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Five-year impact of ICU-acquired neuromuscular complications: a prospective, observational study. Intensive Care Med 2020; 46:1184-1193. [DOI: 10.1007/s00134-020-05927-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 01/08/2020] [Indexed: 10/25/2022]
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Peñuelas O, Muriel A, Frutos-Vivar F, Fan E, Raymondos K, Rios F, Nin N, Thille AW, González M, Villagomez AJ, Davies AR, Du B, Maggiore SM, Matamis D, Abroug F, Moreno RP, Kuiper MA, Anzueto A, Ferguson ND, Esteban A. Prediction and Outcome of Intensive Care Unit-Acquired Paresis. J Intensive Care Med 2016; 33:16-28. [PMID: 27080128 DOI: 10.1177/0885066616643529] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Intensive care unit-acquired paresis (ICUAP) is associated with poor outcomes. Our objective was to evaluate predictors for ICUAP and the short-term outcomes associated with this condition. METHODS A secondary analysis of a prospective study including 4157 mechanically ventilated adults in 494 intensive care units from 39 countries. After sedative interruption, patients were screened for ICUAP daily, which was defined as the presence of symmetric and flaccid quadriparesis associated with decreased or absent deep tendon reflexes. A multinomial logistic regression was used to create a predictive model for ICUAP. Propensity score matching was used to estimate the relationship between ICUAP and short-term outcomes (ie, weaning failure and intensive care unit [ICU] mortality). RESULTS Overall, 114 (3%) patients had ICUAP. Variables associated with ICUAP were duration of mechanical ventilation (relative risk ratio [RRR] per day, 1.10; 95% confidence interval [CI] 1.08-1.12), steroid therapy (RRR 1.8; 95% CI, 1.2-2.8), insulin therapy (RRR 1.8; 95% CI 1.2-2.7), sepsis (RRR 1.9; 95% CI: 1.2 to 2.9), acute renal failure (RRR 2.2; 95% CI 1.5-3.3), and hematological failure (RRR 1.9; 95% CI: 1.2-2.9). Coefficients were used to generate a weighted scoring system to predict ICUAP. ICUAP was significantly associated with both weaning failure (paired rate difference of 22.1%; 95% CI 9.8-31.6%) and ICU mortality (paired rate difference 10.5%; 95% CI 0.1-24.0%). CONCLUSIONS Intensive care unit-acquired paresis is relatively uncommon but is significantly associated with weaning failure and ICU mortality. We constructed a weighted scoring system, with good discrimination, to predict ICUAP in mechanically ventilated patients at the time of awakening.
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Affiliation(s)
- Oscar Peñuelas
- 1 Hospital Universitario de Getafe & Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain
| | - Alfonso Muriel
- 2 Unidad de Bioestadística Clinica Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigaciones Sanitarias (IRYCIS) & Centro de Investigación en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Fernando Frutos-Vivar
- 1 Hospital Universitario de Getafe & Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain
| | - Eddy Fan
- 3 Interdepartmental Division of Critical Care Medicine, and Departments of Medicine & Physiology, University of Toronto, Canada
| | | | - Fernando Rios
- 5 Hospital Nacional Alejandro Posadas, Buenos Aires, Argentina
| | - Nicolás Nin
- 6 Hospital Universitario de Montevideo, Uruguay
| | | | - Marco González
- 8 Clínica Medellín & Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Asisclo J Villagomez
- 9 Hospital Regional 1° de Octubre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), México DF, México
| | - Andrew R Davies
- 10 Alfred Hospital & Monash University, Melbourne, Australia
| | - Bin Du
- 11 Peking Union Medical College Hospital, Beijing, Popular Republic of China
| | - Salvatore M Maggiore
- 12 Policlinico "Agostino Gemelli", Università Cattolica Del Sacro Cuore, Roma, Italy
| | | | - Fekri Abroug
- 14 Hospital Fattouma Bourguina, Monastir, Tunisia
| | - Rui P Moreno
- 15 Hospital de São José, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | | | - Antonio Anzueto
- 17 South Texas Veterans Health Care System and University of Texas Health Science Center, San Antonio, Texas
| | - Niall D Ferguson
- 3 Interdepartmental Division of Critical Care Medicine, and Departments of Medicine & Physiology, University of Toronto, Canada
| | - Andrés Esteban
- 1 Hospital Universitario de Getafe & Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain
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