Usefulness of a clinical diagnosis of ICU-acquired paresis to predict outcome in patients with SIRS and acute respiratory failure

Abstract

Purpose: Neuromuscular abnormalities are common in ICU patients. We aimed to assess the incidence of clinically diagnosed ICU-acquired paresis (ICUAP) and its impact on outcome. Methods: Forty-two patients with systemic inflammatory response syndrome on mechanical ventilation for C48 h were prospectively studied. Diagnosis of ICUAP was defined as symmetric limb muscle weakness in at least two muscle groups at ICU discharge without other explanation. The threshold Medical Research Council (MRC) Score was set at 35 (of 50) points. Activities in daily living were scored using the Barthel Index 28 and 180 days after ICU discharge. Results: Three patients died before sedation was stopped. I-CUAP was diagnosed in 13 of the 39 patients (33%). Multivariate regression analysis yielded five ICU-AP-predicting variables (P \ 0.05): SAPS II at ICU admission, treatment with steroids, muscle relaxants or norepinephrine, and days with sepsis. Patients with ICUAP had lower admission SAPS II scores [37 ± 13 vs. 49 ± 15 (P = 0.018)], lower Barthel Index at 28 days and lower survival at 180 days after ICU discharge (38 vs. 77%, P = 0.033) than patients without ICUAP. Daily TISS-28 scores were similar but cumulative TISS-28 scores were higher in patients with ICUAP (664 ± 275) than in patients without ICUAP (417 ± 236; P = 0.008). The only independent risk factor for death before day 180 was the presence of ICUAP. Conclusions: A clinical diagnosis of ICUAP was frequently established in this patient group. Despite lower SAPS II scores, these patients needed more resources and had high mortality and prolonged recovery periods after ICU discharge.

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.…”

Trend Analysis of Hospital Resource Utilization for Prolonged Mechanical Ventilation Patients in Taiwan: A Population-Based Study

“…3 Of all patients who receive mechanical ventilation, an estimated 5-13% required PMV. 3,4 Although PMV patients consume substantial medical resources, their outcomes tend to be poor, especially in the rapidly growing elderly population. [2][3][4][5] Historically, patients requiring PMV tend to be treated in ICUs, and associated discharge rates are low.…”

“…3,4 Although PMV patients consume substantial medical resources, their outcomes tend to be poor, especially in the rapidly growing elderly population. [2][3][4][5] Historically, patients requiring PMV tend to be treated in ICUs, and associated discharge rates are low. However in the 1990s, changes in the medical care reimbursement regulations of the Taiwan healthcare system created incentives to transfer patients requiring PMV from ICUs of acute care hospitals to long-term assisted care facilities.…”

“…However in the 1990s, changes in the medical care reimbursement regulations of the Taiwan healthcare system created incentives to transfer patients requiring PMV from ICUs of acute care hospitals to long-term assisted care facilities. [2][3][4][5][6] The policy for PMV patients implemented by the Taiwan Bureau of National Health Insurance (BNHI) in 2000 required the transfer of such patients to a respiratory care center after an ICU stay of 21 days, and to a respiratory care ward after a respiratory care center stay of 42 days. 7 Although many studies have evaluated PMV outcomes, few longitudinal studies have exceeded 2 years, [1][2][3][4][5] and most published data are limited to United States or European populations.…”