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Hosse C, Beetz NL, Fehrenbach U, Elkilany A, Auer TA, Gebauer B, Pille C, Geisel D, Kolck J. Quantification of muscle recovery in post-ICU patients admitted for acute pancreatitis: a longitudinal single-center study. BMC Anesthesiol 2024; 24:308. [PMID: 39237875 DOI: 10.1186/s12871-024-02687-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Accepted: 08/20/2024] [Indexed: 09/07/2024] Open
Abstract
OBJECTIVES Critically ill patients with severe pancreatitis exhibit substantial muscle wasting, which limits in-hospital and post-hospital outcomes. Survivors of critical illness undergo extensive recovery processes. Previous studies have explored pancreatic function, quality of life, and costs post-hospitalization for AP patients, but none have comprehensively quantified muscle loss and recovery post-discharge. By applying an AI-based automated segmentation tool, we aimed to quantify muscle mass recovery in ICU patients after discharge. MATERIALS Muscle segmentation was performed on 22 patients, with a minimum of three measurements taken during hospitalization and one clinically indicated examination after hospital discharge. Changes in psoas muscle area (PMA) between admission, discharge and follow up were calculated. T-Test was performed to identify significant differences between patients able and not able to recover their muscle mass. RESULTS Monitoring PMA shows muscle loss during and gain after hospitalization: The mean PMA at the first scan before or at ICU admission (TP1) was 17.08 cm², at the last scan before discharge (TP2), mean PMA was 9.61 cm². The percentage change in PMA between TP1 and TP2 ranged from - 85.42% to -2.89%, with a mean change of -40.18%. The maximum muscle decay observed during the stay was - 50.61%. After a mean follow-up period of 438.73 days most patients (81%) were able to increase their muscle mass. Compared to muscle status at TP1, only 27% of patients exhibited full recovery, with the majority still presenting a deficit of 31.96%. CONCLUSION Muscle recovery in ICU patients suffering from severe AP is highly variable, with only about one third of patients recovering to their initial physical status. Opportunistic screening of post-ICU patient recovery using clinically indicated imaging and AI-based segmentation tools enables precise quantification of patients' muscle status and can be employed to identify individuals who fail to recover and would benefit from secondary rehabilitation. Understanding the dynamics of muscle atrophy may improve prognosis and support personalized patient care.
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Affiliation(s)
- Clarissa Hosse
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Nick L Beetz
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Uli Fehrenbach
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Aboelyazid Elkilany
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Timo A Auer
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Bernhard Gebauer
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Pille
- Department of Anesthesiology and Intensive Care Medicine | CCM | CVK, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Dominik Geisel
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Johannes Kolck
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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De Bruyn L, Téblick A, Van Oudenhove T, Vander Perre S, Derese I, Pauwels L, Derde S, De Vlieger G, Van den Berghe G, Langouche L. Glucocorticoid treatment increases cholesterol availability during critical illness: effect on adrenal and muscle function. Crit Care 2024; 28:295. [PMID: 39238038 DOI: 10.1186/s13054-024-05079-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 08/27/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND Hypocholesterolemia hallmarks critical illness though the underlying pathophysiology is incompletely understood. As low circulating cholesterol levels could partly be due to an increased conversion to cortisol/corticosterone, we hypothesized that glucocorticoid treatment, via reduced de novo adrenal cortisol/corticosterone synthesis, might improve cholesterol availability and as such affect adrenal gland and skeletal muscle function. METHODS In a matched set of prolonged critically ill patients (n = 324) included in the EPaNIC RCT, a secondary analysis was performed to assess the association between glucocorticoid treatment and plasma cholesterol from ICU admission to day five. Next, in a mouse model of cecal ligation and puncture-induced sepsis, septic mice were randomized to receive either hydrocortisone (1.2 mg/day) (n = 17) or placebo (n = 15) for 5 days, as compared with healthy mice (n = 18). Plasma corticosterone, cholesterol, and adrenocortical and myofiber cholesterol were quantified. Adrenal structure and steroidogenic capacity were evaluated. Muscle force and markers of atrophy, fibrosis and regeneration were quantified. In a consecutive mouse study with identical design (n = 24), whole body composition was assessed by EchoMRI to investigate impact on lean mass, fat mass, total and free water. RESULTS In human patients, glucocorticoid treatment was associated with higher plasma HDL- and LDL-cholesterol from respectively ICU day two and day three, up to day five (P < 0.05). Plasma corticosterone was no longer elevated in hydrocortisone-treated septic mice compared to placebo, whereas the sepsis-induced reduction in plasma HDL- and LDL-cholesterol and in adrenocortical cholesterol was attenuated (P < 0.05), but without improving the adrenocortical ACTH-induced CORT response and with increased adrenocortical inflammation and apoptosis (P < 0.05). Total body mass was further decreased in hydrocortisone-treated septic mice (P < 0.01) compared to placebo, with no additional effect on muscle mass, force or myofiber size. The sepsis-induced rise in markers of muscle atrophy and fibrosis was unaffected by hydrocortisone treatment, whereas markers of muscle regeneration were suppressed compared to placebo (P < 0.05). An increased loss of lean body mass and total and free water was observed in hydrocortisone-treated septic mice compared to placebo (P < 0.05). CONCLUSIONS Glucocorticoid treatment partially attenuated critical illness-induced hypocholesterolemia, but at a cost of impaired adrenal function, suppressed muscle regeneration and exacerbated loss of body mass.
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Affiliation(s)
- Lauren De Bruyn
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, O&N1 Box 503, 3000, Leuven, Belgium
| | - Arno Téblick
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, O&N1 Box 503, 3000, Leuven, Belgium
| | - Tim Van Oudenhove
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, O&N1 Box 503, 3000, Leuven, Belgium
| | - Sarah Vander Perre
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, O&N1 Box 503, 3000, Leuven, Belgium
| | - Inge Derese
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, O&N1 Box 503, 3000, Leuven, Belgium
| | - Lies Pauwels
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, O&N1 Box 503, 3000, Leuven, Belgium
| | - Sarah Derde
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, O&N1 Box 503, 3000, Leuven, Belgium
| | - Greet De Vlieger
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, O&N1 Box 503, 3000, Leuven, Belgium
| | - Greet Van den Berghe
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, O&N1 Box 503, 3000, Leuven, Belgium
| | - Lies Langouche
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, O&N1 Box 503, 3000, Leuven, Belgium.
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Fuentes-Aspe R, Gutierrez-Arias R, González-Seguel F, Marzuca-Nassr GN, Torres-Castro R, Najum-Flores J, Seron P. Which factors are associated with acquired weakness in the ICU? An overview of systematic reviews and meta-analyses. J Intensive Care 2024; 12:33. [PMID: 39232808 PMCID: PMC11375885 DOI: 10.1186/s40560-024-00744-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 08/15/2024] [Indexed: 09/06/2024] Open
Abstract
RATIONALE Intensive care unit-acquired weakness (ICUAW) is common in critically ill patients, characterized by muscle weakness and physical function loss. Determining risk factors for ICUAW poses challenges due to variations in assessment methods and limited generalizability of results from specific populations, the existing literature on these risk factors lacks a clear and comprehensive synthesis. OBJECTIVE This overview aimed to synthesize risk factors for ICUAW, categorizing its modifiable and nonmodifiable factors. METHODS An overview of systematic reviews was conducted. Six relevant databases were searched for systematic reviews. Two pairs of reviewers selected reviews following predefined criteria, where bias was evaluated. Results were qualitatively summarized and an overlap analysis was performed for meta-analyses. RESULTS Eighteen systematic reviews were included, comprising 24 risk factors for ICUAW. Meta-analyses were performed for 15 factors, while remaining reviews provided qualitative syntheses. Twelve reviews had low risk of bias, 4 reviews were unclear, and 2 reviews exhibited high risk of bias. The extent of overlap ranged from 0 to 23% for the corrected covered area index. Nonmodifiable factors, including advanced age, female gender, and multiple organ failure, were consistently associated with ICUAW. Modifiable factors, including neuromuscular blocking agents, hyperglycemia, and corticosteroids, yielded conflicting results. Aminoglycosides, renal replacement therapy, and norepinephrine were associated with ICUAW but with high heterogeneity. CONCLUSIONS Multiple risk factors associated with ICUAW were identified, warranting consideration in prevention and treatment strategies. Some risk factors have produced conflicting results, and several remain underexplored, emphasizing the ongoing need for personalized studies encompassing all potential contributors to ICUAW development.
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Affiliation(s)
- Rocío Fuentes-Aspe
- Departamento Ciencias de la Rehabilitación, Facultad de Medicina, Universidad de La Frontera, Claro Solar 115, Temuco, Chile
- Facultad de Medicina, Centro de Excelencia CIGES, Universidad de La Frontera, Temuco, Chile
| | - Ruvistay Gutierrez-Arias
- Departamento de Apoyo en Rehabilitación Cardiopulmonar Integral, Instituto Nacional del Tórax, Santiago, Chile
- Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
- INTRehab Research Group, Instituto Nacional del Tórax, Santiago, Chile
| | - Felipe González-Seguel
- School of Physical Therapy, Faculty of Medicine, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, USA
| | - Gabriel Nasri Marzuca-Nassr
- Departamento Ciencias de la Rehabilitación, Facultad de Medicina, Universidad de La Frontera, Claro Solar 115, Temuco, Chile
| | - Rodrigo Torres-Castro
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Jasim Najum-Flores
- Hospital Dr. Hernán Henríquez Aravena, Unidad de Paciente Crítico Adulto, Temuco, Chile
| | - Pamela Seron
- Departamento Ciencias de la Rehabilitación, Facultad de Medicina, Universidad de La Frontera, Claro Solar 115, Temuco, Chile.
- Facultad de Medicina, Centro de Excelencia CIGES, Universidad de La Frontera, Temuco, Chile.
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Schmidbauer ML, Putz T, Gehri L, Ratkovic L, Maskos A, Zibold J, Bauchmüller J, Imhof S, Weig T, Wuehr M, Dimitriadis K. Accelerometer-derived movement features as predictive biomarkers for muscle atrophy in neurocritical care: a prospective cohort study. Crit Care 2024; 28:288. [PMID: 39217360 PMCID: PMC11366141 DOI: 10.1186/s13054-024-05067-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 08/15/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Physical inactivity and subsequent muscle atrophy are highly prevalent in neurocritical care and are recognized as key mechanisms underlying intensive care unit acquired weakness (ICUAW). The lack of quantifiable biomarkers for inactivity complicates the assessment of its relative importance compared to other conditions under the syndromic diagnosis of ICUAW. We hypothesize that active movement, as opposed to passive movement without active patient participation, can serve as a valid proxy for activity and may help predict muscle atrophy. To test this hypothesis, we utilized non-invasive, body-fixed accelerometers to compute measures of active movement and subsequently developed a machine learning model to predict muscle atrophy. METHODS This study was conducted as a single-center, prospective, observational cohort study as part of the MINCE registry (metabolism and nutrition in neurointensive care, DRKS-ID: DRKS00031472). Atrophy of rectus femoris muscle (RFM) relative to baseline (day 0) was evaluated at days 3, 7 and 10 after intensive care unit (ICU) admission and served as the dependent variable in a generalized linear mixed model with Least Absolute Shrinkage and Selection Operator regularization and nested-cross validation. RESULTS Out of 407 patients screened, 53 patients (age: 59.2 years (SD 15.9), 31 (58.5%) male) with a total of 91 available accelerometer datasets were enrolled. RFM thickness changed - 19.5% (SD 12.0) by day 10. Out of 12 demographic, clinical, nutritional and accelerometer-derived variables, baseline RFM muscle mass (beta - 5.1, 95% CI - 7.9 to - 3.8) and proportion of active movement (% activity) (beta 1.6, 95% CI 0.1 to 4.9) were selected as significant predictors of muscle atrophy. Including movement features into the prediction model substantially improved performance on an unseen test data set (including movement features: R2 = 79%; excluding movement features: R2 = 55%). CONCLUSION Active movement, as measured with thigh-fixed accelerometers, is a key risk factor for muscle atrophy in neurocritical care patients. Quantifiable biomarkers reflecting the level of activity can support more precise phenotyping of ICUAW and may direct tailored interventions to support activity in the ICU. Studies addressing the external validity of these findings beyond the neurointensive care unit are warranted. TRIAL REGISTRATION DRKS00031472, retrospectively registered on 13.03.2023.
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Affiliation(s)
| | - Timon Putz
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Leon Gehri
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Luka Ratkovic
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Andreas Maskos
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Julia Zibold
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Johanna Bauchmüller
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Sophie Imhof
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Thomas Weig
- Department of Anaesthesiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Max Wuehr
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
- German Center for Vertigo and Balance Disorders (DSGZ), LMU University Hospital, LMU Munich, Munich, Germany
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Goswami K, Kumari L, Maaz M. Letter to the Editor: Acute Skeletal Muscle Wasting is Associated with Prolonged Hospital Stay in Critical Illness with Brain Injury. Neurocrit Care 2024:10.1007/s12028-024-02103-1. [PMID: 39179944 DOI: 10.1007/s12028-024-02103-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2024] [Accepted: 08/08/2024] [Indexed: 08/26/2024]
Affiliation(s)
- Kertee Goswami
- Liaquat University of Medical and Health Sciences, Bungalow No#2, Doctors Colony, Jamshoro, Pakistan.
| | - Lata Kumari
- Gambat Institute of Medical Sciences, Gambat, Shop No# 7/1 Al-Rahim Villaz, Pakistan
| | - Muhammad Maaz
- Shaheed Mohtarma Benazir Bhutto Medical College Liyari, Flat No. B-16, Hasham Apartment, Rafa-e-aam, Malir Halt, Karachi, Pakistan
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6
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Zhang Y, Pan S, Hu Y, Ling B, Hua T, Tang L, Yang M. Establishing an artificial intelligence-based predictive model for long-term health-related quality of life for infected patients in the ICU. Heliyon 2024; 10:e35521. [PMID: 39170285 PMCID: PMC11336746 DOI: 10.1016/j.heliyon.2024.e35521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 07/30/2024] [Accepted: 07/30/2024] [Indexed: 08/23/2024] Open
Abstract
Objective To develop a model using a Chinese ICU infection patient database to predict long-term health-related quality of life (HRQOL) in survivors. Methods A patient database from the ICU of the Fourth People's Hospital in Zigong was analyzed, including data from 2019 to 2020. The subjects of the study were ICU infection survivors, and their post-discharge HRQOL was assessed through the SF-36 survey. The primary outcomes were the physical component summary (PCS) and mental component summary (MCS). We used artificial intelligence techniques for both feature selection and model building. Least absolute shrinkage and selection operator regression was used for feature selection, extreme gradient boosting (XGBoost) was used for model building, and the area under the receiver operating characteristic curve (AUROC) was used to assess model performance. Results The study included 917 ICU infection survivors. The median follow-up was 507.8 days. Their SF-36 scores, including PCS and MCS, were below the national average. The final prognostic model showed an AUROC of 0.72 for PCS and 0.63 for MCS. Within the sepsis subgroup, the predictive model AUROC values for PCS and MCS were 0.76 and 0.68, respectively. Conclusions This study established a valuable prognostic model using artificial intelligence to predict long-term HRQOL in ICU infection patients, which supports clinical decision making, but requires further optimization and validation.
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Affiliation(s)
- Yang Zhang
- The Second Department of Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230601, PR China
- Laboratory of Cardiopulmonary Resuscitation and Critical Care, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230601, PR China
| | - Sinong Pan
- The Second Department of Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230601, PR China
- Laboratory of Cardiopulmonary Resuscitation and Critical Care, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230601, PR China
| | - Yan Hu
- The Second Department of Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230601, PR China
- Laboratory of Cardiopulmonary Resuscitation and Critical Care, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230601, PR China
| | - Bingrui Ling
- The Second Department of Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230601, PR China
- Laboratory of Cardiopulmonary Resuscitation and Critical Care, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230601, PR China
| | - Tianfeng Hua
- The Second Department of Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230601, PR China
- Laboratory of Cardiopulmonary Resuscitation and Critical Care, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230601, PR China
| | - Lunxian Tang
- The Second Department of Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230601, PR China
- Department of Internal Emergency Medicine (North), Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, PR China
| | - Min Yang
- The Second Department of Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230601, PR China
- Laboratory of Cardiopulmonary Resuscitation and Critical Care, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230601, PR China
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Chuang YC, Shiu SI, Lee YC, Tsai YL, Cheng YY. Prevalence and Risk Factors of Intensive Care Unit-acquired Weakness in Patients With COVID-19: A Systematic Review and Meta-analysis. J Intensive Care Med 2024:8850666241268437. [PMID: 39140376 DOI: 10.1177/08850666241268437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
BACKGROUND Intensive care unit acquired weakness (ICUAW) is a common neuromuscular complication of critical illness, impacting patients' recovery and long-term outcomes. However, limited evidence is available on pooled prevalence and risk factors of ICUAW specifically in the COVID-19-infected population. METHODS We searched on PubMed, Embase, Cochrane Library, Web of Science, PEDro, and EBSCOhost/CINAHL up to January 31, 2024. Data synthesis was conducted using the Freeman-Tukey double-arcsine transformation model for the pooled prevalence rate and odds ratios with corresponding 95% confidence intervals was used to identify risk factors. RESULTS The pooled prevalence of ICUAW in COVID-19 patients was 55% in eight studies on 868 patients. Risk factors for developing ICUAW in these patients were: old age (WMD 4.78, 95% CI, 1.06-8.49), pre-existing hypertension (OR = 1.63, 95% CI, 1.02-2.61), medical intervention of prone position (OR = 5.21, 95% CI, 2.72-9.98), use of neuromuscular blocking agents (NMBA) (OR = 12.04, 95% CI, 6.20-23.39), needed tracheostomy (OR = 18.07, 95% CI, 5.64-57.92) and renal replacement therapy (RRT) (OR = 5.24, 95% CI = 2.36-11.63). CONCLUSIONS The prevalence of ICUAW in patients with COVID-19 was considered relatively high. Older age, pre-existing hypertension, medical intervention of prone position, NMBA use, needed tracheostomy and RRT were likely risk factors. In the future, interdisciplinary medical team should pay attention to high-risk groups for ICUAW prevention and early treatments.
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Affiliation(s)
- Ya-Chi Chuang
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Sz-Iuan Shiu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Evidence-Based Practice and Policymaking Committee, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Yu-Chun Lee
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Department of Exercise Health Science, National Taiwan University of Sport, Taichung, Taiwan, ROC
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan, ROC
| | - Yu-Lin Tsai
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan, ROC
| | - Yuan-Yang Cheng
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
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8
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Cussen J, Mukpradab S, Tobiano G, Haines KJ, O'Connor L, Marshall AP. Exploring critically ill patients' functional recovery through family partnerships: A descriptive qualitative study. Aust Crit Care 2024:S1036-7314(24)00120-6. [PMID: 39107155 DOI: 10.1016/j.aucc.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 05/02/2024] [Accepted: 06/11/2024] [Indexed: 08/09/2024] Open
Abstract
BACKGROUND Early mobilisation interventions play a role in preventing intensive care unit-acquired weakness in critically ill patients and may contribute to improved recovery. Patient-and-family-centred care includes collaborative partnerships between healthcare professionals and families and is a potential strategy to promote early mobilisation in critical care; however, we currently do not know family member preferences for partnering and involvement in early mobilisation interventions. OBJECTIVES The objective of this study was to explore family member perspectives on the acceptability and feasibility of partnering with healthcare professionals in early mobilisation interventions for adult critically ill patients. METHODS A descriptive qualitative design. Semistructured interviews were conducted with family members of adult critically ill patients admitted to an intensive care unit. Data were collected through individual audio-recorded interviews. Interview data were analysed using the six phases of thematic analysis described by Braun and Clark. This study is reported following the Consolidated Criteria for Reporting Qualitative Research guidelines. RESULTS Most family members of critically ill patients found the idea of partnering with healthcare professionals in early mobilisation interventions acceptable and feasible, although none had ever considered a partnership before. Participants thought their involvement in early mobilisation would have a positive impact on both the patient's and their own wellbeing. Themes uncovered showed that understanding family-member readiness and their need to feel welcome and included in the unfamiliar critical care environment are required before family member and healthcare professional partnerships in early mobilisation interventions can be enacted. CONCLUSIONS Family members found partnering with healthcare professionals in early mobilisation interventions acceptable and feasible to enact, but implementation is influenced by their readiness and sense of belonging.
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Affiliation(s)
- Julie Cussen
- Gold Coast University Hospital, Southport, Queensland, Australia; Griffith University, Southport, Queensland, Australia.
| | - Sasithorn Mukpradab
- Griffith University, Southport, Queensland, Australia; Faculty of Nursing, Prince of Songkla University, Hat Yai, Thailand.
| | - Georgia Tobiano
- Gold Coast University Hospital, Southport, Queensland, Australia; Griffith University, Southport, Queensland, Australia.
| | - Kimberley J Haines
- Physiotherapy Department, Western Health, Melbourne, Victoria, Australia; Department of Critical Care, Melbourne Medical School, The University of Melbourne, Victoria, Australia.
| | - Lauren O'Connor
- Gold Coast University Hospital, Southport, Queensland, Australia.
| | - Andrea P Marshall
- Gold Coast University Hospital, Southport, Queensland, Australia; Griffith University, Southport, Queensland, Australia.
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Augustin KJ, Wieruszewski PM, McLean L, Leiendecker E, Ramakrishna H. Analysis of the 2023 European Multidisciplinary Consensus Statement on the Management of Short-term Mechanical Circulatory Support of Cardiogenic Shock in Adults in the Intensive Cardiac Care Unit. J Cardiothorac Vasc Anesth 2024; 38:1786-1801. [PMID: 38862282 DOI: 10.1053/j.jvca.2024.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 04/21/2024] [Indexed: 06/13/2024]
Affiliation(s)
- Katrina Joy Augustin
- Division of Anesthesia and Critical Care Medicine, Department of Anesthesiology & Perioperative Medicine, Mayo Clinic, Rochester, MN; Department of Emergency Medicine, Mayo Clinic, Rochester, MN
| | - Patrick M Wieruszewski
- Department of Pharmacy, Mayo Clinic, Rochester, MN; Department of Anesthesiology, Mayo Clinic, Rochester, MN
| | - Lewis McLean
- Intensive Care Unit, John Hunter Hospital, Newcastle, Australia
| | | | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
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Maia TFLD, Magalhães PAF, Santos DTS, de Brito Gomes JL, Schwingel PA, de Freitas Brito A. Current Concepts in Early Mobilization of Critically Ill Patients Within the Context of Neurologic Pathology. Neurocrit Care 2024; 41:272-284. [PMID: 38396279 DOI: 10.1007/s12028-023-01934-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 12/27/2023] [Indexed: 02/25/2024]
Abstract
Neurocritical patients (NCPs) in the intensive care unit (ICU) rapidly progress to respiratory and peripheral muscle dysfunctions, which significantly impact morbidity and death. Early mobilization in NCPs to decrease the incidence of ICU-acquired weakness has been showing rapid growth, although pertinent literature is still scarce. With this review, we summarize and discuss current concepts in early mobilization of critically ill patients within the context of neurologic pathology in NCPs. A narrative synthesis of literature was undertaken trying to answer the following questions: How do the respiratory and musculoskeletal systems in NCPs behave? Which metabolic biomarkers influence physiological responses in NCPs? Which considerations should be taken when prescribing exercises in neurocritically ill patients? The present review detected safety, feasibility, and beneficial response for early mobilization in NCPs, given successes in other critically ill populations and many smaller intervention trials in neurocritical care. However, precautions should be taken to elect the patient for early care, as well as monitoring signs that indicate interruption for intervention, as worse outcomes were associated with very early mobilization in acute stroke trials.
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Affiliation(s)
- Thaís Ferreira Lopes Diniz Maia
- Post Graduation Program in Rehabilitation and Functional Performance, Universidade de Pernambuco, BR 203, Km 2, s/n, Vila Eduardo, 56, Petrolina, Pernambuco, 328-900, Brazil.
| | - Paulo André Freire Magalhães
- Post Graduation Program in Rehabilitation and Functional Performance, Universidade de Pernambuco, BR 203, Km 2, s/n, Vila Eduardo, 56, Petrolina, Pernambuco, 328-900, Brazil
| | - Dasdores Tatiana Silva Santos
- Post Graduation Program in Rehabilitation and Functional Performance, Universidade de Pernambuco, BR 203, Km 2, s/n, Vila Eduardo, 56, Petrolina, Pernambuco, 328-900, Brazil
| | - Jorge Luiz de Brito Gomes
- Post Graduation Program in Rehabilitation and Functional Performance, Universidade de Pernambuco, BR 203, Km 2, s/n, Vila Eduardo, 56, Petrolina, Pernambuco, 328-900, Brazil
| | - Paulo Adriano Schwingel
- Post Graduation Program in Rehabilitation and Functional Performance, Universidade de Pernambuco, BR 203, Km 2, s/n, Vila Eduardo, 56, Petrolina, Pernambuco, 328-900, Brazil
| | - Aline de Freitas Brito
- Post Graduation Program in Rehabilitation and Functional Performance, Universidade de Pernambuco, BR 203, Km 2, s/n, Vila Eduardo, 56, Petrolina, Pernambuco, 328-900, Brazil
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11
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Negro M, Crisafulli O, D'Antona G. Effects of essential amino acid (EAA) and glutamine supplementation on skeletal muscle wasting in acute, subacute, and postacute conditions. Clin Nutr ESPEN 2024; 62:224-233. [PMID: 38843393 DOI: 10.1016/j.clnesp.2024.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 05/24/2024] [Accepted: 05/25/2024] [Indexed: 06/22/2024]
Abstract
Under optimal physiological conditions, muscle mass maintenance is ensured by dietary protein, which balances the amino acid loss during the post-absorption period and preserves the body's protein homeostasis. Conversely, in critical clinical conditions (acute, subacute or postacute), particularly those related to hypomobility or immobility, combined with malnutrition, and local/systemic inflammation, the loss of muscle mass and strength can be quantitatively significant. A decline of more than 1% in muscle mass and of more than 3% in muscle strength has been registered in subjects with aged 20-37 yr after just five days of bed rest, similarly to those observed during one year of age-related decline in individuals over the age of 50. Loss of muscle mass and strength can have a dramatic effect on subjects' functional capacities, on their systemic metabolic control and on the amino acid reserve function, all of which are fundamental for the maintenance of other organs' and tissues' cell processes. References available indicate that the average 1%-2% reduction per day of muscle mass in patients in the intensive care unit (ICU) could represent an independent predictor of hospital mortality and physical disability in the five years following hospitalization. After just a few days or weeks of administration, supplementation with EAAs and glutamine has shown significant effects in maintaining muscle size and strength, which are typically negatively affected by some acute/subacute or postacute critical conditions (muscle recovery after surgery, oncology patients, ICU treatments), especially in the elderly or in those with pre-existing degenerative diseases. In this review, we focused on the theoretical bases and the most relevant clinical studies of EAA and glutamine supplementation as a single compound, with the aim of clarifying whether their combined use in a blend (EAAs-glutamine) could be potentially synergistic to prevent disease-related muscle wasting and its impact on the duration and quality of patients' clinical course.
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Affiliation(s)
- Massimo Negro
- Centro di Ricerca Interdipartimentale nelle Attività Motorie e Sportive (CRIAMS) - Sport Medicine Centre, University of Pavia, Voghera, Italy
| | - Oscar Crisafulli
- Centro di Ricerca Interdipartimentale nelle Attività Motorie e Sportive (CRIAMS) - Sport Medicine Centre, University of Pavia, Voghera, Italy
| | - Giuseppe D'Antona
- Centro di Ricerca Interdipartimentale nelle Attività Motorie e Sportive (CRIAMS) - Sport Medicine Centre, University of Pavia, Voghera, Italy; Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy.
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Khattar G, Bou Sanayeh E. Advancing critical care recovery: The pivotal role of machine learning in early detection of intensive care unit-acquired weakness. World J Clin Cases 2024; 12:4455-4459. [PMID: 39070840 PMCID: PMC11235497 DOI: 10.12998/wjcc.v12.i21.4455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/14/2024] [Accepted: 05/27/2024] [Indexed: 06/30/2024] Open
Abstract
This editorial explores the significant challenge of intensive care unit-acquired weakness (ICU-AW), a prevalent condition affecting critically ill patients, characterized by profound muscle weakness and complicating patient recovery. Highlighting the paradox of modern medical advances, it emphasizes the urgent need for early identification and intervention to mitigate ICU-AW's impact. Innovatively, the study by Wang et al is showcased for employing a multilayer perceptron neural network model, achieving high accuracy in predicting ICU-AW risk. This advancement underscores the potential of neural network models in enhancing patient care but also calls for continued research to address limitations and improve model applicability. The editorial advocates for the development and validation of sophisticated predictive tools, aiming for personalized care strategies to reduce ICU-AW incidence and severity, ultimately improving patient outcomes in critical care settings.
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Affiliation(s)
- Georges Khattar
- Department of Medicine, Staten Island University Hospital, Staten Island, NY 10305, United States
| | - Elie Bou Sanayeh
- Department of Medicine, Staten Island University Hospital, Staten Island, NY 10305, United States
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Liu M, Chen YT, Wang GL, Wu XM. Risk factors for intensive-care-unit-acquired weakness. World J Clin Cases 2024; 12:4853-4855. [PMID: 39070851 PMCID: PMC11235492 DOI: 10.12998/wjcc.v12.i21.4853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/08/2024] [Accepted: 06/05/2024] [Indexed: 06/30/2024] Open
Abstract
Wang et al reported 1063 cases from the initial 14 d of intensive care unit (ICU) stay, and analyzed relevant data such as age, comorbidities, recent dosages, vapor pressure dosages, duration of mechanical ventilation, length of ICU stay, and rehabilitation therapy, which are closely related to ICU-acquired weakness (ICU-AW). It is suggested that the length of ICU stay and the duration of mechanical ventilation are the main factors. ICU-AW is the most common neuromuscular injury in the ICU, which affects clinical progression and outcomes of patients. This manuscript helps to improve the early recognition of ICU-AW, thereby reducing mortality and improving prognosis.
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Affiliation(s)
- Ming Liu
- Department of Pediatric Neurology, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Yu-Tong Chen
- Department of Pediatric Neurology, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Guang-Liang Wang
- Department of Cardiology, Guo Jin Hospital, Changchun 130000, Jilin Province, China
| | - Xue-Mei Wu
- Department of Pediatric Neurology, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
- Jilin Provincial Key Laboratory of Pediatric Neurology, Jilin Provincial Key Laboratory, Changchun 130000, Jilin Province, China
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Cerrito A, Fang J, Schertenleib SJG, Hunt KJ, Schmitt KU. First iteration of a User-Centered Design process to develop an in-bed leg press. Technol Health Care 2024:THC240816. [PMID: 39093093 DOI: 10.3233/thc-240816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
BACKGROUND Physical inactivity is prevalent among hospitalized patients and the daytime spent lying should be utilised for exercise. However, implementing new interventions in hospitals' complex daily routines is difficult and requires a participatory approach. OBJECTIVE Exploring clinical settings and clinicians' perspectives regarding exercise in hospitalized patients to gauge the potential of further development of an in-bed training device and to formulate development goals. METHODS A User-Centered Design approach was employed, consisting of work shadowing and focus groups with physiotherapists and nurses. Content and network analyses of the focus group data were performed. Personas were then developed and used to create clinical scenarios. RESULTS Some clinicians perceived in-bed exercise counterproductive, while others recognized potential for unsupervised training. The most important design characteristics appeared to be a small size, low weight and simplicity of use to facilitate storage, transportation, and administration, respectively. The scenarios revealed that the device's use could increase the physical activity time by 1.4%, although it would also increase the working time of clinicians. CONCLUSION The study highlighted the difficulties in developing a usable training device but encouraged the authors to pursue their efforts under the strict condition of following the formulated development goals.
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Affiliation(s)
- Adrien Cerrito
- Academic-Practice-Partnership between Bern University of Applied Sciences and Insel Gruppe, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Juan Fang
- The Laboratory for Rehabilitation Engineering, Institute for Human Centered Engineering HuCE, School of Engineering and Computer Science, Bern University of Applied Sciences, Biel, Switzerland
| | - Simón Javier Gamero Schertenleib
- The Laboratory for Rehabilitation Engineering, Institute for Human Centered Engineering HuCE, School of Engineering and Computer Science, Bern University of Applied Sciences, Biel, Switzerland
| | - Kenneth James Hunt
- The Laboratory for Rehabilitation Engineering, Institute for Human Centered Engineering HuCE, School of Engineering and Computer Science, Bern University of Applied Sciences, Biel, Switzerland
| | - Kai-Uwe Schmitt
- Academic-Practice-Partnership between Bern University of Applied Sciences and Insel Gruppe, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
- Department of Nursing, Bern University Hospital, Bern, Switzerland
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Ayenew T, Gedfew M, Fetene MG, Workneh BS, Telayneh AT, Edmealem A, Tiruneh BG, Yinges GT, Getie A, Meselu MA. Prevalence of mortality among mechanically ventilated patients in the intensive care units of Ethiopian hospitals and the associated factors: A systematic review and meta-analysis. PLoS One 2024; 19:e0306277. [PMID: 39042621 PMCID: PMC11265714 DOI: 10.1371/journal.pone.0306277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 06/13/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND In the intensive care unit (ICU), mechanical ventilation (MV) is a typical way of respiratory support. The severity of the illness raises the likelihood of death in patients who require MV. Several studies have been done in Ethiopia; however, the mortality rate differs among them. The objective of this systematic review and meta-analysis is to provide a pooled prevalence of mortality and associated factors among ICU-admitted patients receiving MV in Ethiopian hospitals. METHODS We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 criteria to conduct a comprehensive systematic review and meta-analysis in this study. We searched PubMed/Medline, SCOPUS, Embase, Hinari, and Web of Science and found 22 articles that met our inclusion criteria. We used a random-effects model. To identify heterogeneity within the included studies, meta-regression and subgroup analysis were used. We employed Egger's regression test and funnel plots for assessing publication bias. STATA version 17.0 software was used for all statistical analyses. RESULTS In this systematic review and meta-analysis, the pooled prevalence of mortality among 7507 ICU-admitted patients from 22 articles, who received MV was estimated to be 54.74% [95% CI = 47.93, 61.55]. In the subgroup analysis by region, the Southern Nations, Nationalities, and Peoples (SNNP) subgroup (64.28%, 95% CI = 51.19, 77.37) had the highest prevalence. Patients with COVID-19 have the highest mortality rate (75.80%, 95% CI = 51.10, 100.00). Sepsis (OR = 6.85, 95%CI = 3.24, 14.46), Glasgow Coma Scale (GCS) score<8 (OR = 6.58, 95%CI = 1.96, 22.11), admission with medical cases (OR = 4.12, 95%CI = 2.00, 8.48), Multi Organ Dysfunction Syndrome (MODS) (OR = 2.70, 95%CI = 4.11, 12.62), and vasopressor treatment (OR = 19.06, 95%CI = 9.34, 38.88) were all statistically associated with mortality. CONCLUSION Our review found that the pooled prevalence of mortality among mechanically ventilated ICU-admitted patients in Ethiopia was considerably high compared to similar studies in the United States (US), China, and other countries. Sepsis, GCS<8, medical cases, MODS, and use of vasopressors were statistically associated with mortality. Clinicians should exercise caution while mechanically ventilating ICU-admitted patients with these factors. However, it should be noted that the exact cause and effect relationship could not be established with this meta-analysis, as the available evidence is not sufficient. Thus, more studies using prospective methods will be required.
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Affiliation(s)
- Temesgen Ayenew
- Department of Nursing, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Mihretie Gedfew
- Department of Nursing, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Mamaru Getie Fetene
- Department of Midwifery, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Belayneh Shetie Workneh
- Department of Emergency Medicine and Critical Care Nursing, University of Gondar, Gondar, Ethiopia
| | - Animut Takele Telayneh
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Afework Edmealem
- Department of Nursing, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Bekele Getenet Tiruneh
- Department of Internal Medicine, School of Medicine, Debre Markos University, Debre Markos, Ethiopia
| | | | - Addisu Getie
- Department of Nursing, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Mengistu Abebe Meselu
- Department of Nursing, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Yao H, Zhang J, Jiang R, Xie Q, Zhou C, Yang Y, Zeng Z, Zhang W. Early predictive value of ultrasound measurements of rectus femoris cross-sectional area to diagnose ICU-acquired weakness in patients undergoing invasive mechanical ventilation: a prospective cohort study. Eur J Med Res 2024; 29:379. [PMID: 39033122 PMCID: PMC11264894 DOI: 10.1186/s40001-024-01966-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 07/08/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND The diagnosis of ICU-acquired weakness (ICUAW) may be delayed due to the complexity of critically ill patients. This study aimed to investigate the value of ultrasound measurements of rectus femoris cross-sectional area (RFCSA) in predicting ICUAW in patients undergoing invasive mechanical ventilation. METHODS This was a prospective cohort study of patients undergoing mechanical ventilation for at least 48 h. RFCSA was measured using ultrasound in patients upon ICU admission and followed until discharge. Using the Medical Research Council score as the gold standard, we evaluated the diagnostic value of ultrasound measurements in predicting ICUAW. Kaplan-Meier curves were constructed to evaluate and compare the length of ICU stay and duration of invasive mechanical ventilation between patients with and without ICUAW. RESULTS Among the 76 patients, 34 (44.7%) were diagnosed with ICUAW using the Medical Research Council score as the gold standard. The RFCSA atrophy rate between day 1 and day 3 was significantly higher in the ICUAW group (7.9 ± 2.8% vs. 4.3 ± 2.1%, p < 0.001). By utilizing a cutoff point of 6.9%, we discovered that the RFCSA atrophy rate exhibited excellent diagnostic accuracy in predicting ICUAW, with a sensitivity of 76.5% and specificity of 92.9%. In ICUAW patients diagnosed based on an RFCSA atrophy rate, the proportion of patients with an ICU stay longer than 14 days was 42.9%, which was significantly higher compared to 22.9% in the non-ICUAW group (HR: 1.768; 95% CI 1.128-2.772; p = 0.006). Similarly, the proportion of patients continuing mechanical ventilation at 14 days was 28.6% versus 4.2% between the two groups (HR: 1.988; 95% CI 1.266-3.120; p < 0.001). CONCLUSION Ultrasound measurements of RFCSA provide a reliable method for diagnosing ICUAW and indicating prognosis in patients undergoing invasive mechanical ventilation.
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Affiliation(s)
- Huiming Yao
- Department of Critical Care Medicine, Medical Center of Anesthesiology and Pain, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Jie Zhang
- Department of Critical Care Medicine, Medical Center of Anesthesiology and Pain, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Rong Jiang
- Department of Critical Care Medicine, Medical Center of Anesthesiology and Pain, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Qian Xie
- Department of Critical Care Medicine, Medical Center of Anesthesiology and Pain, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Chaoqi Zhou
- Department of Critical Care Medicine, Medical Center of Anesthesiology and Pain, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Yuting Yang
- Department of Critical Care Medicine, Medical Center of Anesthesiology and Pain, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Zhenguo Zeng
- Department of Critical Care Medicine, Medical Center of Anesthesiology and Pain, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China.
| | - Wei Zhang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China.
- Jiangxi Provincial Key Laboratory of Respiratory Diseases, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China.
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Akama Y, Park EJ, Satoh-Takayama N, Ito A, Kawamoto E, Gaowa A, Matsuo E, Oikawa S, Saito M, Inoue S, Akimoto T, Suzuki K, Shimaoka M. Roles of programmed death-1 and muscle innate lymphoid cell-derived interleukin 13 in sepsis-induced intensive care unit-acquired weakness. J Cachexia Sarcopenia Muscle 2024. [PMID: 39016179 DOI: 10.1002/jcsm.13548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 06/13/2024] [Accepted: 06/25/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND Intensive care unit-acquired weakness (ICU-AW) is a syndrome characterized by a long-term muscle weakness often observed in sepsis-surviving patients during the chronic phase. Although ICU-AW is independently associated with increased mortality, effective therapies have yet to be established. Programmed death-1 (PD-1) inhibitors have attracted attention as potential treatments for reversing immune exhaustion in sepsis; however, its impact on ICU-AW remains to be elucidated. Here, we study how PD-1 deficiency affects sepsis-induced skeletal muscle dysfunction in a preclinical sepsis model. METHODS Chronic sepsis model was developed by treating wild-type (WT) and PD-1 knockout (KO) mice with caecal slurry, followed by resuscitation with antibiotics and saline. Mice were euthanized on days 15-17. Body weights, muscle weights, and limb muscle strengths were measured. Interleukin 13 (IL-13) and PD-1 expressions were examined by flow cytometry. Messenger RNA (mRNA) expressions of slow-twitch muscles were measured by reverse transcription and quantitative polymerase chain reaction (RT-qPCR). In an in vitro study, C2C12 myotubes were treated with lipopolysaccharide (LPS) and recombinant IL-13 followed by gene expression measurements. RESULTS WT septic mice exhibited decreased muscle weight (quadriceps, P < 0.01; gastrocnemius, P < 0.05; and tibialis anterior, P < 0.01) and long-term muscle weakness (P < 0.0001), whereas PD-1 KO septic mice did not exhibit any reduction in muscle weights and strengths. Slow-twitch specific mRNAs, including myoglobin (Mb), troponin I type 1 (Tnni1), and myosin heavy chain 7 (Myh7) were decreased in WT skeletal muscle (Mb, P < 0.0001; Tnni1, P < 0.05; and Myh7, P < 0.05) after sepsis induction, but mRNA expressions of Tnni1 and Myh7 were increased in PD-1 KO septic mice (Mb, not significant; Tnni1, P < 0.0001; and Myh7, P < 0.05). Treatment of C2C12 myotube cells with LPS decreased the expression of slow-twitch mRNAs, which was restored by IL-13 (Mb, P < 0.0001; Tnni1, P < 0.001; and Myh7, P < 0.05). IL-13 production was significantly higher in ILC2s compared to T cells in skeletal muscle (P < 0.05). IL-13-producing ILC2s in skeletal muscle were examined and found to increase in PD-1 KO septic mice, compared with WT septic mice (P < 0.05). ILC2-derived IL-13 was increased by PD-1 KO septic mice and thought to protect the muscles from experimental ICU-AW. CONCLUSIONS Long-term muscle weakness in experimental ICU-AW was ameliorated in PD-1 KO mice. ILC2-derived IL-13 production in skeletal muscles was increased in PD-1 KO mice, thereby suggesting that IL-13 alleviates muscle weakness during sepsis. This study demonstrates the effects of PD-1 blockade in preserving muscle strength during sepsis through an increase in ILC2-derived IL-13 and may be an attractive therapeutic target for sepsis-induced ICU-AW.
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Affiliation(s)
- Yuichi Akama
- Department of Molecular Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, Tsu, Japan
- Department of Emergency and Critical Care Medicine, Mie University Graduate School of Medicine, Tsu, Japan
| | - Eun Jeong Park
- Department of Molecular Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Naoko Satoh-Takayama
- Precision Immune Regulation RIKEN Research Unit, Center for Integrative Medical Sciences, RIKEN, Yokohama, Japan
| | - Atsushi Ito
- Department of Molecular Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, Tsu, Japan
- Department of Thoracic and Cardiovascular Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Eiji Kawamoto
- Department of Molecular Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, Tsu, Japan
- Department of Emergency and Critical Care Medicine, Mie University Graduate School of Medicine, Tsu, Japan
| | - Arong Gaowa
- Department of Molecular Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Eri Matsuo
- Department of Molecular Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Satoshi Oikawa
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
| | - Masafumi Saito
- Department of Disaster and Emergency and Critical Care Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shigeaki Inoue
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, Wakayama, Japan
| | | | - Kei Suzuki
- Department of Emergency and Critical Care Medicine, Mie University Graduate School of Medicine, Tsu, Japan
| | - Motomu Shimaoka
- Department of Molecular Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, Tsu, Japan
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Zhou Y, Sun Y, Pan Y, Dai Y, Xiao Y, Yu Y. Risk prediction models for intensive care unit-acquired weakness in critically ill patients: A systematic review. Aust Crit Care 2024:S1036-7314(24)00090-0. [PMID: 39013706 DOI: 10.1016/j.aucc.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/27/2024] [Accepted: 05/02/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND Intensive care unit (ICU)-acquired weakness (ICU-AW) is a critical complication that significantly worsens patient prognosis. It is widely thought that risk prediction models can be harnessed to guide preventive interventions. While the number of ICU-AW risk prediction models is increasing, the quality and applicability of these models in clinical practice remain unclear. OBJECTIVE The objective of this study was to systematically review published studies on risk prediction models for ICU-AW. METHODS We searched electronic databases (PubMed, Web of Science, The Cochrane Library, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), China National Knowledge Infrastructure (CNKI), China Science and Technology Periodical Database (VIP), and Wanfang Database) from inception to October 2023 for studies on ICU-AW risk prediction models. Two independent researchers screened the literature, extracted data, and assessed the risk of bias and applicability of the included studies. RESULTS A total of 2709 articles were identified. After screening, 25 articles were selected, encompassing 25 risk prediction models. The area under the curve for these models ranged from 0.681 to 0.926. Evaluation of bias risk indicated that all included models exhibited a high risk of bias, with three models demonstrating poor applicability. The top five predictors among these models were mechanical ventilation duration, age, Acute Physiology and Chronic Health Evaluation II score, blood lactate levels, and the length of ICU stay. The combined area under the curve of the ten validation models was 0.83 (95% confidence interval: 0.77-0.88), indicating a strong discriminative ability. CONCLUSIONS Overall, ICU-AW risk prediction models demonstrate promising discriminative ability. However, further optimisation is needed to address limitations, including data source heterogeneity, potential biases in study design, and the need for robust statistical validation. Future efforts should prioritise external validation of existing models or the development of high-quality predictive models with superior performance. REGISTRATION The protocol for this study is registered with the International Prospective Register of Systematic Reviews (registration number: CRD42023453187).
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Affiliation(s)
- Yue Zhou
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - YuJian Sun
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - YuFan Pan
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yu Dai
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yi Xiao
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - YuFeng Yu
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China.
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Barbosa FDS, Nascimento BSS, Silva MCDFS, Cerqueira TCF, de Santana Filho VJ. Impact of Muscle Changes Assessed by Ultrasonography on Muscle Strength and Functioning after ICU Discharge: A Systematic Review with Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:908. [PMID: 39063485 PMCID: PMC11276795 DOI: 10.3390/ijerph21070908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Revised: 07/01/2024] [Accepted: 07/02/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Ultrasonography has been used to identify structural, quantitative, and qualitative muscle changes. These changes have been assessed in different muscles during ICU stays; however, it is unclear if it can predict functioning after ICU discharge. OBJECTIVE To analyze the relationship between muscle changes assessed by ultrasonography and the strength and functioning of ICU survivors. METHODS A systematic review with a meta-analysis was performed according to the MOOSE guidelines and registered in PROSPERO. Searches of the following databases were performed by two of the authors: PubMed, Cinahl, Embase, Scopus, LILACS, Web of Science, and Science Direct. Qualitative analysis was performed using NOS and AHRQ scales. Meta-analysis was performed using the "R", "metafor" package. Heterogeneity was assessed by I2 and Cochran's Q test. Meta-regression analyses were performed to verify the moderators, and funnel plots and Egger's regression intercept test were used to analyze the publication bias. RESULTS Sixteen articles were included in the qualitative assessment, and nine were used in the quantitative assessment. There is evidence of correlations between MT and muscle strength (r = 0.20 [0.11; 0.27]; p < 0.0001), and MT (r = 0.35 [0.19; 0.49]; p < 0.0001), CSA (r = 0.30 [0.10; 0.47]; p = 0.0038), EI (r = -0.29 [-0.53; -0.01]; p = 0.043) and mobility. In the subgroup analyses, some evidence of a correlation between specific muscles and strength and mobility were found. CONCLUSIONS There is evidence for the correlation between muscle characteristics assessed by US and functioning outcomes.
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Affiliation(s)
- Felipe Douglas Silva Barbosa
- Department of Family Health and Occupational Therapy, Faculty of Medicine, Federal University of Bahia, Salvador 40026-010, BA, Brazil
- Post-Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju 49060-100, SE, Brazil;
| | - Brenda Stephanie Santos Nascimento
- Department of Physioterapy, Campus Lagarto, Federal University of Sergipe, Lagarto 49400-000, SE, Brazil; (B.S.S.N.); (M.C.d.F.S.S.); (T.C.F.C.)
| | - Maysa Carolina de França Souza Silva
- Department of Physioterapy, Campus Lagarto, Federal University of Sergipe, Lagarto 49400-000, SE, Brazil; (B.S.S.N.); (M.C.d.F.S.S.); (T.C.F.C.)
| | - Telma Cristina Fontes Cerqueira
- Department of Physioterapy, Campus Lagarto, Federal University of Sergipe, Lagarto 49400-000, SE, Brazil; (B.S.S.N.); (M.C.d.F.S.S.); (T.C.F.C.)
| | - Valter Joviniano de Santana Filho
- Post-Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju 49060-100, SE, Brazil;
- Department of Physioterapy, Campus São Cristóvão, Federal University of Sergipe, São Cristóvão 49100-000, SE, Brazil
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20
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Klawitter F, Laukien F, Fischer DC, Rahn A, Porath K, Danckert L, Bajorat R, Walter U, Patejdl R, Ehler J. Longitudinal Assessment of Blood-Based Inflammatory, Neuromuscular, and Neurovascular Biomarker Profiles in Intensive Care Unit-Acquired Weakness: A Prospective Single-Center Cohort Study. Neurocrit Care 2024:10.1007/s12028-024-02050-x. [PMID: 38982001 DOI: 10.1007/s12028-024-02050-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 06/13/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND The diagnosis of intensive care unit (ICU)-acquired weakness (ICUAW) and critical illness neuromyopathy (CINM) is frequently hampered in the clinical routine. We evaluated a novel panel of blood-based inflammatory, neuromuscular, and neurovascular biomarkers as an alternative diagnostic approach for ICUAW and CINM. METHODS Patients admitted to the ICU with a Sequential Organ Failure Assessment score of ≥ 8 on 3 consecutive days within the first 5 days as well as healthy controls were enrolled. The Medical Research Council Sum Score (MRCSS) was calculated, and motor and sensory electroneurography (ENG) for assessment of peripheral nerve function were performed at days 3 and 10. ICUAW was defined by an MRCSS < 48 and CINM by pathological ENG alterations, both at day 10. Blood samples were taken at days 3, 10, and 17 for quantitative analysis of 18 different biomarkers (white blood cell count, C-reactive protein, procalcitonin, C-terminal agrin filament, fatty-acid-binding protein 3, growth and differentiation factor 15, syndecan 1, troponin I, interferon-γ, tumor necrosis factor-α, interleukin-1α [IL-1α], IL-1β, IL-4, IL-6, IL-8, IL-10, IL-13, and monocyte chemoattractant protein 1). Results of the biomarker analysis were categorized according to the ICUAW and CINM status. Clinical outcome was assessed after 3 months. RESULTS Between October 2016 and December 2018, 38 critically ill patients, grouped into ICUAW (18 with and 20 without) and CINM (18 with and 17 without), as well as ten healthy volunteers were included. Biomarkers were significantly elevated in critically ill patients compared to healthy controls and correlated with disease severity and 3-month outcome parameters. However, none of the biomarkers enabled discrimination of patients with and without neuromuscular impairment, irrespective of applied classification. CONCLUSIONS Blood-based biomarkers are generally elevated in ICU patients but do not identify patients with ICUAW or CINM. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02706314.
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Affiliation(s)
- Felix Klawitter
- Department of Anesthesiology, Intensive Care Medicine, and Pain Therapy, Rostock University Medical Center, Rostock, 18057, Germany.
| | - Friederike Laukien
- Department of Anesthesiology, Intensive Care Medicine, and Pain Therapy, Rostock University Medical Center, Rostock, 18057, Germany
| | - Dagmar-C Fischer
- Department of Pediatrics, Rostock University Medical Center, Rostock, Germany
| | - Anja Rahn
- Department of Pediatrics, Rostock University Medical Center, Rostock, Germany
| | - Katrin Porath
- Oscar Langendorff Institute of Physiology, Rostock University Medical Center, Rostock, Germany
| | - Lena Danckert
- Department of Anesthesiology, Intensive Care Medicine, and Pain Therapy, Rostock University Medical Center, Rostock, 18057, Germany
| | - Rika Bajorat
- Department of Anesthesiology, Intensive Care Medicine, and Pain Therapy, Rostock University Medical Center, Rostock, 18057, Germany
| | - Uwe Walter
- Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Robert Patejdl
- Oscar Langendorff Institute of Physiology, Rostock University Medical Center, Rostock, Germany
- Department of Medicine, Health and Medical University Erfurt, Erfurt, Germany
| | - Johannes Ehler
- Department of Anesthesiology, Intensive Care Medicine, and Pain Therapy, Rostock University Medical Center, Rostock, 18057, Germany
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Jena, Jena, Germany
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21
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Santana-Padilla YG, Linares-Pérez T, Santana-López BN, Santana-Cabrera L. Dysphagia management by nurses in Spanish intensive care units. ENFERMERIA INTENSIVA 2024:S2529-9840(24)00031-4. [PMID: 38981780 DOI: 10.1016/j.enfie.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 02/18/2024] [Accepted: 02/26/2024] [Indexed: 07/11/2024]
Abstract
INTRODUCTION/PURPOSE Dysphagia is a disorder that presents with specific signs and symptoms in critically ill patients. Intensive care unit (ICU) nurses are responsible for monitoring and detecting abnormalities in critically ill patients, so they must be trained to assess swallowing and the complications that may arise. The aim of this research is to analyse the dynamics of the detection and assessment of dysphagia by ICU nurses. METHOD Cross-sectional descriptive study using an electronic questionnaire to nurses from different Spanish ICUs. The survey was adapted from previous research and consisted of 6 sections with 30 items of qualitative questions. The collection period was between December 2022 and March 2023. Statistical analysis was performed using frequencies and percentages, and the Chi-Square test was used for bivariate analysis. OUTCOMES 43 nurses were recruited. Dysphagia is considered an important problem (90,7%) but in 50,3% of the units there is no standard or care protocol for this disorder. The most common technique is the swallowing test (32,6%). There is a consensus in our sample that aspiration pneumonia is the main problem; however, nurses in the busiest care units consider sepsis to be a frequent complication (p = ,029). The most common treatment is modification of food consistency (86,0%). CONCLUSION The findings of this research show a low systematisation of dysphagia screening in the units included. There is a need for greater implementation of interventions and clinical protocols for monitoring complications as well as for compensatory and rehabilitative management.
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Affiliation(s)
- Y G Santana-Padilla
- Subdirección de Enfermería del Hospital Universitario Materno-Infantil de Canarias, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain.
| | - T Linares-Pérez
- Centro de Salud Cueva Torres, Gerencia de Atención Primaria, Las Palmas de Gran Canaria, Spain
| | - B N Santana-López
- Cuidados Intensivos, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain; Departamento de Enfermería, Universidad Fernando Pessoa-Canarias (UFPC), Santa María de Guía, Spain
| | - L Santana-Cabrera
- Medicina Intensiva, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
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22
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Sunder T. Intensive care unit-acquired weakness - preventive, and therapeutic aspects; future directions and special focus on lung transplantation. World J Clin Cases 2024; 12:3665-3670. [PMID: 38994273 PMCID: PMC11235433 DOI: 10.12998/wjcc.v12.i19.3665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/24/2024] [Accepted: 05/11/2024] [Indexed: 06/29/2024] Open
Abstract
In this editorial, comments are made on an interesting article in the recent issue of the World Journal of Clinical Cases by Wang and Long. The authors describe the use of neural network model to identify risk factors for the development of intensive care unit (ICU)-acquired weakness. This condition has now become common with an increasing number of patients treated in ICUs and continues to be a source of morbidity and mortality. Despite identification of certain risk factors and corrective measures thereof, lacunae still exist in our understanding of this clinical entity. Numerous possible pathogenetic mechanisms at a molecular level have been described and these continue to be increasing. The amount of retrievable data for analysis from the ICU patients for study can be huge and enormous. Machine learning techniques to identify patterns in vast amounts of data are well known and may well provide pointers to bridge the knowledge gap in this condition. This editorial discusses the current knowledge of the condition including pathogenesis, diagnosis, risk factors, preventive measures, and therapy. Furthermore, it looks specifically at ICU acquired weakness in recipients of lung transplantation, because - unlike other solid organ transplants- muscular strength plays a vital role in the preservation and survival of the transplanted lung. Lungs differ from other solid organ transplants in that the proper function of the allograft is dependent on muscle function. Muscular weakness especially diaphragmatic weakness may lead to prolonged ventilation which has deleterious effects on the transplanted lung - ranging from ventilator associated pneumonia to bronchial anastomotic complications due to prolonged positive pressure on the anastomosis.
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Affiliation(s)
- Thirugnanasambandan Sunder
- Department of Heart Lung Transplantation and Mechanical Circulatory Support, Apollo Hospitals, Chennai 600086, Tamil Nadu, India
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23
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Richardson BR, Decavèle M, Demoule A, Murtagh FEM, Johnson MJ. Breathlessness assessment, management and impact in the intensive care unit: a rapid review and narrative synthesis. Ann Intensive Care 2024; 14:107. [PMID: 38967813 PMCID: PMC11229436 DOI: 10.1186/s13613-024-01338-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 06/18/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Adults in the intensive care unit (ICU) commonly experience distressing symptoms and other concerns such as pain, delirium, and breathlessness. Breathlessness management is not supported by any ICU guidelines, unlike other symptoms. AIM To review the literature relating to (i) prevalence, intensity, assessment, and management of breathlessness in critically ill adults in the ICU receiving invasive and non-invasive mechanical ventilation (NIV) and high-flow oxygen therapy, (HFOT), (ii) the impact of breathlessness on ICU patients with regard to engagement with rehabilitation. METHODS A rapid review and narrative synthesis using the Cochrane Methods Group Recommendations was conducted and reported in accordance with PRISMA. All study designs investigating breathlessness in adult ICU patients receiving either invasive mechanical ventilation (IMV), NIV or HFOT were eligible. PubMed, MEDLINE, The Cochrane Library and CINAHL databased were searched from June 2013 to June 2023. Studies were quality appraised. RESULTS 19 studies representing 2822 ICU patients were included (participants mean age 48 years to 71 years; proportion of males 43-100%). The weighted mean prevalence of breathlessness in ICU patients receiving IMV was 49% (range 34-66%). The proportion of patients receiving NIV self-reporting moderate to severe dyspnoea was 55% prior to initiation. Breathlessness assessment tools included visual analogue scale, (VAS), numerical rating scale, (NRS) and modified BORG scale, (mBORG). In patients receiving NIV the highest reported median (interquartile range [IQR]) VAS, NRS and mBORG scores were 6.2cm (0-10 cm), 5 (2-7) and 6 (2.3-7) respectively (moderate to severe breathlessness). In patients receiving either NIV or HFOT the highest reported median (IQR) VAS, NRS and mBORG scores were 3 cm (0-6 cm), 8 (5-10) and 4 (3-5) respectively. CONCLUSION Breathlessness in adults receiving IMV, NIV or HFOT in the ICU is prevalent and clinically important with median intensity ratings indicating the presence of moderate to severe symptoms.
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Affiliation(s)
- Ben R Richardson
- School of Health and Life Sciences, Teesside University, Tees Valley, Middlesbrough, TS1 3BX, UK
| | - Maxens Decavèle
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, 75005, Paris, France
- Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Service de Médecine Intensive et Réanimation (Département R3S), 75013, Paris, France
| | - Alexandre Demoule
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, 75005, Paris, France
- Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Service de Médecine Intensive et Réanimation (Département R3S), 75013, Paris, France
| | - Fliss E M Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Cottingham Road, Hull, HU6 7RX, UK
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Cottingham Road, Hull, HU6 7RX, UK.
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24
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Armestar F, Vitoria Rubio S, Ojanguren Sabán I, Coll-Cantí J, Perez Molto H. Role of neuromuscular blocking agents in the development of polyneuropathy and myopathy in critically ill patients. Med Clin (Barc) 2024:S0025-7753(24)00358-0. [PMID: 38960793 DOI: 10.1016/j.medcli.2024.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND Acquired critical illness weakness (AWCIP) is the most frequent neuromuscular disease in intensive care medicine departments. Its importance is given by the prolongation of hospital stay and the delayed recovery it causes to patients after hospitalization. The main objective of this study was to investigate the association between neuromuscular blocking agents and the development of acquired weakness in critically ill patients. MATERIAL AND METHODS We conducted a prospective study of 103 critically ill patients who were periodically monitored with electromyography. RESULTS The development of AWCIP was observed in 63 patients. The group of patients who developed AWCIP had a significantly higher utilization of neuromuscular blocking agents than the group who did not develop AWCIP [79.4% vs 50%, OR:3.85 (1.63-9.39), p <0.02]; likewise, this group of patients had a longer ICU stay [32 days vs 14 days, OR: 1.11 (1.06-1.17), p <0. 001] and a longer mechanical ventilation time [24 days vs 9 days, OR:1.2 (1.11-1.32), p <0.001]. CONCLUSION Neuromuscular blocking agents are a factor associated with the occurrence of AWCIP.
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Affiliation(s)
- Fernando Armestar
- Servicio de Medicina Intensiva, Hospital Universitario Germans Trias i Pujol, Barcelona, España; Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, España.
| | - Sara Vitoria Rubio
- Servicio de Medicina Intensiva, Hospital Universitario Germans Trias i Pujol, Barcelona, España
| | - Isabel Ojanguren Sabán
- Servicio de Anatomía Patológica, Hospital Universitario Germans Trias i Pujol, Barcelona, España
| | - Jaume Coll-Cantí
- Unidad Patología Neuromuscular, Departamento Neurociencias, Hospital Universitario Germans Trias i Pujol, Barcelona, España
| | - Hipólito Perez Molto
- Servicio de Medicina Intensiva, Hospital Universitario Germans Trias i Pujol, Barcelona, España
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25
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de Man AME, Gunst J, Reintam Blaser A. Nutrition in the intensive care unit: from the acute phase to beyond. Intensive Care Med 2024; 50:1035-1048. [PMID: 38771368 PMCID: PMC11245425 DOI: 10.1007/s00134-024-07458-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 04/21/2024] [Indexed: 05/22/2024]
Abstract
Recent randomized controlled trials (RCTs) have shown no benefit but dose-dependent harm by early full nutritional support in critically ill patients. Lack of benefit may be explained by anabolic resistance, suppression of cellular repair processes, and aggravation of hyperglycemia and insulin needs. Also early high amino acid doses did not provide benefit, but instead associated with harm in patients with organ dysfunctions. However, most studies focused on nutritional interventions initiated during the first days after intensive care unit admission. Although the intervention window of some RCTs extended into the post-acute phase of critical illness, no large RCTs studied nutritional interventions initiated beyond the first week. Hence, clear evidence-based guidance on when and how to initiate and advance nutrition is lacking. Prolonged underfeeding will come at a price as there is no validated metabolic monitor that indicates readiness for medical nutrition therapy, and an adequate response to nutrition, which likely varies between patients. Also micronutrient status cannot be assessed reliably, as inflammation can cause redistribution, so that plasma micronutrient concentrations are not necessarily reflective of total body stores. Moreover, high doses of individual micronutrients have not proven beneficial. Accordingly, current evidence provides clear guidance on which nutritional strategies to avoid, but the ideal nutritional regimen for individual patients remains unclear. In this narrative review, we summarize the findings of recent studies, discuss possible mechanisms explaining the results, point out pitfalls in interpretation of RCTs and their effect on clinical practice, and formulate suggestions for future research.
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Affiliation(s)
- Angelique M E de Man
- Department of Intensive Care, Amsterdam UMC, Location Vrije Universiteit, Amsterdam, The Netherlands.
- Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.
| | - Jan Gunst
- Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
- Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Annika Reintam Blaser
- Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia
- Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Spitalstrasse, 6000, Lucerne, Switzerland
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Matsuoka W, Mizuguchi S, Kaku N, Higashi K, Tetsuhara K, Akahoshi T, Ohga S. Skeletal Muscle Mass Assessment in Pediatric Patients: Development of a Normative Equation and Assessment of Factors Associated With a Low Skeletal Muscle Mass in PICU Patients. Pediatr Crit Care Med 2024; 25:621-628. [PMID: 38629921 DOI: 10.1097/pcc.0000000000003511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
OBJECTIVES To develop an equation for defining a low skeletal muscle mass (SMM) in children and to investigate risk factors and outcomes associated with low SMM in critically ill pediatric patients. DESIGN Single-center retrospective pediatric cohorts, 2011-2018. SETTING Tertiary Emergency and Critical Care Center of Kyushu University Hospital in Japan. PATIENTS We studied two cohorts of pediatric patients 1-15 years old who underwent abdominal CT at the level of the third lumbar vertebra (L3). First a cohort of trauma patients presented to the emergency department in whom we developed an SMM regression equation. Second, a cohort of patients who had undergone abdominal CT within 3 days of PICU admission. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The equation for estimating normal SMM used sex, age, and weight. Low SMM was defined as less than 80% of normal. In the 112 patients in the PICU cohort, median (range) age was 68 (13-191) months, and 83 (74.1%) had underlying disease. There was low SMM in 54 patients (48.2%). Regarding associations, using odds ratio (OR) and 95% CI, we found that low dietary intake (OR 4.33 [95% CI, 1.37-13.70]; p = 0.013) and the presence of underlying disease (OR 7.44 [95% CI, 2.10-26.30]; p = 0.002) were independently associated with greater odds of low SMM. Low SMM, compared with normal SMM, was also associated with longer hospital stays (42.5 d vs. 20.5 d; p = 0.007; β, 1.59; 95% CI, 1.09-2.33; p = 0.016). CONCLUSIONS In this retrospective PICU cohort from a single center in Japan, we found that low SMM at PICU admission was present in almost half the cases. Low SMM, as defined by being less than 80% of the normal, was associated with greater odds of low dietary intake and underlying chronic disease. Furthermore, low SMM was associated with longer hospital stays.
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Affiliation(s)
- Wakato Matsuoka
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan
| | - Soichi Mizuguchi
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan
| | - Noriyuki Kaku
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan
| | - Kanako Higashi
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan
| | - Kenichi Tetsuhara
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan
| | - Tomohiko Akahoshi
- Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Al-Ali AH, Alraeyes KA, Julkarnain PR, Lakshmanan AP, Alobaid A, Aljoni AY, Saleem NH, Al Odat MA, Aletreby WT. Independent Risk Factors of Failed Extubation among Adult Critically Ill Patients: A Prospective Observational Study from Saudi Arabia. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2024; 12:216-222. [PMID: 39055080 PMCID: PMC11268545 DOI: 10.4103/sjmms.sjmms_19_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/12/2024] [Accepted: 03/28/2024] [Indexed: 07/27/2024]
Abstract
Background Mechanical ventilation provides essential support for critically ill patients in several diagnoses; however, extubation failure can affect patient outcomes. From Saudi Arabia, no study has assessed the factors associated with extubation failure in adults. Methods This prospective observational study was conducted in the intensive care unit of a tertiary care hospital in Riyadh, Saudi Arabia. Adult patients who had been mechanically ventilated via the endotracheal tube for a minimum of 24 hours and then extubated according to the weaning protocol were included. Failed extubation was defined as reintubation within 48 hours of extubation. Results A total of 505 patients were included, of which 72 patients had failed extubation (14.3%, 95% CI: 11.4%-17.7%). Compared with the failed extubation group, the successfully extubated group had significantly shorter duration of mechanical ventilation (mean difference: -2.6 days, 95% CI: -4.3 to -1; P = 0.001), a slower respiratory rate at the time of extubation (mean difference: -2.3 breath/min, 95% CI: -3.8 to -1; P = 0.0005), higher pH (mean difference: 0.02, 95% CI: 0.001-0.04; P = 0.03), and more patients with strong cough (percent difference: 17.7%, 95% CI: 4.8%-30.5%; P = 0.02). Independent risk factors of failed extubation were age (aOR = 1.02; 95% CI: 1.002-1.03; P = 0.03), respiratory rate (aOR = 1.06, 95% CI: 1.01-1.1; P = 0.008), duration of mechanical ventilation (aOR = 1.08, 95% CI: 1.03 - 1.1; P < 0.001), and pH (aOR = 0.02, 95% CI: 0.0006-0.5; P = 0.02). Conclusion Older age, longer duration of mechanical ventilation, faster respiratory rate, and lower pH were found to be independent risk factors that significantly increased the odds of extubation failure among adults.
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Affiliation(s)
- Aqeel Hamad Al-Ali
- Respiratory Care Administration, King Saud Medical City, Riyadh, Saudi Arabia
| | | | | | | | - Alzahra Alobaid
- Respiratory Care Administration, King Saud Medical City, Riyadh, Saudi Arabia
| | - Ahmed Yahya Aljoni
- Respiratory Care Administration, King Saud Medical City, Riyadh, Saudi Arabia
| | - Nada Hadi Saleem
- Respiratory Care Administration, King Saud Medical City, Riyadh, Saudi Arabia
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Wu TT, Su QP, Xiong J, Hiser S, Needham DM, Li H. Reliability and validity of the Chinese version of the functional status score for the ICU (FSS-ICU) after translation and cross-cultural adaptation. Disabil Rehabil 2024:1-8. [PMID: 38934539 DOI: 10.1080/09638288.2024.2369944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE The Functional Status Score for the Intensive Care Unit (FSS-ICU) is designed to assess the physical functional status of patients in ICU settings. This study aimed to translate and culturally adapt the FSS-ICU for the Chinese context and to evaluate its reliability and validity. METHODS Following Beaton's translation model, the original FSS-ICU was subjected to forward translation, back-translation, and synthesis. After cultural adaptation and preliminary testing, the Chinese version of the FSS-ICU was established, and then two rehabilitation therapists assessed the functional status of 51 ICU patients using this scale, evaluating its reliability and validity. RESULTS The Chinese version of the FSS-ICU exhibits excellent internal consistency with a Cronbach's alpha coefficient of 0.934. The inter-rater and intra-rater correlation coefficients are 0.995 and 0.997, respectively. Both item-level and scale-level content validity indices are 1.00. The FSS-ICU demonstrates good convergent validity with other physical function assessment tools (Medical Research Council Sum-Score, grip strength, the Intensive Care Unit Mobility Scale), with |rs| values all above 0.5, and satisfactory discriminant validity with non-physical function assessment indicators (body mass index, blood glucose), with |rs| values all below 0.2. Additionally, it demonstrated no ceiling or floor effects. CONCLUSION The Chinese FSS-ICU, demonstrating strong reliability and validity, can serve as an effective assessment tool for physical function in ICU patients.
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Affiliation(s)
- Ting-Ting Wu
- Department of Nursing, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Qing-Ping Su
- Academy of Rehabilitation Industry, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
- Department of Rehabilitation Medicine, Fujian Provincial Hospital, Fuzhou, China
| | - Jing Xiong
- Department of Nursing, Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Stephanie Hiser
- Department of Health, Human Function, and Rehabilitation Sciences, The George University, Washington, DC, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University Baltimore, MD, USA
| | - Dale M Needham
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University Baltimore, MD, USA
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine Baltimore, MD, USA
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Hong Li
- School of Nursing, Fujian Medical University, Fuzhou, China
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Sinha RK, Sinha S, Nishant P, Morya AK. Intensive care unit-acquired weakness and mechanical ventilation: A reciprocal relationship. World J Clin Cases 2024; 12:3644-3647. [PMID: 38983411 PMCID: PMC11229901 DOI: 10.12998/wjcc.v12.i18.3644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 04/21/2024] [Accepted: 05/08/2024] [Indexed: 06/13/2024] Open
Abstract
Intensive care unit-acquired weakness (ICU-AW; ICD-10 Code: G72.81) is a syndrome of generalized weakness described as clinically detectable weakness in critically ill patients with no other credible cause. The risk factors for ICU-AW include hyperglycemia, parenteral nutrition, vasoactive drugs, neuromuscular blocking agents, corticosteroids, sedatives, some antibiotics, immobilization, the disease severity, septicemia and systemic inflammatory response syndrome, multiorgan failure, prolonged mechanical ventilation (MV), high lactate levels, older age, female sex, and pre-existing systemic morbidities. There is a definite association between the duration of ICU stay and MV with ICU-AW. However, the interpretation that these are modifiable risk factors influencing ICU-AW, appears to be flawed, because the relationship between longer ICU stays and MV with ICU-AW is reciprocal and cannot yield clinically meaningful strategies for the prevention of ICU-AW. Prevention strategies must be based on other risk factors. Large multicentric randomized controlled trials as well as meta-analysis of such studies can be a more useful approach towards determining the influence of these risk factors on the occurrence of ICU-AW in different populations.
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Affiliation(s)
- Ranjeet Kumar Sinha
- Department of Community Medicine, Patna Medical College, Bihar, Patna 800004, India
| | - Sony Sinha
- Department of Ophthalmology-Vitreo-Retina, Neuro-Ophthalmology and Oculoplasty, All India Institute of Medical Sciences, Bihar, Patna 801507, India
| | - Prateek Nishant
- Department of Ophthalmology, ESIC Medical College, Bihar, Patna 801113, India
| | - Arvind Kumar Morya
- Department of Ophthalmology, All India Institute of Medical Sciences, Telangana, Hyderabad 508126, India
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30
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Hassan MA, Nashwan AJ. Machine learning insights on intensive care unit-acquired weakness. World J Clin Cases 2024; 12:3285-3287. [PMID: 38983426 PMCID: PMC11229897 DOI: 10.12998/wjcc.v12.i18.3285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/14/2024] [Accepted: 04/28/2024] [Indexed: 06/13/2024] Open
Abstract
Intensive care unit-acquired weakness (ICU-AW) significantly hampers patient recovery and increases morbidity. With the absence of established preventive strategies, this study utilizes advanced machine learning methodologies to unearth key predictors of ICU-AW. Employing a sophisticated multilayer perceptron neural network, the research methodically assesses the predictive power for ICU-AW, pinpointing the length of ICU stay and duration of mechanical ventilation as pivotal risk factors. The findings advocate for minimizing these elements as a preventive approach, offering a novel perspective on combating ICU-AW. This research illuminates critical risk factors and lays the groundwork for future explorations into effective prevention and intervention strategies.
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Affiliation(s)
- Muad Abdi Hassan
- Department of Medical Education, Hamad Medical Corporation, Doha 3050, Qatar
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31
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Kangalgil M, Ulusoy H, Ayaz S. Acute Skeletal Muscle Wasting is Associated with Prolonged Hospital Stay in Critical Illness with Brain Injury. Neurocrit Care 2024:10.1007/s12028-024-02017-y. [PMID: 38918337 DOI: 10.1007/s12028-024-02017-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 05/16/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND Acute muscle wasting is common in critically ill patients, and this can lead to unfavorable clinical outcomes. The aim of this study was to identify factors associated with muscle wasting and to investigate the association between skeletal muscle wasting and prolonged hospital stay in critically ill patients with acute brain injury. METHODS This single-center prospective observational study was conducted in critically ill patients with acute brain injury who stayed in the intensive care unit for at least 1 week. The rectus femoris cross-sectional area was measured via ultrasound at baseline and a week after the first assessment. Univariate and multivariate logistic regression analyses were performed to identify factors that predicted prolonged hospital stay. RESULTS A total of 86 patients were included in the study. Their mean age was 49.4 ± 16.9 years, 57% were male, and 46.5% had an admission diagnosis of subarachnoid hemorrhage. The percentage change in the rectus femoris cross-sectional area was 15.8% (95% confidence interval [CI] - 19.8% to - 12.0%; p < 0.001), and 57% of all patients had acute muscle wasting. According to the univariate analysis, there was a significant association between prolonged hospital stay and acute muscle wasting (odds ratio [OR] 3.677; 95% CI 1.487-9.043; p = 0.005), mechanical ventilation status (OR 3.600; 95% CI 1.455-8.904; p = 0.006), and Glasgow Coma Scale score (OR 0.888; 95% CI 0.808-0.976; p = 0.014) at intensive care unit admission. The multivariate analysis demonstrated that acute muscle wasting (OR 3.449; 95% CI 1.344-8.853; p = 0.010) was an independent risk factor for prolonged hospital stay. CONCLUSIONS There was considerable muscle wasting in critically ill patients with brain injuries over a 1-week period. Acute muscle wasting was associated with prolonged hospital stay in critically ill patients with acute brain injury.
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Affiliation(s)
- Melda Kangalgil
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Sivas Cumhuriyet University, Sivas, Turkey.
| | - Hülya Ulusoy
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Sekine Ayaz
- Department of Anesthesiology and Reanimation, Pasinler Ibrahim Hakkı State Hospital, Erzurum, Turkey
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32
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Tarnawski J, Czub M, Dymecki M, Sunil M, Folwarski M. Anabolic Strategies for ICU-Acquired Weakness. What Can We Learn from Bodybuilders? Nutrients 2024; 16:2011. [PMID: 38999759 PMCID: PMC11243134 DOI: 10.3390/nu16132011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 06/20/2024] [Accepted: 06/22/2024] [Indexed: 07/14/2024] Open
Abstract
The study aimed to show the potential clinical application of supplements used among sportsmen for patients suffering from Intensive Care Unit-acquired Weakness (ICUAW) treatment. ICUAW is a common complication affecting approximately 40% of critically ill patients, often leading to long-term functional disability. ICUAW comprises critical illness polyneuropathy, critical illness myopathy, or a combination of both, such as critical illness polyneuromyopathy. Muscle degeneration begins shortly after the initiation of mechanical ventilation and persists post-ICU discharge until proteolysis and autophagy processes normalize. Several factors, including prolonged bedrest and muscle electrical silencing, contribute to muscle weakness, resulting from an imbalance between protein degradation and synthesis. ICUAW is associated with tissue hypoxia, oxidative stress, insulin resistance, reduced glucose uptake, lower adenosine triphosphate (ATP) formation, mitochondrial dysfunction, and increased free-radical production. Several well-studied dietary supplements and pharmaceuticals commonly used by athletes are proven to prevent the aforementioned mechanisms or aid in muscle building, regeneration, and maintenance. While there is no standardized treatment to prevent the occurrence of ICUAW, nutritional interventions have demonstrated the potential for its mitigation. The use of ergogenic substances, popular among muscle-building sociates, may offer potential benefits in preventing muscle loss and aiding recovery based on their work mechanisms.
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Affiliation(s)
| | - Maja Czub
- Department of Endocrinology and Internal Diseases, Medical University of Gdansk, 80-210 Gdańsk, Poland
| | - Marta Dymecki
- Independent Public Health Care Center, Ministry of Internal Affairs and Administration, 80-104 Gdańsk, Poland
| | - Medha Sunil
- Students' Scientific Circle of Clinical Nutrition, Medical University of Gdansk, 80-210 Gdańsk, Poland
| | - Marcin Folwarski
- Department of Clinical Nutrition and Dietetics, Medical University of Gdansk, 80-210 Gdańsk, Poland
- Home Enteral and Parenteral Nutrition Unit, General Surgery, Nicolaus Copernicus Hospital, 80-803 Gdansk, Poland
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33
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Liu J, Xu Z, Luo S, Bai Y, Feng J, Li F. Risk factors for ICU-acquired weakness in sepsis patients: A retrospective study of 264 patients. Heliyon 2024; 10:e32253. [PMID: 38867955 PMCID: PMC11168428 DOI: 10.1016/j.heliyon.2024.e32253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 05/29/2024] [Accepted: 05/30/2024] [Indexed: 06/14/2024] Open
Abstract
Background Sepsis is a common critical illness in intensive care unit (ICU) and an important risk factor for intensive care unit-acquired weakness (ICU-AW). The objective of the study is to analyze the risk factors of ICU-AW in septic patients. Methods A total of 264 septic patients admitted to the General Hospital of the Western Theater Command from January 2018 to April 2022 were included in this study. The cohort was divided into 2 groups according to the presence or absence of ICU-AW. Clinical characteristics included age, sex, body mass index, length of ICU stay, multiple organ dysfunction syndrome, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), mechanical ventilation time, intubation, tracheotomy, protective constraint, lactic acid, fasting blood glucose, etc. The clinical characteristics of sepsis were evaluated using logistic regression analysis. Results A total of 114 septic patients suffered ICU-AW during their ICU stay. Multivariate binary logistic regression analysis showed that APACHE Ⅱ score, mechanical ventilation time, protective constraint, and lactic acid were independent risk factors for ICU-AW in septic patients. The areas under the receiver operating characteristic curve (AUCs) were 0.791, 0.740 and 0.812, all P < 0.05, and the optimal cut-off values were 24 points, 5 days and 2.12 mmol/L, respectively. Conclusions A high APACHE Ⅱ score, long mechanical ventilation time, protective constraint and high lactate concentration are independent risk factors for ICU-AW in septic patients. An APACHE Ⅱ score greater than 24 points, mechanical ventilation time longer than 5 days and lactate concentration higher than 2.12 mmol/L are likely to cause ICU-AW.
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Affiliation(s)
- Jiajiao Liu
- Department of Critical Care Medicine, The General Hospital of Western Theater Command PLA, Chengdu, 610036, China
| | - Zhaoxia Xu
- Department of Emergency Department, The General Hospital of Western Theater Command PLA, Chengdu, 610036, China
| | - Shuhong Luo
- Department of Critical Care Medicine, The General Hospital of Western Theater Command PLA, Chengdu, 610036, China
| | - Yujie Bai
- Department of Critical Care Medicine, The General Hospital of Western Theater Command PLA, Chengdu, 610036, China
| | - Jian Feng
- Department of Critical Care Medicine, The General Hospital of Western Theater Command PLA, Chengdu, 610036, China
| | - Fuxiang Li
- Department of Critical Care Medicine, The General Hospital of Western Theater Command PLA, Chengdu, 610036, China
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Piel S, McManus MJ, Heye KN, Beaulieu F, Fazelinia H, Janowska JI, MacTurk B, Starr J, Gaudio H, Patel N, Hefti MM, Smalley ME, Hook JN, Kohli NV, Bruton J, Hallowell T, Delso N, Roberts A, Lin Y, Ehinger JK, Karlsson M, Berg RA, Morgan RW, Kilbaugh TJ. Effect of dimethyl fumarate on mitochondrial metabolism in a pediatric porcine model of asphyxia-induced in-hospital cardiac arrest. Sci Rep 2024; 14:13852. [PMID: 38879681 PMCID: PMC11180202 DOI: 10.1038/s41598-024-64317-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/07/2024] [Indexed: 06/19/2024] Open
Abstract
Neurological and cardiac injuries are significant contributors to morbidity and mortality following pediatric in-hospital cardiac arrest (IHCA). Preservation of mitochondrial function may be critical for reducing these injuries. Dimethyl fumarate (DMF) has shown potential to enhance mitochondrial content and reduce oxidative damage. To investigate the efficacy of DMF in mitigating mitochondrial injury in a pediatric porcine model of IHCA, toddler-aged piglets were subjected to asphyxia-induced CA, followed by ventricular fibrillation, high-quality cardiopulmonary resuscitation, and random assignment to receive either DMF (30 mg/kg) or placebo for four days. Sham animals underwent similar anesthesia protocols without CA. After four days, tissues were analyzed for mitochondrial markers. In the brain, untreated CA animals exhibited a reduced expression of proteins of the oxidative phosphorylation system (CI, CIV, CV) and decreased mitochondrial respiration (p < 0.001). Despite alterations in mitochondrial content and morphology in the myocardium, as assessed per transmission electron microscopy, mitochondrial function was unchanged. DMF treatment counteracted 25% of the proteomic changes induced by CA in the brain, and preserved mitochondrial structure in the myocardium. DMF demonstrates a potential therapeutic benefit in preserving mitochondrial integrity following asphyxia-induced IHCA. Further investigation is warranted to fully elucidate DMF's protective mechanisms and optimize its therapeutic application in post-arrest care.
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Affiliation(s)
- Sarah Piel
- Resuscitation Science Center of Emphasis, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, USA.
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
- CARID, Cardiovascular Research Institute Düsseldorf, Medical Faculty of the Heinrich-Heine-University, Düsseldorf, Germany.
| | - Meagan J McManus
- Resuscitation Science Center of Emphasis, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, USA
| | - Kristina N Heye
- Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, USA
| | - Forrest Beaulieu
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, USA
| | - Hossein Fazelinia
- Proteomics Core Facility, The Children's Hospital of Philadelphia, Philadelphia, USA
| | - Joanna I Janowska
- Resuscitation Science Center of Emphasis, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, USA
| | - Bryce MacTurk
- Resuscitation Science Center of Emphasis, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, USA
| | - Jonathan Starr
- Resuscitation Science Center of Emphasis, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, USA
| | - Hunter Gaudio
- Resuscitation Science Center of Emphasis, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, USA
| | - Nisha Patel
- Resuscitation Science Center of Emphasis, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, USA
| | - Marco M Hefti
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Martin E Smalley
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Jordan N Hook
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Neha V Kohli
- Resuscitation Science Center of Emphasis, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, USA
| | - James Bruton
- Resuscitation Science Center of Emphasis, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, USA
| | - Thomas Hallowell
- Resuscitation Science Center of Emphasis, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, USA
| | - Nile Delso
- Resuscitation Science Center of Emphasis, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, USA
| | - Anna Roberts
- Resuscitation Science Center of Emphasis, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, USA
| | - Yuxi Lin
- Resuscitation Science Center of Emphasis, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, USA
| | - Johannes K Ehinger
- Mitochondrial Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Otorhinolaryngology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Otorhinolaryngology, Head and Neck Surgery, Skåne University Hospital, Lund, Sweden
| | | | - Robert A Berg
- Resuscitation Science Center of Emphasis, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, USA
| | - Ryan W Morgan
- Resuscitation Science Center of Emphasis, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, USA
| | - Todd J Kilbaugh
- Resuscitation Science Center of Emphasis, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, USA
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Rollinson TC, Connolly B, Denehy L, Hepworth G, Berlowitz DJ, Berney S. Ultrasound-derived rates of muscle wasting in the intensive care unit and in the post-intensive care ward for patients with critical illness: Post hoc analysis of an international, multicentre randomised controlled trial of early rehabilitation. Aust Crit Care 2024:S1036-7314(24)00076-6. [PMID: 38834392 DOI: 10.1016/j.aucc.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 03/06/2024] [Accepted: 03/25/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND AND AIMS Muscle wasting results in weakness for patients with critical illness. We aim to explore ultrasound-derived rates of change in skeletal muscle in the intensive care unit (ICU) and following discharge to the post-ICU ward. DESIGN Post hoc analysis of a multicentre randomised controlled trial of functional-electrical stimulated cycling, recumbent cycling, and usual care delivered in intensive care. METHOD Participants underwent ultrasound assessment of rectus femoris at ICU admission, weekly in the ICU, upon awakening, ICU discharge, and hospital discharge. The primary outcome was rate of change in rectus femoris cross-sectional area (ΔRFCSA) in mm2/day in the ICU (enrolment to ICU discharge) and in the post-ICU ward (ICU discharge to hospital discharge). Secondary outcomes included rate of change in echo intensity (ΔEI), standard deviation of echo intensity (ΔEISD), and the intervention effect on ultrasound measures. Echo intensity is a quantitative assessment of muscle quality. Elevated echo intensity may indicate fluid infiltration, adipose tissue, and reduced muscle quality. RESULTS 154 participants were included (mean age: 58 ± 15 years, 34% female). Rectus femoris cross-sectional area declined in the ICU (-4 mm2/day [95% confidence interval {CI}: -9 to 1]) and declined further in the ward (-9 mm2/day [95% CI: -14 to -3]) with a mean difference between ICU and ward of -5 mm2/day ([95% CI: -2, to 11]; p = 0.1396). There was a nonsignificant difference in ΔEI between in-ICU and the post-ICU ward of 1.2 ([95% CI: -0.1 to 2.6]; p = 0.0755), a statistically significant difference in ΔEISD between in-ICU and in the post-ICU ward of 1.0 ([95% CI, 0.5 to 1.5]; p = 0.0003), and no difference in rate of change in rectus femoris cross-sectional area between groups in intensive care (p = 0.411) or at hospital discharge (p = 0.1309). CONCLUSIONS Muscle wasting occurs in critical illness throughout the hospital admission. The average rate of loss in muscle cross-sectional area does not slow after ICU discharge, even with active rehabilitation.
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Affiliation(s)
- Thomas C Rollinson
- Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Australia; Department of Physiotherapy, The University of Melbourne, Melbourne, Australia; Institute for Breathing and Sleep, Melbourne, Australia.
| | - Bronwen Connolly
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, United Kingdom; Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom; Centre for Human and Applied Physiological Sciences, King's College London, United Kingdom
| | - Linda Denehy
- Department of Physiotherapy, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Graham Hepworth
- Statistical Consulting Centre, The University of Melbourne, Melbourne, Australia
| | - David J Berlowitz
- Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Australia; Department of Physiotherapy, The University of Melbourne, Melbourne, Australia; Institute for Breathing and Sleep, Melbourne, Australia
| | - Sue Berney
- Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Australia; Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
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36
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Walsh TS. Vibration Therapy: A New Buzzword for Treating ICU-Acquired Weakness? Crit Care Med 2024; 52:984-986. [PMID: 38752817 DOI: 10.1097/ccm.0000000000006231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Affiliation(s)
- Timothy S Walsh
- Anaesthesia, Critical Care and Pain Medicine, Usher Institute of Population Health Sciences, University of Edinburgh, Little France Crescent, Edinburgh, Scotland
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37
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van der Knaap N, de Vreeze F, van Rosmalen F, Wintjens MSJN, van Santen S, Linden DEJ, Staals J, van Mook WNKA, Jansen JFA, van der Horst ICC, van Bussel BCT, Ariës MJH. The incidence of neurological complications in mechanically ventilated COVID-19 ICU patients: An observational single-center cohort study in three COVID-19 periods. Clin Neurol Neurosurg 2024; 241:108311. [PMID: 38704879 DOI: 10.1016/j.clineuro.2024.108311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/07/2024] [Accepted: 04/29/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Neurological complications in COVID-19 patients admitted to an intensive care unit (ICU) have been previously reported. As the pandemic progressed, therapeutic strategies were tailored to new insights. This study describes the incidence, outcome, and types of reported neurological complications in invasively mechanically ventilated (IMV) COVID-19 patients in relation to three periods during the pandemic. METHODS IMV COVID-19 ICU patients from the Dutch Maastricht Intensive Care COVID (MaastrICCht) cohort were included in a single-center study (March 2020 - October 2021). Demographic, clinical, and follow-up data were collected. Electronic medical records were screened for neurological complications during hospitalization. Three distinct periods (P1, P2, P3) were defined, corresponding to periods with high hospitalization rates. ICU survivors with and without reported neurological complications were compared in an exploratory analysis. RESULTS IMV COVID-19 ICU patients (n=324; median age 64 [IQR 57-72] years; 238 males (73.5%)) were stratified into P1 (n=94), P2 (n=138), and P3 (n=92). ICU mortality did not significantly change over time (P1=38.3%; P2=41.3%; P3=37.0%; p=.787). The incidence of reported neurological complications during ICU admission gradually decreased over the periods (P1=29.8%; P2=24.6%; P3=18.5%; p=.028). Encephalopathy/delirium (48/324 (14.8%)) and ICU-acquired weakness (32/324 (9.9%)) were most frequently reported and associated with ICU treatment intensity. ICU survivors with neurological complications (n=53) were older (p=.025), predominantly male (p=.037), and had a longer duration of IMV (p<.001) and ICU stay (p<.001), compared to survivors without neurological complications (n=132). A multivariable analysis revealed that only age was independently associated with the occurrence of neurological complications (ORadj=1.0541; 95% CI=1.0171-1.0925; p=.004). Health-related quality-of-life at follow-up was not significantly different between survivors with and without neurological complications (n = 82, p=.054). CONCLUSIONS A high but decreasing incidence of neurological complications was reported during three consecutive COVID-19 periods in IMV COVID-19 patients. Neurological complications were related to the intensity of ICU support and treatment, and associated with prolonged ICU stay, but did not lead to significantly worse reported health-related quality-of-life at follow-up.
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Affiliation(s)
- Noa van der Knaap
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Radiology & Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; Research Institute of Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands
| | - Fleur de Vreeze
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Frank van Rosmalen
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - Marieke S J N Wintjens
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands; Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Susanne van Santen
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - David E J Linden
- Research Institute of Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands; Department of Neurology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Julie Staals
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands; Department of Neurology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Walther N K A van Mook
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Jacobus F A Jansen
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; Research Institute of Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Iwan C C van der Horst
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - Bas C T van Bussel
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Marcel J H Ariës
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; Research Institute of Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.
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Lathyris D. Early mobilisation of critically ill patients: How soon is soon enough? Intensive Crit Care Nurs 2024; 82:103651. [PMID: 38340543 DOI: 10.1016/j.iccn.2024.103651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Affiliation(s)
- Dimitrios Lathyris
- Critical Care Unit, General Hospital G. Gennimatas, Thessaloniki, Greece.
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Battaglini D, Iavarone IG, Rocco PRM. An update on the pharmacological management of acute respiratory distress syndrome. Expert Opin Pharmacother 2024; 25:1229-1247. [PMID: 38940703 DOI: 10.1080/14656566.2024.2374461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 06/26/2024] [Indexed: 06/29/2024]
Abstract
INTRODUCTION Acute respiratory distress syndrome (ARDS) is characterized by acute inflammatory injury to the lungs, alterations in vascular permeability, loss of aerated tissue, bilateral infiltrates, and refractory hypoxemia. ARDS is considered a heterogeneous syndrome, which complicates the search for effective therapies. The goal of this review is to provide an update on the pharmacological management of ARDS. AREAS COVERED The difficulties in finding effective pharmacological therapies are mainly due to the challenges in designing clinical trials for this unique, varied population of critically ill patients. Recently, some trials have been retrospectively analyzed by dividing patients into hyper-inflammatory and hypo-inflammatory sub-phenotypes. This approach has led to significant outcome improvements with some pharmacological treatments that previously failed to demonstrate efficacy, which suggests that a more precise selection of ARDS patients for clinical trials could be the key to identifying effective pharmacotherapies. This review is provided after searching the main studies on this topics on the PubMed and clinicaltrials.gov databases. EXPERT OPINION The future of ARDS therapy lies in precision medicine, innovative approaches to drug delivery, immunomodulation, cell-based therapies, and robust clinical trial designs. These should lead to more effective and personalized treatments for patients with ARDS.
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Affiliation(s)
- Denise Battaglini
- Anesthesia and Intensive Care, IRCCS Ospedale Policlinico, Genova, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genova, Italy
| | - Ida Giorgia Iavarone
- Anesthesia and Intensive Care, IRCCS Ospedale Policlinico, Genova, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genova, Italy
| | - Patricia R M Rocco
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Wu TT, Li CX, Zhuang YN, Luo CJ, Chen JM, Li Y, Xiong J, Jin S, Li H. Resistance training combined with β-hydroxy β-methylbutyrate for patients with critical illness: A four-arm, mixed-methods, feasibility randomised controlled trial. Intensive Crit Care Nurs 2024; 82:103616. [PMID: 38246040 DOI: 10.1016/j.iccn.2023.103616] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 12/15/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024]
Abstract
OBJECTIVES This study aimed to assess the feasibility, safety, acceptability, and potential effectiveness of resistance training (RT) with or without β-Hydroxy β-Methylbutyrate (HMB) intervention program for ICU patients. DESIGN Open-label, parallel group, mixed method, randomized controlled trial. SETTINGS A tertiary general hospital in Fuzhou, China. METHODS Participants were randomly allocated to one of four groups. The RT group received supervised multilevel resistance training (RT) using elastic bands, administered by trained ICU nurses. The HMB group received an additional daily dose of 3.0 g HMB. The combination group underwent both interventions concurrently, while the control group received standard care. These interventions were implemented throughout the entire hospitalization period. Primary outcomes included feasibility indicators such as recruitment rate, enrollment rate, retention rate, and compliance rate. Secondary outcomes covered adverse events, acceptability (evaluated through questionnaires and qualitative interviews), and physical function. Quantitative analysis utilized a generalized estimation equation model, while qualitative analysis employed directed content analysis. RESULTS All feasibility indicators met predetermined criteria. Forty-eight patients were randomly assigned across four arms, achieving a 96% enrollment rate. Most patients adhered to the intervention until discharge, resulting in a 97.9% retention rate. Compliance rates for both RT and HMB interventions approached or exceeded 85%. No adverse events were reported. The intervention achieved 100% acceptability, with a prevailing expression of positive experiences and perception of appropriateness. The RT intervention shows potential improvement in physical function, while HMB does not. CONCLUSIONS Implementing nurse-led resistance training with elastic bands with or without HMB proved to be feasible and safe for ICU patients. IMPLICATIONS FOR CLINICAL PRACTICE A large-scale, multicenter clinical trials are imperative to definitively assess the impact of this intervention on functional outcomes in this population.
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Affiliation(s)
- Ting-Ting Wu
- Shengli Clinical College of Fujian Medical University, Fuzhou, China; School of Nursing, Fujian Medical University, Fuzhou, China; Department of Nursing, Fujian Provincial Hospital, Fuzhou, China
| | - Chang-Xin Li
- Intensive Care Unit, First Hospital of NanPing City, Nanping, China
| | - Yao-Ning Zhuang
- Respiratory and Intensive Care Unit, Affiliated Hospital of Putian University, Putian, China
| | - Chen-Juan Luo
- Intensive Care Unit, First Hospital of NanPing City, Nanping, China
| | - Ji-Min Chen
- Emergency Intensive Care Unit, Fujian Provincial Hospital, Fuzhou, China
| | - Yun Li
- Internal Medicine Intensive Care Unit, Fujian Provincial Hospital, Fuzhou, China
| | - Jing Xiong
- Operating Room, Second Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Shuang Jin
- Department of Nursing, Fujian Provincial Hospital, Fuzhou, China.
| | - Hong Li
- School of Nursing, Fujian Medical University, Fuzhou, China.
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Yarnell CJ, Barrett K, Heath A, Herridge M, Fowler RA, Sung L, Naimark DM, Tomlinson G. What Is the Potential Value of a Randomized Trial of Different Thresholds to Initiate Invasive Ventilation? A Health Economic Analysis. Crit Care Explor 2024; 6:e1098. [PMID: 38836575 DOI: 10.1097/cce.0000000000001098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024] Open
Abstract
OBJECTIVES To estimate the expected value of undertaking a future randomized controlled trial of thresholds used to initiate invasive ventilation compared with usual care in hypoxemic respiratory failure. PERSPECTIVE Publicly funded healthcare payer. SETTING Critical care units capable of providing invasive ventilation and unconstrained by resource limitations during usual (nonpandemic) practice. METHODS We performed a model-based cost-utility estimation with individual-level simulation and value-of-information analysis focused on adults, admitted to critical care, receiving noninvasive oxygen. In the primary scenario, we compared hypothetical threshold A to usual care, where threshold A resulted in increased use of invasive ventilation and improved survival compared with usual care. In the secondary scenario, we compared hypothetical threshold B to usual care, where threshold B resulted in decreased use of invasive ventilation and similar survival compared with usual care. We assumed a willingness-to-pay of 100,000 Canadian dollars (CADs) per quality-adjusted life year. RESULTS In the primary scenario, threshold A was cost-effective compared with usual care due to improved hospital survival (78.1% vs. 75.1%), despite more use of invasive ventilation (62% vs. 30%) and higher lifetime costs (86,900 vs. 75,500 CAD). In the secondary scenario, threshold B was cost-effective compared with usual care due to similar survival (74.5% vs. 74.6%) with less use of invasive ventilation (20.2% vs. 27.6%) and lower lifetime costs (71,700 vs. 74,700 CAD). Value-of-information analysis showed that the expected value to Canadian society over 10 years of a 400-person randomized trial comparing a threshold for invasive ventilation to usual care in hypoxemic respiratory failure was 1.35 billion CAD or more in both scenarios. CONCLUSIONS It would be highly valuable to society to identify thresholds that, in comparison to usual care, either increase survival or reduce invasive ventilation without reducing survival.
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Affiliation(s)
- Christopher J Yarnell
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Department of Critical Care Medicine, Scarborough Health Network, Toronto, ON, Canada
- Scarborough Health Network Research Institute, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Kali Barrett
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Division of Respirology, University Health Network and Sinai Health System, Toronto, ON, Canada
| | - Anna Heath
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Statistical Science, University College London, London, United Kingdom
| | - Margaret Herridge
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Division of Respirology, University Health Network and Sinai Health System, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Robert A Fowler
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Department of Medicine and Department of Critical Care Medicine, Toronto, ON, Canada
| | - Lillian Sung
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - David M Naimark
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Department of Medicine, Division of Nephrology, Toronto, ON, Canada
| | - George Tomlinson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University Health Network and Sinai Health System, Toronto, ON, Canada
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Xue Y, Wang TT, Zhang L, Zheng S, Mu YM, Jia FY, Du L. Relationship among low baseline muscle mass, skeletal muscle quality, and mortality in critically ill children. Nutr Clin Pract 2024; 39:589-598. [PMID: 37873591 DOI: 10.1002/ncp.11084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 09/10/2023] [Accepted: 09/24/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Studies in adults have shown that low baseline muscle mass at intensive care unit (ICU) admission was associated with poor clinical outcomes. However, no information on the relationship between baseline muscle quality or mass and clinical outcomes in critically ill children was found. METHODS 3775 children were admitted to the pediatric ICU (PICU), 262 were eligible for inclusion. Abdominal computed tomography was performed to assess baseline skeletal muscle mass and quality. Patients were categorized to normal or low group based on the cutoff value for predicting hospital mortality of the skeletal muscle index (SMI; 30.96 cm2/m2) and skeletal muscle density (SMD; 41.21 Hounsfield units). RESULTS Body mass index (BMI) (18.07 ± 4.44 vs 15.99 ± 4.51) and BMI-for-age z score (0.46 [-0.66 to 1.74] vs -0.87 [-1.69 to 0.05]) were greater in the normal-SMI group, the length of PICU stay was longer in the low-SMI group (16.00 days [8.50-32.50] vs 13.00 days [7.50-20.00]), and the in-PICU mortality rate in the normal-SMI group (10.00%) was lower than the low-SMI group (22.6%). Children with low SMD had a higher in-PICU mortality rate (25.6% vs 7.7%), were younger (36.00 months [12.00-120.00] vs 84.00 months [47.50-147.50]) and weighed less (16.40 kg [10.93-37.25] vs 23.00 kg [16.00-45.00]). Mortality was greater in patients with lower SMD and prolonged hospital stay (log-rank, P = 0.007). SMD was an independent predictor for length of PICU stay and in-PICU mortality. CONCLUSIONS Low baseline skeletal muscle quality in critically ill children is closely tied with a higher in-PICU mortality and longer PICU stay and is an independent risk factor for unfavorable clinical outcomes.
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Affiliation(s)
- Yang Xue
- Department of Developmental and Behavioral Pediatrics, The First Hospital of Jilin University, Jilin University, Changchun, China
| | - Tian-Tian Wang
- Department of Developmental and Behavioral Pediatrics, The First Hospital of Jilin University, Jilin University, Changchun, China
| | - Lei Zhang
- Department of Radiology, The First Hospital of Jilin University, Jilin University, Changchun, China
| | - Shuang Zheng
- Department of Radiology, The First Hospital of Jilin University, Jilin University, Changchun, China
| | - Yue-Ming Mu
- Department of Dermatology, The First Hospital of Jilin University, Jilin University, Changchun, China
| | - Fei-Yong Jia
- Department of Developmental and Behavioral Pediatrics, The First Hospital of Jilin University, Jilin University, Changchun, China
| | - Lin Du
- Department of Developmental and Behavioral Pediatrics, The First Hospital of Jilin University, Jilin University, Changchun, China
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Kolck J, Hosse C, Leimbach A, Beetz NL, Auer TA, Collettini F, Fehrenbach U, Pille C, Geisel D. Opportunistic screening for long-term muscle wasting in critically ill patients: insights from an acute pancreatitis cohort. Eur J Med Res 2024; 29:294. [PMID: 38778361 PMCID: PMC11110383 DOI: 10.1186/s40001-024-01884-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVES To assess the feasibility of long-term muscle monitoring, we implemented an AI-guided segmentation approach on clinically indicated Computed Tomography (CT) examinations conducted throughout the hospitalization period of patients admitted to the intensive care unit (ICU) with acute pancreatitis (AP). In addition, we aimed to investigate the potential of muscle monitoring for early detection of patients at nutritional risk and those experiencing adverse outcomes. This cohort served as a model for potential integration into clinical practice. MATERIALS Retrospective cohort study including 100 patients suffering from AP that underwent a minimum of three CT scans during hospitalization, totaling 749 assessments. Sequential segmentation of psoas muscle area (PMA) was performed and was relative muscle loss per day for the entire monitoring period, as well as for the interval between each consecutive scan was calculated. Subgroup and outcome analyses were performed including ANOVA. Discriminatory power of muscle decay rates was evaluated using ROC analysis. RESULTS Monitoring PMA decay revealed significant long-term losses of 48.20% throughout the hospitalization period, with an average daily decline of 0.98%. Loss rates diverged significantly between survival groups, with 1.34% PMA decay per day among non-survivors vs. 0.74% in survivors. Overweight patients exhibited significantly higher total PMA losses (52.53 vs. 42.91%; p = 0.02) and average PMA loss per day (of 1.13 vs. 0.80%; p = 0.039). The first and the maximum decay rate, in average available after 6.16 and 17.03 days after ICU admission, showed convincing discriminatory power for survival in ROC analysis (AUC 0.607 and 0.718). Both thresholds for maximum loss (at 3.23% decay per day) and for the initial loss rate (at 1.98% per day) proved to be significant predictors of mortality. CONCLUSIONS The innovative AI-based PMA segmentation method proved robust and effortless, enabling the first comprehensive assessment of muscle wasting in a large cohort of intensive care pancreatitis patients. Findings revealed significant muscle wasting (48.20% on average), particularly notable in overweight individuals. Higher rates of initial and maximum muscle loss, detectable early, correlated strongly with survival. Integrating this tool into routine clinical practice will enable continuous muscle status tracking and early identification of those at risk for unfavorable outcomes.
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Affiliation(s)
- Johannes Kolck
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Clarissa Hosse
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Alexandra Leimbach
- Department of Anesthesiology and Intensive Care Medicine | CCM | CVK, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Nick L Beetz
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Timo A Auer
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Federico Collettini
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Uli Fehrenbach
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Christian Pille
- Department of Anesthesiology and Intensive Care Medicine | CCM | CVK, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Dominik Geisel
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
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Chen XH, Zhao JJ, Chen C, Yao L. Establishment and validation of a predictive model for tracheotomy in critically ill patients and analysis of the impact of different tracheotomy timing on patient prognosis. BMC Anesthesiol 2024; 24:175. [PMID: 38760700 PMCID: PMC11100231 DOI: 10.1186/s12871-024-02558-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 05/14/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND In critically ill patients receiving invasive mechanical ventilation (IMV), it is unable to determine early which patients require tracheotomy and whether early tracheotomy is beneficial. METHODS Clinical data of patients who were first admitted to the ICU and underwent invasive ventilation for more than 24 h in the Medical Information Marketplace in Intensive Care (MIMIC)-IV database were retrospectively collected. Patients were categorized into successful extubation and tracheotomy groups according to whether they were subsequently successfully extubated or underwent tracheotomy. The patients were randomly divided into model training set and validation set in a ratio of 7:3. Constructing predictive models and evaluating and validating the models. The tracheotomized patients were divided into the early tracheotomy group (< = 7 days) and the late tracheotomy group (> 7 days), and the prognosis of the two groups was analyzed. RESULTS A total of 7 key variables were screened: Glasgow coma scale (GCS) score, pneumonia, traumatic intracerebral hemorrhage, hemorrhagic stroke, left and right pupil responses to light, and parenteral nutrition. The area under the receiver operator characteristic (ROC) curve of the prediction model constructed through these seven variables was 0.897 (95% CI: 0.876-0.919), and 0.896 (95% CI: 0.866-0.926) for the training and validation sets, respectively. Patients in the early tracheotomy group had a shorter length of hospital stay, IMV duration, and sedation duration compared to the late tracheotomy group (p < 0.05), but there was no statistically significant difference in survival outcomes between the two groups. CONCLUSION The prediction model constructed and validated based on the MIMIC-IV database can accurately predict the outcome of tracheotomy in critically ill patients. Meanwhile, early tracheotomy in critically ill patients does not improve survival outcomes but has potential advantages in shortening the duration of hospitalization, IMV, and sedation.
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Affiliation(s)
- Xing-Hua Chen
- Department of Intensive Care Unit, Hefei Hospital Affiliated to Anhui Medical University, The Second People's Hospital of Hefei, Hefei, Anhui, 230011, China
| | - Jing-Jing Zhao
- Department of Intensive Care Unit, Hefei Hospital Affiliated to Anhui Medical University, The Second People's Hospital of Hefei, Hefei, Anhui, 230011, China
| | - Cheng Chen
- Department of Intensive Care Unit, Hefei Hospital Affiliated to Anhui Medical University, The Second People's Hospital of Hefei, Hefei, Anhui, 230011, China
| | - Li Yao
- Department of Intensive Care Unit, Hefei Hospital Affiliated to Anhui Medical University, The Second People's Hospital of Hefei, Hefei, Anhui, 230011, China.
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Mellado-Artigas R, Borrat X, Ferreyro BL, Yarnell C, Hao S, Wanis KN, Barbeta E, Torres A, Ferrando C, Brochard L. Effect of immediate initiation of invasive ventilation on mortality in acute hypoxemic respiratory failure: a target trial emulation. Crit Care 2024; 28:157. [PMID: 38730306 PMCID: PMC11088053 DOI: 10.1186/s13054-024-04926-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 04/21/2024] [Indexed: 05/12/2024] Open
Abstract
PURPOSE Invasive ventilation is a fundamental treatment in intensive care but its precise timing is difficult to determine. This study aims at assessing the effect of initiating invasive ventilation versus waiting, in patients with hypoxemic respiratory failure without immediate reason for intubation on one-year mortality. METHODS Emulation of a target trial to estimate the benefit of immediately initiating invasive ventilation in hypoxemic respiratory failure, versus waiting, among patients within the first 48-h of hypoxemia. The eligible population included non-intubated patients with SpO2/FiO2 ≤ 200 and SpO2 ≤ 97%. The target trial was emulated using a single-center database (MIMIC-IV) which contains granular information about clinical status. The hourly probability to receive mechanical ventilation was continuously estimated. The hazard ratios for the primary outcome, one-year mortality, and the secondary outcome, 30-day mortality, were estimated using weighted Cox models with stabilized inverse probability weights used to adjust for measured confounding. RESULTS 2996 Patients fulfilled the inclusion criteria of whom 792 were intubated within 48 h. Among the non-invasive support devices, the use of oxygen through facemask was the most common (75%). Compared to patients with the same probability of intubation but who were not intubated, intubation decreased the hazard of dying for the first year after ICU admission HR 0.81 (95% CI 0.68-0.96, p = 0.018). Intubation was associated with a 30-day mortality HR of 0.80 (95% CI 0.64-0.99, p = 0.046). CONCLUSION The initiation of mechanical ventilation in patients with acute hypoxemic respiratory failure reduced the hazard of dying in this emulation of a target trial.
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Affiliation(s)
- Ricard Mellado-Artigas
- Surgical Intensive Care Unit, Hospital Clínic de Barcelona, Barcelona, Spain.
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
| | - Xavier Borrat
- Surgical Intensive Care Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Bruno L Ferreyro
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
- Division of Respirology, Department of Medicine, University Health Network and Sinai Health System, Toronto, Canada
| | - Christopher Yarnell
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
- Division of Respirology, Department of Medicine, University Health Network and Sinai Health System, Toronto, Canada
- Department of Critical Care Medicine, Scarborough Health Network, Toronto, ON, Canada
| | - Sicheng Hao
- MIT IMES: Massachussetts Institute of Technology Institute for Medical Engineering and Science, Cambridge, USA
| | - Kerollos N Wanis
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Enric Barbeta
- Surgical Intensive Care Unit, Hospital Clínic de Barcelona, Barcelona, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Antoni Torres
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Respiratory Intensive Care Unit, Pneumology, Respiratory Institute, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Carlos Ferrando
- Surgical Intensive Care Unit, Hospital Clínic de Barcelona, Barcelona, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Laurent Brochard
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
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Volpe MS, dos Santos ACC, Gaspar S, de Melo JL, Harada G, Ferreira PRA, da Silva KRS, Souza NTS, Toufen C, Chiavegato LD, Amato MBP, Feltrim MIZ, de Carvalho CRR. A comprehensive physical functional assessment of survivors of critical care unit stay due to COVID-19. CRITICAL CARE SCIENCE 2024; 36:e20240284en. [PMID: 38716961 PMCID: PMC11098067 DOI: 10.62675/2965-2774.20240284-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/22/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVE To examine the physical function and respiratory muscle strength of patients - who recovered from critical COVID-19 - after intensive care unit discharge to the ward on Days one (D1) and seven (D7), and to investigate variables associated with functional impairment. METHODS This was a prospective cohort study of adult patients with COVID-19 who needed invasive mechanical ventilation, non-invasive ventilation or high-flow nasal cannula and were discharged from the intensive care unit to the ward. Participants were submitted to Medical Research Council sum-score, handgrip strength, maximal inspiratory pressure, maximal expiratory pressure, and short physical performance battery tests. Participants were grouped into two groups according to their need for invasive ventilation: the Invasive Mechanical Ventilation Group (IMV Group) and the Non-Invasive Mechanical Ventilation Group (Non-IMV Group). RESULTS Patients in the IMV Group (n = 31) were younger and had higher Sequential Organ Failure Assessment scores than those in the Non-IMV Group (n = 33). The short physical performance battery scores (range 0 - 12) on D1 and D7 were 6.1 ± 4.3 and 7.3 ± 3.8, respectively for the Non-Invasive Mechanical Ventilation Group, and 1.3 ± 2.5 and 2.6 ± 3.7, respectively for the IMV Group. The prevalence of intensive care unit-acquired weakness on D7 was 13% for the Non-IMV Group and 72% for the IMV Group. The maximal inspiratory pressure, maximal expiratory pressure, and handgrip strength increased on D7 in both groups, but the maximal expiratory pressure and handgrip strength were still weak. Only maximal inspiratory pressure was recovered (i.e., > 80% of the predicted value) in the Non-IMV Group. Female sex, and the need and duration of invasive mechanical were independently and negatively associated with the short physical performance battery score and handgrip strength. CONCLUSION Patients who recovered from critical COVID-19 and who received invasive mechanical ventilation presented greater disability than those who were not invasively ventilated. However, they both showed marginal functional improvement during early recovery, regardless of the need for invasive mechanical ventilation. This might highlight the severity of disability caused by SARS-CoV-2.
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Affiliation(s)
- Marcia Souza Volpe
- Universidade Federal de São PauloDepartment of Human Movement SciencesSantosSPBrazilDepartment of Human Movement Sciences, Universidade Federal de São Paulo - Santos (SP), Brazil.
| | - Ana Carolina Cardoso dos Santos
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrazilDivision of Pneumology, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil.
| | - Sílvia Gaspar
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrazilDepartment of Physiotherapy, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil.
| | - Jade Lara de Melo
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrazilDivision of Pneumology, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil.
| | - Gabriela Harada
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrazilDepartment of Physiotherapy, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil.
| | - Patrícia Rocha Alves Ferreira
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrazilDepartment of Physiotherapy, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil.
| | - Karina Ramiceli Soares da Silva
- Universidade Federal de São PauloDepartment of Human Movement SciencesSantosSPBrazilDepartment of Human Movement Sciences, Universidade Federal de São Paulo - Santos (SP), Brazil.
| | - Natália Tiemi Simokomaki Souza
- Universidade Federal de São PauloDiscipline of PneumologySão PauloSPBrazilDiscipline of Pneumology, Universidade Federal de São Paulo - São Paulo (SP), Brazil.
| | - Carlos Toufen
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrazilDivision of Pneumology, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil.
| | - Luciana Dias Chiavegato
- Universidade Federal de São PauloDiscipline of PneumologySão PauloSPBrazilDiscipline of Pneumology, Universidade Federal de São Paulo - São Paulo (SP), Brazil.
| | - Marcelo Britto Passos Amato
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrazilDivision of Pneumology, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil.
| | - Maria Ignez Zanetti Feltrim
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrazilDepartment of Physiotherapy, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil.
| | - Carlos Roberto Ribeiro de Carvalho
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrazilDivision of Pneumology, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil.
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47
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Eggmann S, Timenetsky KT, Hodgson C. Promoting optimal physical rehabilitation in ICU. Intensive Care Med 2024; 50:755-757. [PMID: 38563898 DOI: 10.1007/s00134-024-07384-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 03/03/2024] [Indexed: 04/04/2024]
Affiliation(s)
- Sabrina Eggmann
- Department of Physiotherapy, Inselspital, Bern University Hospital, Bern, Switzerland
| | | | - Carol Hodgson
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
- Department of Physiotherapy, Alfred Health, Melbourne, Australia.
- Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia.
- Critical Care Division, The George Institute for Global Health, Sydney, Australia.
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48
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Ekong M, Monga TS, Daher JC, Sashank M, Soltani SR, Nwangene NL, Mohammed C, Halfeld FF, AlShelh L, Fukuya FA, Rai M. From the Intensive Care Unit to Recovery: Managing Post-intensive Care Syndrome in Critically Ill Patients. Cureus 2024; 16:e61443. [PMID: 38953087 PMCID: PMC11215031 DOI: 10.7759/cureus.61443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2024] [Indexed: 07/03/2024] Open
Abstract
Post-intensive care syndrome (PICS) is the term used to describe the decline in the physical, cognitive, and/or mental condition of individuals who have been discharged from the intensive care unit (ICU). This complication could result in a significant reduction in quality of life, with some patients experiencing symptoms of prolonged weakness, depression, anxiety, and post-traumatic stress disorder (PTSD). Intensive care advancement over the years has resulted in an increase in ICU survival rates and a proportional increase in PICS, creating a need for more in-depth research into the prevention and management of the disease. Hence, this study aims to examine the present body of literature on PICS, encompassing its underlying physiological processes and elements that contribute to its development, methods for evaluating and diagnosing the condition, current treatment choices as well as potential new approaches, and the constraints in managing PICS and the necessity for further investigation. In this article, studies were compiled from several databases, including, but not limited to, Google Scholar, PubMed, and Cochrane Library. These studies were reviewed, and their data were used to highlight important aspects regarding the efficacy of current PICS screening tools, the optimization and limitations of both pharmacologic and non-pharmacologic treatment methods, and the feasibility and safety of emerging treatments and technologies. The major conclusions of this review were centered around the need for multidisciplinary management of PICS. From pharmacological management using analgesia to non-pharmacological management using early mobilization and exercise therapy, the effective treatment of PICS requires a multifaceted approach. Patient follow-up and its importance were touched upon, including strategies and policies to bolster proper follow-up, thereby increasing favorable outcomes. Lastly, the importance of family involvement and the increased need for research into this topic were highlighted.
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Affiliation(s)
- Mfonido Ekong
- Internal Medicine, St. George's University School of Medicine, True Blue, GRD
| | | | - Jean Carlo Daher
- Medicine, Lakeland Regional Health, Lakeland, USA
- Medicine, Universidad de Ciencias Medicas Andres Vesalio Guzman, San Jose, CRI
| | - Mutyala Sashank
- Internal Medicine, Davao Medical School Foundation Inc., Davao, PHL
| | - Setareh Reza Soltani
- Advanced Diagnostic & Interventional Radiology Center (ADIR), Tehran University of Medical Sciences, Tehran, IRN
| | | | - Cara Mohammed
- Orthopaedic Surgery, Sangre Grande Hospital, Sangre Grande, TTO
| | | | - Leen AlShelh
- Internal Medicine, Medical University of Lublin, Lublin, POL
| | | | - Manju Rai
- Biotechnology, Shri Venkateshwara University, Punjab, IND
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49
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Fritsch SJ, Siemer AG, Dreher M, Simon TP, Marx G, Bickenbach J. Diaphragm ultrasound in patients with prolonged weaning from mechanical ventilation. Quant Imaging Med Surg 2024; 14:3248-3263. [PMID: 38720844 PMCID: PMC11074767 DOI: 10.21037/qims-23-1712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/18/2024] [Indexed: 05/12/2024]
Abstract
Background Several publications have examined diaphragmatic ultrasound using two-dimensional (2D) parameters in the context of weaning from mechanical ventilation (MV) and extubation. However, the studied cohorts had rather short duration of ventilation. Examinations on patients with prolonged weaning after long-term ventilation were missing. It was the aim of this study to assess of the diaphragm and peripheral musculature of patients undergoing prolonged weaning creating a chronological sequence of ultrasonic parameters during the course of weaning. Methods This study was carried out as a monocentric, prospective observational cross-sectional study. Patients in prolonged weaning who were transferred to a specialized weaning unit were eligible for inclusion if they were ventilated invasively by means of an endotracheal tube or tracheal cannula and if their expected treatment period was at least 5 days. Diaphragmatic function and one representative peripheral muscle were examined in 50 patients between March 2020 and April 2021. The 2D sonographic parameters of diaphragm and diaphragmatic function consisted of diaphragmatic thickness (Tdi) at the end of inspiration and expiration, the fractional thickening (FT) and the diaphragmatic excursion. Additionally, the M. quadriceps femoris was sonographically assessed at two locations. The difference of measurements between the first and the last measuring timepoint were examined using the Wilcoxon signed-rank test. For a longer chronological sequence, the Friedman's rank sum test with subsequent Wilcoxon-Nemenyi-McDonald-Thompson test for multiple comparisons was carried out. Results Fifty patients with prolonged weaning were included. The median duration of MV before transfer to the weaning unit was 11.5 [interquartile range (IQR) 10] days. Forty-one patients could be assessed over the full course of weaning, with 38 successfully weaned. Within these 41 patients, the sonographic parameters of the diaphragm slightly increased over the course of weaning indicating an increase in thickness and mobility. Especially parameters which represented an active movement reached statistical significance, i.e., inspiratory Tdi when assessed under spontaneous breathing [begin 3.41 (0.99) vs. end 3.43 (1.31) mm; P=0.01] and diaphragmatic excursion [begin 0.7 (0.8) vs. end 0.9 (0.6) cm; P=0.01]. The presence of positive end-expiratory pressure (PEEP) and pressure support did not influence the sonographic parameters significantly. The M. quadriceps femoris, in contrast, decreased slightly but constantly over the time [lower third: begin 1.36 (0.48) vs. end 1.28 (0.36) cm; P=0.054]. Conclusions The present study is the first one to longitudinally analyse diaphragmatic ultrasound in patients with prolonged weaning. Sonographic assessment showed that Tdi and excursion increased over the course of prolonged weaning, while the diameter of a representative peripheral muscle decreased. However, the changes are rather small, and data show a wide dispersion. To allow a potential, standardized use of diaphragm ultrasound for diagnostic decision support in prolonged weaning, further studies in this specific patient group are required.
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Affiliation(s)
- Sebastian Johannes Fritsch
- Department of Intensive Care Medicine, University Hospital Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen, Aachen, Germany
- Jülich Supercomputing Centre, Forschungszentrum Jülich, Jülich, Germany
| | - Anna Große Siemer
- Department of Intensive Care Medicine, University Hospital Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen, Aachen, Germany
- Department of Neurology, Protestant Hospital Oldenburg, Oldenburg, Germany
| | - Michael Dreher
- Department of Pneumology and Intensive Care Medicine, University Hospital Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen, Aachen, Germany
| | - Tim-Philipp Simon
- Department of Intensive Care Medicine, University Hospital Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen, Aachen, Germany
| | - Gernot Marx
- Department of Intensive Care Medicine, University Hospital Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen, Aachen, Germany
| | - Johannes Bickenbach
- Department of Intensive Care Medicine, University Hospital Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen, Aachen, Germany
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50
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Young DL, Al-Ani A, Lakhmalla M, Raman V, Fatima A, Friedman LA, Challa SR, Vasishta S, Koneru M, Colantuoni E, Needham DM, Dinglas VD. Participant retention in follow-up studies of intensive care unit survivors - A scoping review. Aust Crit Care 2024:S1036-7314(24)00031-6. [PMID: 38582625 DOI: 10.1016/j.aucc.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/27/2023] [Accepted: 02/04/2024] [Indexed: 04/08/2024] Open
Abstract
OBJECTIVE To synthesize participant retention data and related reporting in studies evaluating post-hospital outcomes of survivors of critical illness after an intensive care unit (ICU) stay. REVIEW METHOD USED A synthesis of literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist. DATA SOURCES PubMed, EMBASE, PsycINFO, Cumulative Index of Nursing and Allied Health Literature, and the Cochrane Controlled Trials Registry. Hand searched reference lists and personal files of relevant narrative and systematic review articles. REVIEW METHODS Articles were screened by pairs of independent reviewers. Similarly, data were abstracted by pairs of data collectors, with conflicts resolved by consensus or by a third reviewer. RESULTS We included 243 publications, from 225 unique studies of 87,602 participants. Participant retention could not be calculated for any time-points in 13% of studies nor in 22% of all follow-up time-points. Retention ranged from 18-100%. When compared to follow-up before 1-month, retention at each later timepoint was not significantly different. Age and sex were not associated with retention and more recent studies had decreased retention (odds ratio: 0.94 [95% confidence interval: 0.92-0.96; p < 0.001]). Reporting of retention-related study methodology was inconsistent. CONCLUSION Retention rate could not be calculated for 22% of study follow-up time-points, with retention at the remaining time-points generally being high (≥85%), but with high variability (18% - 100%). ICU survivorship research could be improved via: (i) more detailed guidance on reporting participant retention, and (ii) use of existing resources and best practices to facilitate better study design and to improve participant retention to preserve statistical power and reduce selection bias.
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Affiliation(s)
- Daniel L Young
- Department of Physical Therapy, University of Nevada, Las Vegas, Las Vegas, NV, USA; Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, MD, USA; Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, USA
| | - Awsse Al-Ani
- Preventive Cardiology Department, Brigham and Women's Hospital, Boston, MA, USA
| | - Mounika Lakhmalla
- Department of Internal Medicine, Baton Rouge General Medical Center, Baton Rouge, LA, USA
| | - Vaishnavi Raman
- Division of Geriatric Medicine, Department of Medicine, Grand River Hospital and St. Mary's General Hospital, Kitchener, Ontario, Canada
| | - Arooj Fatima
- Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, MD, USA; Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, USA
| | - Lisa Aronson Friedman
- Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, MD, USA; Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, USA
| | | | - Sumana Vasishta
- NHS Wales Shared Service Partnership (NWSSP), Wales, United Kingdom
| | - Mounica Koneru
- Department of Pediatrics, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Elizabeth Colantuoni
- Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, MD, USA; Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dale M Needham
- Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, MD, USA; Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, USA; Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, USA
| | - Victor D Dinglas
- Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, MD, USA; Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, USA.
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