as well as the accumulation of experience in daily practice, have made the revision of this guideline necessary. The following topics are dealt with in the present guideline: Definitions, epidemiology, weaning categories, underlying pathophysiology, prevention of prolonged weaning, treatment strategies in prolonged weaning, the weaning unit, discharge from hospital on MV, and recommendations for end-of-life decisions. Special emphasis was placed on the following themes: (1) A new classification of patient sub-groups in prolonged weaning. (2) Important aspects of pulmonary rehabilitation and neurorehabilitation in prolonged weaning. (3) Infrastructure and process organisation in the care of patients in prolonged weaning based on a continuous treatment concept. (4) Changes in therapeutic goals and communication with relatives. Aspects of paediatric weaning are addressed separately within individual chapters. The main aim of the revised guideline was to summarize both current evidence and expert-based knowledge on the topic of “prolonged weaning”, and to use this information as a foundation for formulating recommendations related to “prolonged weaning”, not only in acute medicine but also in the field of chronic intensive care medicine. The following professionals served as important addressees for this guideline: intensivists, pulmonary medicine specialists, anaesthesiologists, internists, cardiologists, surgeons, neurologists, paediatricians, geriatricians, palliative care clinicians, rehabilitation physicians, intensive/chronic care nurses, physiotherapists, respiratory therapists, speech therapists, medical service of health insurance, and associated ventilator manufacturers.

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Section: Pathophysiology Of Weaning Failurementioning

confidence: 99%

Prolonged Weaning: S2k Guideline Published by the German Respiratory Society

et al. 2020

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“…[ 11 17 ] The minimal change in the peak torque value can be measured in units of weight such as pounds or kilograms. [ 18 19 20 ]…”

Section: Introductionmentioning

confidence: 99%

Measurement of muscle strength with handheld dynamometer in Intensive Care Unit

Samosawala

Vaishali

Kalyana

2016

Indian Journal of Critical Care Medicine

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Background:Intensive Care Unit (ICU) acquired weakness is a common complication in critically ill patients affecting their prognosis. The handheld dynamometry is an objective method in detecting minimum muscle strength change, which has an impact on the physical function of ICU survivors. The minimal change in the force can be measured in units of weight such as pounds or kilograms.Aim of the Study:To detect the changes in peripheral muscle strength with handheld dynamometer in the early stage of ICU stay and to observe the progression of muscle weakness.Methodology:Three upper and three lower limb muscles force measured with handheld dynamometer during ICU stay. Data were analyzed using repeated measures ANOVA to detect changes in force generated by muscle on alternate days of ICU stay.Results:There was a reduction in peripheral muscle strength from day 3 to day 5 as well from day 5 to day 7 of ICU stay (P < 0.01). The average reduction in peripheral muscle strength was 11.8% during ICU stay.Conclusion:This study showed a progressive reduction in peripheral muscle strength as measured by handheld dynamometer during early period of ICU stay.

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“…Pathophysiologisch kann der ICU-AW eine Myopathie ("Critical-illness"-Myopathie, CIM), eine Neuropathie ("Critical-illness"-Polyneuropathie, CIP) oder ein gemischtes Krankheitsbild ("Critical-illness"-Polyneuromyopathie, CIPNM) zugrunde liegen. Klinisch zeigt sich häufig eine schlaffe Tetraparese mit reduzierten oder erloschenen Muskeleigenreflexen unter Aussparung der kraniofazialen Muskulatur [12]. Ist zusätzlich die Atemmuskulatur betroffen (v. a. das Zwerchfell), verschlechtert sich das Langzeit-Outcome der Patienten zusätzlich [20].…”

Section: Hintergrundunclassified

„Intensive Care Unit-Acquired Weakness“

et al. 2022

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Zusammenfassung Hintergrund Die „Intensive Care Unit-Acquired Weakness“ (ICU-AW) ist eine der häufigsten Ursachen für eine neuromuskuläre Dysfunktion in der Intensivmedizin. Gegenwärtig fehlen evidenzbasierte Empfehlungen zur Diagnostik, zum Monitoring und zu therapeutischen Maßnahmen. Ziel der Arbeit Die Erfassung des derzeitigen Vorgehens bei Diagnostik, Monitoring und präventiven und therapeutischen Ansätzen bei der ICU-AW auf deutschen Intensivstationen. Material und Methoden Onlinebefragung von 448 Mitgliedern des Wissenschaftlichen Arbeitskreises Intensivmedizin (WAKI) und des Wissenschaftlichen Arbeitskreises Neuroanästhesie (WAKNA). Ergebnisse Insgesamt wurden 68/448 (15,2 %) Fragebogen ausgewertet. Bei 13,4 % (9/67) der Befragten existiert ein strukturiertes diagnostisches Vorgehen zur Detektion der ICU-AW. Für Screening (60/68; 88,2 %) und Verlaufsbeurteilung (57/65; 87,7 %) wird die klinische Untersuchung präferiert. Etablierte Scores, wie der „Medical Research Council sum score“ (MRC-SS) spielen für Screening und Verlaufskontrolle der ICU-AW eine untergeordnete Rolle (7/68; 10,3 % und 7/65; 10,8 %). Mobilisation (45/68; 66,2 %) und Sedativareduktion (38/68; 55,9 %) stellen die häufigsten präventiven und therapeutischen Ansätze dar. Ein Mangel an Physiotherapeuten (64/68; 94,1 %) und Pflegekräften (57/68; 83,8 %) wird als Hauptdefizit bei der Versorgung von Patienten mit ICU-AW identifiziert. Insgesamt 91,2 % (62/68) der Befragten befürworten die Erstellung evidenzbasierter Empfehlungen zur Diagnostik, zum Monitoring und zu therapeutischen Ansätzen bei ICU-AW. Diskussion Ein einheitliches Konzept für Diagnostik, Monitoring, Prävention und Therapie der ICU-AW auf deutschen Intensivstationen fehlt weitgehend. Innovative diagnostische Ansätze könnten in Zukunft helfen, Patienten mit einem hohem Risiko für eine ICU-AW frühzeitig zu detektieren, präventive Maßnahmen einzuleiten sowie wertvolle prognostische Informationen zu gewinnen.

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Erworbene Muskelschwäche beim kritisch Kranken

Cited by 26 publications

References 136 publications

Prolonged Weaning: S2k Guideline Published by the German Respiratory Society

Prolonged Weaning: S2k Guideline Published by the German Respiratory Society

Measurement of muscle strength with handheld dynamometer in Intensive Care Unit

„Intensive Care Unit-Acquired Weakness“

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