Measurement of muscle strength in the intensive care unit

Bittner, Edward A.; Martyn, Jeevendra; George, Edward; Frontera, Walter R.; Eikermann, Matthias

doi:10.1097/ccm.0b013e3181b6f727

Cited by 61 publications

(46 citation statements)

References 113 publications

(109 reference statements)

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“…[33][34][35] An association between ICU-acquired muscle weakness and pharyngeal dysphagia leading to aspiration likely contributes to such poor clinical outcomes. Notably, aspiration does not always lead to pathology and can remain asymptomatic or "silent."…”

Section: Discussionmentioning

confidence: 99%

Muscle Weakness Predicts Pharyngeal Dysfunction and Symptomatic Aspiration in Long-term Ventilated Patients

et al. 2013

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Background: Prolonged mechanical ventilation is associated with muscle weakness, pharyngeal dysfunction, and symptomatic aspiration. The authors hypothesized that muscle strength measurements can be used to predict pharyngeal dysfunction (endoscopic evaluation-primary hypothesis), as well as symptomatic aspiration occurring during a 3-month follow-up period. Methods: Thirty long-term ventilated patients admitted in two intensive care units at Massachusetts General Hospital were included. The authors conducted a fiberoptic endoscopic evaluation of swallowing and measured muscle strength using medical research council score within 24 h of each fiberoptic endoscopic evaluation of swallowing. A medical research council score less than 48 was considered clinically meaningful muscle weakness. A retrospective chart review was conducted to identify symptomatic aspiration events.Results: Muscle weakness predicted pharyngeal dysfunction, defined as either valleculae and pyriform sinus residue scale of more than 1, or penetration aspiration scale of more than 1. Area under the curve of the receiver-operating curves for muscle strength (medical research council score) to predict pharyngeal, valleculae, and pyriform sinus residue scale of more than 1, penetration aspiration scale of more than 1, and symptomatic aspiration were 0.77 (95% CI, 0.63-0.97; P = 0.012), 0.79 (95% CI, 0.56-1; P = 0.02), and 0.74 (95% CI, 0.56-0.93; P = 0.02), respectively. Seventy percent of patients with muscle weakness showed symptomatic aspiration events. Muscle weakness was associated with an almost 10-fold increase in the symptomatic aspiration risk (odds ratio = 9.8; 95% CI, 1.6-60; P = 0.009). Conclusion: In critically ill patients, muscle weakness is an independent predictor of pharyngeal dysfunction and symptomatic aspiration. Manual muscle strength testing may help identify patients at risk of symptomatic aspiration.

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Section: Discussionmentioning

confidence: 99%

Muscle Weakness Predicts Pharyngeal Dysfunction and Symptomatic Aspiration in Long-term Ventilated Patients

et al. 2013

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“…In addition, a pediatric progressive mobility protocol administered to 25 medical/surgical PICU patients aged 3 to 18 years using cycle ergometry and/or interactive video gaming interventions in the PICU is practical [69]. Neither of the described pediatric studies reported any adverse events despite 50% to 52% of children being mechanically ventilated while receiving the intervention [68,69].…”

Section: Pediatric Mobilizationmentioning

confidence: 99%

Early mobilization in the critical care unit: A review of adult and pediatric literature

Cameron¹,

Ball²,

Cepinskas³

et al. 2015

Journal of Critical Care

242

179

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“…B. auch im Rahmen eines täglichen Aufwachversuchs) lässt sich eine erworbene Muskelschwäche recht frühzeitig mit Hilfe der Handdynamometrie oder aber durch die Beurteilung des Kraftgrades anhand der Medical-Research-Council(MRC)-Skala feststellen [7,62]. Dabei gelten bei der Handdynamometrie der dominanten Seite Kraftwerte < 11 kg bei Männern bzw.…”

Section: E Es Mehren Sich Die Hinweise Dass Eine Exakte Differenzierunclassified

Erworbene Muskelschwäche beim kritisch Kranken

et al. 2011

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Intensive care unit-acquired weakness (ICUAW) is a severe complication in critically ill patients which has been increasingly recognized over the last two decades. By definition ICUAW is caused by distinct neuromuscular disorders, namely critical illness polyneuropathy (CIP) and critical illness myopathy (CIM). Both CIP and CIM can affect limb and respiratory muscles and thus complicate weaning from a ventilator, increase the length of stay in the intensive care unit and delay mobilization and physical rehabilitation. It is controversially discussed whether CIP and CIM are distinct entities or whether they just represent different organ manifestations with common pathomechanisms. These basic pathomechanisms, however, are complex and still not completely understood but metabolic, inflammatory and bioenergetic alterations seem to play a crucial role. In this respect several risk factors have recently been revealed: in addition to the administration of glucocorticoids and non-depolarizing muscle relaxants, sepsis and multi-organ failure per se as well as elevated levels of blood glucose and muscular immobilization have been shown to have a profound impact on the occurrence of CIP and CIM. For the diagnosis, careful physical and neurological examinations, electrophysiological testing and in rare cases nerve and muscle biopsies are recommended. Nevertheless, it appears to be difficult to clearly distinguish between CIM and CIP in a clinical setting. At present no specific therapy for these neuromuscular disorders has been established but recent data suggest that in addition to avoidance of risk factors early active mobilization of critically ill patients may be beneficial.

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Measurement of muscle strength in the intensive care unit

Cited by 61 publications

References 113 publications

Muscle Weakness Predicts Pharyngeal Dysfunction and Symptomatic Aspiration in Long-term Ventilated Patients

Muscle Weakness Predicts Pharyngeal Dysfunction and Symptomatic Aspiration in Long-term Ventilated Patients

Early mobilization in the critical care unit: A review of adult and pediatric literature

Erworbene Muskelschwäche beim kritisch Kranken

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