tetano
Editor, Senior Moderator
Heart Lung
. 2023 Mar 24;60:139-145.
doi: 10.1016/j.hrtlng.2023.03.008. Online ahead of print.
Predictive factors and clinical impact of ICU-acquired weakness on functional disability in mechanically ventilated patients with COVID-19
Kanji Yamada[SUP] 1 [/SUP], Takeshi Kitai[SUP] 2 [/SUP], Kentaro Iwata[SUP] 1 [/SUP], Hiromasa Nishihara[SUP] 3 [/SUP], Tsubasa Ito[SUP] 3 [/SUP], Rina Yokoyama[SUP] 3 [/SUP], Yuta Inagaki[SUP] 3 [/SUP], Takayuki Shimogai[SUP] 3 [/SUP], Akihiro Honda[SUP] 3 [/SUP], Tetsuya Takahashi[SUP] 4 [/SUP], Ryo Tachikawa[SUP] 5 [/SUP], Chigusa Shirakawa[SUP] 5 [/SUP], Jiro Ito[SUP] 6 [/SUP], Ryutaro Seo[SUP] 7 [/SUP], Hirokazu Kuroda[SUP] 8 [/SUP], Asako Doi[SUP] 8 [/SUP], Keisuke Tomii[SUP] 5 [/SUP], Nobuo Kohara[SUP] 3 [/SUP]
Affiliations
Abstract
Background: Patients with critical COVID-19 often require invasive mechanical ventilation (IMV) and admission to the intensive care unit (ICU), resulting in a higher incidence of ICU-acquired weakness (ICU-AW) and functional decline.
Objective: This study aimed to examine the causes of ICU-AW and functional outcomes in critically ill patients with COVID-19 who required IMV.
Methods: This prospective, single-center, observational study included COVID-19 patients who required IMV for ≥48 h in the ICU between July 2020 and July 2021. ICU-AW was defined as a Medical Research Council sum score <48 points. The primary outcome was functional independence during hospitalization, defined as an ICU mobility score ≥9 points.
Results: A total of 157 patients (age: 68 [59-73] years, men: 72.6%) were divided into two groups (ICU-AW group; n = 80 versus non-ICU-AW; n = 77). Older age (adjusted odds ratio [95% confidence interval]: 1.05 [1.01-1.11], p = 0.036), administration of neuromuscular blocking agents (7.79 [2.87-23.3], p < 0.001), pulse steroid therapy (3.78 [1.49-10.1], p = 0.006), and sepsis (7.79 [2.87-24.0], p < 0.001) were significantly associated with ICU-AW development. In addition, patients with ICU-AW had significantly longer time to functional independence than those without ICU-AW (41 [30-54] vs 19 [17-23] days, p < 0.001). The development of ICU-AW was associated with delayed time to functional independence (adjusted hazard ratio: 6.08; 95% CI: 3.05-12.1; p < 0.001).
Conclusions: Approximately half of the patients with COVID-19 requiring IMV developed ICU-AW, which was associated with delayed functional independence during hospitalization.
Keywords: Coronavirus disease 2019; Functional decline; Intensive care unit; Muscle weakness; Rehabilitation; Respiratory distress syndrome.
. 2023 Mar 24;60:139-145.
doi: 10.1016/j.hrtlng.2023.03.008. Online ahead of print.
Predictive factors and clinical impact of ICU-acquired weakness on functional disability in mechanically ventilated patients with COVID-19
Kanji Yamada[SUP] 1 [/SUP], Takeshi Kitai[SUP] 2 [/SUP], Kentaro Iwata[SUP] 1 [/SUP], Hiromasa Nishihara[SUP] 3 [/SUP], Tsubasa Ito[SUP] 3 [/SUP], Rina Yokoyama[SUP] 3 [/SUP], Yuta Inagaki[SUP] 3 [/SUP], Takayuki Shimogai[SUP] 3 [/SUP], Akihiro Honda[SUP] 3 [/SUP], Tetsuya Takahashi[SUP] 4 [/SUP], Ryo Tachikawa[SUP] 5 [/SUP], Chigusa Shirakawa[SUP] 5 [/SUP], Jiro Ito[SUP] 6 [/SUP], Ryutaro Seo[SUP] 7 [/SUP], Hirokazu Kuroda[SUP] 8 [/SUP], Asako Doi[SUP] 8 [/SUP], Keisuke Tomii[SUP] 5 [/SUP], Nobuo Kohara[SUP] 3 [/SUP]
Affiliations
- PMID: 37018902
- DOI: 10.1016/j.hrtlng.2023.03.008
Abstract
Background: Patients with critical COVID-19 often require invasive mechanical ventilation (IMV) and admission to the intensive care unit (ICU), resulting in a higher incidence of ICU-acquired weakness (ICU-AW) and functional decline.
Objective: This study aimed to examine the causes of ICU-AW and functional outcomes in critically ill patients with COVID-19 who required IMV.
Methods: This prospective, single-center, observational study included COVID-19 patients who required IMV for ≥48 h in the ICU between July 2020 and July 2021. ICU-AW was defined as a Medical Research Council sum score <48 points. The primary outcome was functional independence during hospitalization, defined as an ICU mobility score ≥9 points.
Results: A total of 157 patients (age: 68 [59-73] years, men: 72.6%) were divided into two groups (ICU-AW group; n = 80 versus non-ICU-AW; n = 77). Older age (adjusted odds ratio [95% confidence interval]: 1.05 [1.01-1.11], p = 0.036), administration of neuromuscular blocking agents (7.79 [2.87-23.3], p < 0.001), pulse steroid therapy (3.78 [1.49-10.1], p = 0.006), and sepsis (7.79 [2.87-24.0], p < 0.001) were significantly associated with ICU-AW development. In addition, patients with ICU-AW had significantly longer time to functional independence than those without ICU-AW (41 [30-54] vs 19 [17-23] days, p < 0.001). The development of ICU-AW was associated with delayed time to functional independence (adjusted hazard ratio: 6.08; 95% CI: 3.05-12.1; p < 0.001).
Conclusions: Approximately half of the patients with COVID-19 requiring IMV developed ICU-AW, which was associated with delayed functional independence during hospitalization.
Keywords: Coronavirus disease 2019; Functional decline; Intensive care unit; Muscle weakness; Rehabilitation; Respiratory distress syndrome.