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Zhang Y, Li D, Zhang F, Wang Z, Xue L, Nan X, Li N, Tan X, Guo W, Zhang Y, Zhao H, Ge Q, Wang D. Evaluation and modeling of diaphragm displacement using ultrasound imaging for wearable respiratory assistive robot. Front Bioeng Biotechnol 2024; 12:1436702. [PMID: 39219622 PMCID: PMC11361991 DOI: 10.3389/fbioe.2024.1436702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 06/27/2024] [Indexed: 09/04/2024] Open
Abstract
Introduction Assessing the influence of respiratory assistive devices on the diaphragm mobility is essential for advancing patient care and improving treatment outcomes. Existing respiratory assistive robots have not yet effectively assessed their impact on diaphragm mobility. In this study, we introduce for the first time a non-invasive, real-time clinically feasible ultrasound method to evaluate the impact of soft wearable robots on diaphragm displacement. Methods We measured and compared diaphragm displacement and lung volume in eight participants during both spontaneous and robotic-assisted respiration. Building on these measurements, we proposed a human-robot coupled two-compartment respiratory mechanics model that elucidates the underlying mechanism by which our extracorporeal wearable robots augments respiration. Specifically, the soft robot applies external compression to the abdominal wall muscles, inducing their inward movement, which consequently pushes the diaphragm upward and enhances respiratory function. Finally, we investigated the level and shape of various robotic assistive forces on diaphragm motion. Results This robotic intervention leads to a significant increase in average diaphragm displacement by 1.95 times and in lung volume by 2.14 times compared to spontaneous respiration. Furthermore, the accuracy of the proposed respiratory mechanics model is confirmed by the experimental results, with less than 7% error in measurements of both diaphragm displacement and lung volume. Finally, the magnitude of robotic assistive forces positively correlates with diaphragm movement, while the shape of the forces shows no significant relationship with diaphragm activity. Conclusion Our experimental findings validate the effective assistance mechanism of the proposed robot, which enhances diaphragm mobility and assists in ventilation through extracorporeal robotic intervention. This robotic system can assist with ventilation while increasing diaphragm mobility, potentially resolving the issue of diaphragm atrophy. Additionally, this work paves the way for improved robotic designs and personalized assistance, tailored to the dynamics of the diaphragm in respiratory rehabilitation.
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Affiliation(s)
- Yan Zhang
- The State Key Laboratory of Virtual Reality Technology and Systems, Beihang University, Beijing, China
| | - Danye Li
- China-Japan Friendship Hospital, Beijing, China
| | - Fengyao Zhang
- The State Key Laboratory of Virtual Reality Technology and Systems, Beihang University, Beijing, China
| | - Zongyu Wang
- The Peking University Third Hospital, Beijing, China
| | - Lei Xue
- The Peking University Third Hospital, Beijing, China
| | - Xiaolu Nan
- The State Key Laboratory of Virtual Reality Technology and Systems, Beihang University, Beijing, China
| | - Nianming Li
- The State Key Laboratory of Virtual Reality Technology and Systems, Beihang University, Beijing, China
| | - Xilai Tan
- The State Key Laboratory of Virtual Reality Technology and Systems, Beihang University, Beijing, China
| | - Weidong Guo
- The State Key Laboratory of Virtual Reality Technology and Systems, Beihang University, Beijing, China
| | - Yuru Zhang
- The State Key Laboratory of Virtual Reality Technology and Systems, Beihang University, Beijing, China
- School of Mechanical Engineering and Automation, Beijing, China
| | | | - Qinggang Ge
- The Peking University Third Hospital, Beijing, China
| | - Dangxiao Wang
- The State Key Laboratory of Virtual Reality Technology and Systems, Beihang University, Beijing, China
- School of Mechanical Engineering and Automation, Beijing, China
- The Beijing Advanced Innovation Center for Biomedical Engineering, Beijing, China
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Li K, Alhaskawi A, Zhou H, Dong Y, Zhao Q, Wang C, Lu H. Risk Factors and Electromyographic Characteristics of Acquired Weakness in Critically Ill Patients: A Retrospective Study. Ther Clin Risk Manag 2024; 20:451-463. [PMID: 39104821 PMCID: PMC11299719 DOI: 10.2147/tcrm.s464722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 07/24/2024] [Indexed: 08/07/2024] Open
Abstract
Objective This retrospective study examines risk factors and electromyographic (EMG) characteristics associated with acquired weakness in critically ill patients and assesses their impact on patient prognosis. Methods Ninety-seven critically ill patients, ventilated for over 48 hours, were included. Patient data, encompassing general condition, medical history, Medical Research Council (MRC) scores, serum markers (c-reactive protein, calcitonin gene, albumin, brain natriuretic peptide, urea nitrogen, creatinine), EMG characteristics, respiratory treatment modalities, and parameters, were recorded. Mechanical ventilation duration, ICU stay duration, hospitalization duration, and patient prognosis were documented. Based on MRC scores, patients were categorized into the ICU-acquired weakness (ICU-AW) group (MRC <48 points) and the non-ICU-AW group (MRC ≥48 points). Results The study comprised 47 ICU-AW and 50 non-ICU-AW patients. Significant differences (p <0.05) were observed in age, MRC scores, albumin levels, c-reactive protein, calcitonin gene, brain natriuretic peptide, urea nitrogen, creatinine, mechanical ventilation duration, ICU stay duration, and hospitalization duration between groups. In the ICU-AW group, nerve conduction examinations revealed slow conduction velocity, reduced wave amplitude, and in severe cases, a complete loss of motor and sensory potentials. Multivariate logistic analysis identified low serum albumin levels and MRC scores as potential ICU-AW risk factors. Conclusion This study suggests that low serum albumin levels and MRC scores may contribute to ICU-AW risk. The ICU-AW group exhibited varied peripheral nerve damage and slow conduction velocities on EMG. Additionally, severe systemic inflammatory responses, renal function, brain natriuretic peptide levels, prolonged mechanical ventilation, and peripheral nerve damage may be associated with ICU-AW. Follow-up studies are essential for further understanding these complex interactions.
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Affiliation(s)
- Kun Li
- Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Ahmad Alhaskawi
- Department of Orthopaedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Haiyin Zhou
- Department of Orthopaedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Yanzhao Dong
- Department of Orthopaedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People’s Republic of China
| | - QingFang Zhao
- Department of Plastic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Chenxi Wang
- Medical Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Hui Lu
- Department of Orthopaedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People’s Republic of China
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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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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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Cazeta BBR, de Queiroz RS, Nacimento TS, Ferreira BR, Saquetto MB, Martinez BP, Carvalho VO, Gomes-Neto M. Effects of exercise interventions on functioning and health-related quality of life following hospital discharge for recovery from critical illness: A systematic review and meta-analysis of randomized trials. Clin Rehabil 2024; 38:898-909. [PMID: 38556253 DOI: 10.1177/02692155241241665] [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] [Indexed: 04/02/2024]
Abstract
OBJECTIVE This systematic review and meta-analysis aimed to analyze the published randomized controlled trials (RCTs) that investigated the effects of exercise interventions on functioning and health-related quality of life following hospital discharge for recovery from critical illness. DESIGN Systematic review and meta-analysis of RCTs. DATA SOURCES We searched PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, PEDro data base, and SciELO (from the earliest date available to January 2023) for RCTs that evaluated the effects of physical rehabilitation interventions following hospital discharge for recovery from critical illness. REVIEW METHODS Study quality was evaluated using the PEDro Scale. Mean differences (MDs), standard MDs (SMD), and 95% confidence intervals (CIs) were calculated. RESULTS Fourteen studies met the study criteria, including 1259 patients. Exercise interventions improved aerobic capacity SMD 0.2 (95% CI: 0.03-0.3, I2 = 0% N = 880, nine studies, high-quality evidence), and physical component score of health-related quality of life MD 3.3 (95% CI: 1.0-5.6, I2 = 57%, six studies N = 669, moderate-quality evidence). In addition, a significant reduction in depression was observed MD -1.4 (95% CI: -2.7 to -0.1, I2 = 0% N = 148, three studies, moderate-quality evidence). No serious adverse events were reported. CONCLUSION Exercise intervention was associated with improvement of aerobic capacity, depression, and physical component score of health-related quality of life after hospital discharge for survivors of critical illness.
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Affiliation(s)
- Bianca Bigogno Reis Cazeta
- Physical Therapy Department, Federal University of Bahia - UFBA, Salvador, Brazil
- Programa de Pós-Graduação em Medicina e Saúde, UFBA, Salvador, Brazil
- Physiotherapy Research Group, UFBA, Salvador, Brazil
| | - Rodrigo Santos de Queiroz
- Programa de Pós-Graduação em Medicina e Saúde, UFBA, Salvador, Brazil
- Physiotherapy Research Group, UFBA, Salvador, Brazil
| | - Tais Silva Nacimento
- Programa de Pós-Graduação em Medicina e Saúde, UFBA, Salvador, Brazil
- Physiotherapy Research Group, UFBA, Salvador, Brazil
| | | | - Micheli Bernardone Saquetto
- Physical Therapy Department, Federal University of Bahia - UFBA, Salvador, Brazil
- Programa de Pós-Graduação em Medicina e Saúde, UFBA, Salvador, Brazil
- Physiotherapy Research Group, UFBA, Salvador, Brazil
| | - Bruno Prata Martinez
- Physical Therapy Department, Federal University of Bahia - UFBA, Salvador, Brazil
- Programa de Pós-Graduação em Medicina e Saúde, UFBA, Salvador, Brazil
| | | | - Mansueto Gomes-Neto
- Physical Therapy Department, Federal University of Bahia - UFBA, Salvador, Brazil
- Programa de Pós-Graduação em Medicina e Saúde, UFBA, Salvador, Brazil
- Physiotherapy Research Group, UFBA, Salvador, Brazil
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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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Zhao M, Qiu A, Zhang Z, Pan F, Gao Y. The knowledge, attitude and behavior of ICU nurses regarding ICU-acquired weakness: a cross-sectional survey. BMC Nurs 2024; 23:377. [PMID: 38835021 DOI: 10.1186/s12912-024-01942-9] [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: 12/06/2023] [Accepted: 04/15/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Intensive care unit-acquired weakness (ICU-AW) is very common in ICU patients. It is important to understand the status quo of knowledge, attitude and behavior of ICU nurses about ICU-AW. This survey aimed to investigate the knowledge, attitude and behavior of ICU nurses about ICU-AW, to provide useful implications for clinical care. METHODS ICU nurses from two tertiary hospitals in China from October 10 to November 15, 2023 were included. The ICU-AW knowledge, attitude and behavior questionnaire of ICU nurses with 31 items were used for survey. SPSS24.0 statistical software was used for data analysis. RESULTS A total of 364 ICU nurses were included for survey. The ICU-AW knowledge of ICU nurses was 21.96 ± 5.72 (< 50% of the total knowledge score), the ICU-AW attitude of ICU nurses was 30.24 ± 5.05(< 75% of the total attitude score), the ICU-AW behavior of ICU nurses was 26.77 ± 5.81(< 75% of the total behavior score), the total score was 79.21 ± 12.69(< 75% of the total score). Nurses' ICU-AW knowledge, attitude and behavior were all correlated (all P < 0.05). Multiple linear regression analyses indicated that age, years of ICU work experience, professional ranks and titles, had received the training about the ICU-AW were the influencing factors of knowledge, attitude and behavior of ICU nurses about ICU-AW (all P < 0.05). CONCLUSIONS The knowledge, attitude and behavior of ICU nurses' ICU-AW needs to be improved, and there are many influencing factors. Hospital nursing administrators should strengthen the training of nurses' ICU-AW knowledge and improve the cognitive and practical ability of ICU nurses on ICU-AW, so as to reduce the occurrence of ICU-AW.
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Affiliation(s)
- Mingfeng Zhao
- Department of Emergency and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Anyun Qiu
- Department of general surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210000, China
| | - Zhijing Zhang
- Department of otorhinolaryngology, Children's Hospital of Nanjing Medical University, Nanjing, 210000, China
| | - Fang Pan
- Department of otorhinolaryngology, Children's Hospital of Nanjing Medical University, Nanjing, 210000, China.
| | - Yongxia Gao
- Department of Emergency and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
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Chien SC, Wang CA, Liu HY, Lin CF, Huang CY, Chien LN. Comparison of the prognosis among in-hospital survivors of cardiogenic shock based on etiology: AMI and Non-AMI. Ann Intensive Care 2024; 14:74. [PMID: 38735891 PMCID: PMC11089020 DOI: 10.1186/s13613-024-01305-2] [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: 11/04/2023] [Accepted: 04/29/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND Current data on post-discharge mortality and rehospitalization is still insufficient among in-hospital survivors of cardiogenic shock (CS), including acute myocardial infarction (AMI) and non-AMI survivors. METHODS Patients with CS who survived after hospital discharge were selected from the Taiwan National Health Insurance Research Database. Each patient was followed up at 3-year intervals. Mortality and rehospitalization were analyzed using Kaplan-Meier curves and Cox regression models. RESULTS There were 16,582 eligible patients. Of these, 42.4% and 57.6% were AMI-CS and non-AMI-CS survivors, respectively. The overall mortality and rehospitalization rates were considerably high, with reports of 7.0% and 22.1% at 30 days, 24.5% and 58.2% at 1 year, and 38.9% and 73.0% at 3 years, respectively, among in-hospital CS survivors. Cardiovascular (CV) problems caused approximately 40% mortality and 60% rehospitalization. Overall, the non-AMI-CS group had a higher mortality burden than the AMI-CS group owing to older age and a higher prevalence of comorbidities. In multivariable models, the non-AMI-CS group exhibited a lower risk of all-cause mortality (adjusted hazard ratio [aHR] 0.69, 95% confidence interval [CI] 0.60 to 0.78) and CV mortality (aHR 0.65, 95% CI 0.54 to 0.78) compared to the AMI-CS group. However, these risks diminished and even reversed after one year (aHR 1.13, 95% CI 1.03 to 1.25 for all-cause mortality; aHR 1.27, 95% CI 1.09 to 1.49 for CV mortality).This reversal was not observed in all-cause and CV rehospitalization. For rehospitalization, AMI-CS was associated with the risk of CV rehospitalization in the entire observation period (aHR:0.80, 95% CI:0.76-0.84). CONCLUSIONS In-hospital AMI-CS survivors had an increased risk of CV rehospitalization and 30-day mortality, whereas those with non-AMI-CS had a greater mortality risk after 1-year follow-up.
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Affiliation(s)
- Shih-Chieh Chien
- Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Cheng-An Wang
- Division of Cardiology, Department of Internal Medicine, Taipei Medical University Wan Fang Hospital, Taipei, Taiwan
| | - Hung-Yi Liu
- Health and Clinical Research Data Center, Office of Data Center, Taipei Medical University, Taipei, Taiwan
| | - Chao-Feng Lin
- Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chun-Yao Huang
- Division of Cardiology and Cardiovascular Research Center, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Li-Nien Chien
- Institute of Health and Welfare Policy, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Graduate Institute of Data Science, College of Management, Taipei Medical University, Taipei, Taiwan.
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Ji HM, Won YH. Early Mobilization and Rehabilitation of Critically-Ill Patients. Tuberc Respir Dis (Seoul) 2024; 87:115-122. [PMID: 38228092 PMCID: PMC10990608 DOI: 10.4046/trd.2023.0144] [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: 09/12/2023] [Revised: 11/30/2023] [Accepted: 12/18/2023] [Indexed: 01/18/2024] Open
Abstract
Post-intensive care unit (ICU) syndrome may occur after ICU treatment and includes ICU-acquired weakness (ICU-AW), cognitive decline, and mental problems. ICU-AW is muscle weakness in patients treated in the ICU and is affected by the period of mechanical ventilation. Diaphragmatic weakness may also occur because of respiratory muscle unloading using mechanical ventilators. ICU-AW is an independent predictor of mortality and is associated with longer duration of mechanical ventilation and hospital stay. Diaphragm weakness is also associated with poor outcomes. Therefore, pulmonary rehabilitation with early mobilization and respiratory muscle training is necessary in the ICU after appropriate patient screening and evaluation and can improve ICU-related muscle weakness and functional deterioration.
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Affiliation(s)
- Hye Min Ji
- Veterans Medical Research Institute, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Yu Hui Won
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University–Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
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Hongo T, Naito H, Liu K, Murakami Y, Nozaki S, Maeyama H, Matsuoka A, Dote H, Inaba K, Miike S, Fujitani S, Hiraoka T, Obara T, Nojima T, Nakao A, Yumoto T. Changes in temporal muscle dimensions and their clinical impact in out-of-hospital cardiac arrest survivors. Resusc Plus 2024; 17:100527. [PMID: 38188596 PMCID: PMC10770543 DOI: 10.1016/j.resplu.2023.100527] [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: 10/19/2023] [Revised: 11/13/2023] [Accepted: 11/29/2023] [Indexed: 01/09/2024] Open
Abstract
Objective This study investigates temporal muscle atrophy in out-of-hospital cardiac arrest patients post-resuscitation, seeking associations with neurological outcomes and factors associated with atrophy. Methods Using data from six Japanese intensive care units, adult patients' post-resuscitation who underwent head computed tomography scans on admission and two to five days post-admission were assessed. Temporal muscle area, thickness, and density were quantified from a single cross-sectional image. Patients were categorized into 'atrophy' or 'no atrophy' groups based on median daily temporal muscle atrophy rates. The primary outcome was changes in temporal muscle dimensions between admission and follow-up two to five days later. Secondary outcomes included assessing the impact of temporal muscle atrophy on 30-day survival, as well as identifying any clinical factors associated with temporal muscle atrophy. Results A total of 185 patients were analyzed. Measurements at follow-up revealed significant decreases in temporal muscle area (214 vs. 191 mm2, p < 0.001), thickness (4.9 vs. 4.7 mm, p < 0.001), and density (46 vs. 44 HU, p < 0.001) compared to those at admission. The median daily rate for temporal muscle area atrophy was 2.0% per day. There was no significant association between temporal muscle atrophy and 30-day survival (hazard ratios, 0.71; 95% CI, 0.41-1.23, p = 0.231). Multivariable logistic regression found no clinical factors significantly associated with temporal muscle atrophy. Conclusions Temporal muscle atrophy in post-resuscitation patients occurs rapidly at 2.0% per day. However, there was no significant association with 30-day mortality or any identified clinical factors. Further investigation into its long-term functional implications is warranted.
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Affiliation(s)
- Takashi Hongo
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama Kita-ku, Okayama 700-8558, Japan
- Department of Emergency, Okayama Saiseikai General Hospital, 2-25 Kokutai-cho, Okayama Kita-ku, Okayama 700-8511, Japan
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama Kita-ku, Okayama 700-8558, Japan
| | - Keibun Liu
- Critical Care Research Group, The Prince Charles Hospital, 627 Rode Rd, Chermside, Brisbane, QLD 4032, Australia
- Institute for Molecular Bioscience, The University of Queensland, 306 Carmody Road, St Lucia, Brisbane, QLD 4072, Australia
- Non-Profit Organization ICU Collaboration Network (ICON), 2-15-13 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Yuya Murakami
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama Kita-ku, Okayama 700-8558, Japan
- Department of Emergency and Critical Care Medicine, Tsuyama Chuo Hospital, 1756, Tsuyama, Okayama 708-0841, Japan
| | - Satoshi Nozaki
- Department of Emergency, Okayama Saiseikai General Hospital, 2-25 Kokutai-cho, Okayama Kita-ku, Okayama 700-8511, Japan
| | - Hiroki Maeyama
- Department of Emergency and Critical Care Medicine, Tsuyama Chuo Hospital, 1756, Tsuyama, Okayama 708-0841, Japan
| | - Ayaka Matsuoka
- Emergency and Critical Care Medicine, Saga University Hospital, 5-1-1 Nabeshima, Saga City, Saga 849-8501, Japan
| | - Hisashi Dote
- Department of Emergency and Critical Care Medicine, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu Naka-ku, Shizuoka 430-8558, Japan
| | - Kazumasa Inaba
- Department of Emergency and Critical Care Medicine, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu Naka-ku, Shizuoka 430-8558, Japan
| | - Satoshi Miike
- Emergency/Critical Care Medicine Department, St. Marianna Medical School, 2-16-1 Sugao Miyamae-ku, 216-8511 Kawasaki City, Kanagawa, Japan
| | - Shigeki Fujitani
- Emergency/Critical Care Medicine Department, St. Marianna Medical School, 2-16-1 Sugao Miyamae-ku, 216-8511 Kawasaki City, Kanagawa, Japan
| | - Tomohiro Hiraoka
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama Kita-ku, Okayama 700-8558, Japan
| | - Takafumi Obara
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama Kita-ku, Okayama 700-8558, Japan
| | - Tsuyoshi Nojima
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama Kita-ku, Okayama 700-8558, Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama Kita-ku, Okayama 700-8558, Japan
| | - Tetsuya Yumoto
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama Kita-ku, Okayama 700-8558, Japan
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11
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Nobayashi H, Kanzaki G, Bamba H, Shibata Y, Fujimoto T, Matsuo N, Maruyama Y, Yokoo T. Early diagnosis leading to improvement of critical illness polyneuropathy associated with severe Staphylococcus aureus infection in a patient on hemodialysis. CEN Case Rep 2024; 13:26-31. [PMID: 37120491 PMCID: PMC10834894 DOI: 10.1007/s13730-023-00794-7] [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: 01/04/2023] [Accepted: 04/23/2023] [Indexed: 05/01/2023] Open
Abstract
Critical illness polyneuropathy (CIP) is a very rare complication of sepsis and multi-organ failure. Herein, we report the first case of CIP reported in a patient on maintenance hemodialysis, who improved with rehabilitation. A 55-year-old male patient was emergently admitted with fever and altered consciousness and diagnosed with bacterial meningitis based on cerebral spinal fluid and cranial magnetic resonance imaging findings. Methicillin-susceptible Staphylococcus aureus was detected in blood and cerebral spinal fluid cultures. Despite treatment with appropriate antibiotics, blood cultures were positive for 9 days and serum C-reactive protein (CRP) levels were persistently elevated. Magnetic resonance imaging of hands and feet to determine infection origin revealed osteomyelitis in several fingers and toes, which required the amputation of 14 necrotic fingers and toes. Thereafter, blood cultures became negative and CRP levels declined. However, flaccid paralysis was noted in both upper and lower extremities during sepsis treatment. Nerve conduction studies showed peripheral axonal disorder in motor and sensory nerves, and CIP was determined as the cause of paralysis based on the fulfillment of all four CIP diagnostic criteria. The patient's muscle strength improved with early and appropriate medical treatment and physical therapy, and he was discharged home 147 days after admission. Prolonged high-level inflammation is a cause of CIP. Patients on hemodialysis, who are potentially immunosuppressed and vulnerable to infection, are at high risk for CIP. In patients on maintenance hemodialysis who develop flaccid paralysis during treatment for severe infection, CIP should be considered for early diagnosis and intervention.
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Affiliation(s)
- Hiroki Nobayashi
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Go Kanzaki
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan.
| | - Harui Bamba
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Yuriko Shibata
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Toshinari Fujimoto
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Nanae Matsuo
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Yukio Maruyama
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
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12
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Latronico N, Rasulo FA, Eikermann M, Piva S. Illness Weakness, Polyneuropathy and Myopathy: Diagnosis, treatment, and long-term outcomes. Crit Care 2023; 27:439. [PMID: 37957759 PMCID: PMC10644573 DOI: 10.1186/s13054-023-04676-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/04/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Severe weakness associated with critical illness (CIW) is common. This narrative review summarizes the latest scientific insights and proposes a guide for clinicians to optimize the diagnosis and management of the CIW during the various stages of the disease from the ICU to the community stage. MAIN BODY CIW arises as diffuse, symmetrical weakness after ICU admission, which is an important differentiating factor from other diseases causing non-symmetrical muscle weakness or paralysis. In patients with adequate cognitive function, CIW can be easily diagnosed at the bedside using manual muscle testing, which should be routinely conducted until ICU discharge. In patients with delirium or coma or those with prolonged, severe weakness, specific neurophysiological investigations and, in selected cases, muscle biopsy are recommended. With these exams, CIW can be differentiated into critical illness polyneuropathy or myopathy, which often coexist. On the general ward, CIW is seen in patients with prolonged previous ICU treatment, or in those developing a new sepsis. Respiratory muscle weakness can cause neuromuscular respiratory failure, which needs prompt recognition and rapid treatment to avoid life-threatening situations. Active rehabilitation should be reassessed and tailored to the new patient's condition to reduce the risk of disease progression. CIW is associated with long-term physical, cognitive and mental impairments, which emphasizes the need for a multidisciplinary model of care. Follow-up clinics for patients surviving critical illness may serve this purpose by providing direct clinical support to patients, managing referrals to other specialists and general practitioners, and serving as a platform for research to describe the natural history of post-intensive care syndrome and to identify new therapeutic interventions. This surveillance should include an assessment of the activities of daily living, mood, and functional mobility. Finally, nutritional status should be longitudinally assessed in all ICU survivors and incorporated into a patient-centered nutritional approach guided by a dietician. CONCLUSIONS Early ICU mobilization combined with the best evidence-based ICU practices can effectively reduce short-term weakness. Multi-professional collaborations are needed to guarantee a multi-dimensional evaluation and unitary community care programs for survivors of critical illnesses.
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Affiliation(s)
- Nicola Latronico
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
- Department of Emergency, ASST Spedali Civili University Hospital, Piazzale Ospedali Civili, 1, 25123, Brescia, Italy.
- "Alessandra Bono" Interdepartmental University Research Center On Long-Term Outcome (LOTO) in Critical Illness Survivors, University of Brescia, Brescia, Italy.
| | - Frank A Rasulo
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Department of Emergency, ASST Spedali Civili University Hospital, Piazzale Ospedali Civili, 1, 25123, Brescia, Italy
- "Alessandra Bono" Interdepartmental University Research Center On Long-Term Outcome (LOTO) in Critical Illness Survivors, University of Brescia, Brescia, Italy
| | - Matthias Eikermann
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Simone Piva
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Department of Emergency, ASST Spedali Civili University Hospital, Piazzale Ospedali Civili, 1, 25123, Brescia, Italy
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13
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Bevilacqua Junior DE, Mello ECD, Lage JB, Ribeiro MF, Ferreira AA, Teixeira VDPA, Espindula AP. Analysis of strength and electromyographic activity of lower limbs of individuals with down syndrome assisted in physiotherapy and hippotherapy. J Bodyw Mov Ther 2023; 36:83-88. [PMID: 37949604 DOI: 10.1016/j.jbmt.2023.05.009] [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: 05/11/2021] [Revised: 05/05/2023] [Accepted: 05/27/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION one of the characteristics of Down Syndrome (DS) is muscle hypotonia. Different therapeutic approaches have a positive influence, between them Physiotherapy applications with different therapeutic approaches such as Hippotherapy have a positive effect on the physical health and quality of live of individuals with DS. OBJECTIVE to evaluate the effects of both treatments on the strength and electromyographic activity of the lower limbs of children and adolescents with DS. METHODS fourteen individuals, aged between 10 and 18 years, participated in two groups: Physiotherapy group (n = 5) and Hippotherapy group (n = 9). Thirty interventions were performed for each type of therapy, once a week, lasting 30 min. Pre and post-interventions, the 30-Second Chair Stand Test (30s-CST) was used to assess the strength of the lower limbs and the surface electromyography equipment (EMG 800RF) to assess the lower limb myoelectric activity. RESULTS there was a reduction in the post-intervention electromyographic values for both treatments (p˂0.001), with significantly less myoelectric activity in Hippotherapy compared to Physiotherapy for all evaluated muscles (p˂0.001) and a significant increase in muscle strength for the Hippotherapy, post-intervention group (p = 0.0007). CONCLUSION Physiotherapy and Hippotherapy are interventions that promote positive changes in the myoelectric activities of individuals with DS. However, only hippotherapy promoted an increase in strength of the lower limbs.
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Affiliation(s)
- Domingos Emanuel Bevilacqua Junior
- Universidade Federal do Triângulo Mineiro, Uberaba, Minas Gerais, Brazil; Associação de Pais e Amigos dos Excepcionais de Uberaba, Minas Gerais, Brazil
| | - Edneia Corrêa de Mello
- Universidade Federal do Triângulo Mineiro, Uberaba, Minas Gerais, Brazil; Faculdade de Odontologia de Ribeirão Preto da Universidade de São Paulo, São Paulo, Brazil
| | - Janaine Brandão Lage
- Universidade Federal do Triângulo Mineiro, Uberaba, Minas Gerais, Brazil; Associação de Pais e Amigos dos Excepcionais de Uberaba, Minas Gerais, Brazil
| | - Mariane Fernandes Ribeiro
- Universidade Federal do Triângulo Mineiro, Uberaba, Minas Gerais, Brazil; Faculdade de Patos de Minas, Pato de Minas, Minas Gerais, Brazil
| | | | | | - Ana Paula Espindula
- Universidade Federal do Triângulo Mineiro, Uberaba, Minas Gerais, Brazil; Associação de Pais e Amigos dos Excepcionais de Uberaba, Minas Gerais, Brazil.
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14
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Comparing the Clinical Manifestations of Bell's Palsy between Pre-COVID-19 Pandemic and COVID-19 Pandemic Periods. J Clin Med 2023; 12:jcm12041700. [PMID: 36836235 PMCID: PMC9965973 DOI: 10.3390/jcm12041700] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/17/2023] [Accepted: 02/18/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND COVID-19 has been shown to affect the onset and severity of various diseases. We examined whether the clinical characteristics of Bell's palsy differed between before and during the COVID-19 pandemic. METHODS From January 2005 to December 2021, 1839 patients were diagnosed and treated for Bell's palsy at Kyung Hee University Hospital. These patients were divided into a pre-COVID period group and COVID-19 period group, and the clinical characteristics of the two groups were compared. RESULTS There were 1719 patients in the pre-COVID period group and 120 patients in the COVID-19 period group. There were no between-group differences in sex (p = 0.103) or in the presence of underlying hypertension (p = 0.632) or diabetes (p = 0.807). Regarding symptoms, there were no significant between-group differences in otalgia, dizziness, tinnitus, hyperacusis, or hearing loss (p = 0.304, p = 0.59, p = 0.351, p = 0.605, and p = 0.949). There were also no significant between-group differences in electroneurography results (p = 0.398), electromyography results (p = 0.331), House-Brackmann Grade at visit (p = 0.634), or recovery rate after treatment (p = 0.525). CONCLUSIONS Contrary to our expectation that Bell's palsy cases during the COVID-19 pandemic would show different clinical features than those occurring before COVID-19, the present study found no differences in clinical features or prognosis.
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15
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Gil S, de Oliveira Júnior GN, Sarti FM, Filho WJ, Longobardi I, Turri JAO, Shinjo SK, Ferriolli E, Avelino-Silva TJ, Busse AL, Gualano B, Roschel H. Acute Muscle Mass Loss Predicts Long-Term Fatigue, Myalgia, and Health Care Costs in COVID-19 Survivors. J Am Med Dir Assoc 2023; 24:10-16. [PMID: 36493804 PMCID: PMC9682050 DOI: 10.1016/j.jamda.2022.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/07/2022] [Accepted: 11/17/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We examined the impact of loss of skeletal muscle mass in post-acute sequelae of SARS-CoV-2 infection, hospital readmission rate, self-perception of health, and health care costs in a cohort of COVID-19 survivors. DESIGN Prospective observational study. SETTING AND PARTICIPANTS Tertiary Clinical Hospital. Eighty COVID-19 survivors age 59 ± 14 years were prospectively assessed. METHODS Handgrip strength and vastus lateralis muscle cross-sectional area were evaluated at hospital admission, discharge, and 6 months after discharge. Post-acute sequelae of SARS-CoV-2 were evaluated 6 months after discharge (main outcome). Also, health care costs, hospital readmission rate, and self-perception of health were evaluated 2 and 6 months after hospital discharge. To examine whether the magnitude of muscle mass loss impacts the outcomes, we ranked patients according to relative vastus lateralis muscle cross-sectional area reduction during hospital stay into either "high muscle loss" (-18 ± 11%) or "low muscle loss" (-4 ± 2%) group, based on median values. RESULTS High muscle loss group showed greater prevalence of fatigue (76% vs 46%, P = .0337) and myalgia (66% vs 36%, P = .0388), and lower muscle mass (-8% vs 3%, P < .0001) than low muscle loss group 6 months after discharge. No between-group difference was observed for hospital readmission and self-perceived health (P > .05). High muscle loss group demonstrated greater total COVID-19-related health care costs 2 ($77,283.87 vs. $3057.14, P = .0223, respectively) and 6 months ($90,001.35 vs $12, 913.27, P = .0210, respectively) after discharge vs low muscle loss group. Muscle mass loss was shown to be a predictor of total COVID-19-related health care costs at 2 (adjusted β = $10, 070.81, P < .0001) and 6 months after discharge (adjusted β = $9885.63, P < .0001). CONCLUSIONS AND IMPLICATIONS COVID-19 survivors experiencing high muscle mass loss during hospital stay fail to fully recover muscle health. In addition, greater muscle loss was associated with a higher frequency of post-acute sequelae of SARS-CoV-2 and greater total COVID-19-related health care costs 2 and 6 months after discharge. Altogether, these data suggest that the loss of muscle mass resulting from COVID-19 hospitalization may incur in an economical burden to health care systems.
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Affiliation(s)
- Saulo Gil
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, SP, Brazil; Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Gersiel Nascimento de Oliveira Júnior
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Flavia Mori Sarti
- School of Arts, Sciences and Humanities, University of São Paulo (USP), São Paulo, Brazil, SP, BR
| | - Wilson Jacob Filho
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Igor Longobardi
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | | | - Samuel Katsuyuki Shinjo
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Eduardo Ferriolli
- Division of Internal and Geriatric Medicine, Department of Internal Medicine - Ribeirão Preto Medical School, Universidade de Sao Paulo, Ribeirao Preto, SP, BR
| | - Thiago Junqueira Avelino-Silva
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Alexandre Leopold Busse
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Bruno Gualano
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, SP, Brazil; Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Hamilton Roschel
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, SP, Brazil; Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR.
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16
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Evaluation of a new insertion site for arterial pressure line in intensive care unit management: a prospective study. J Clin Monit Comput 2022; 37:867-872. [PMID: 36550346 DOI: 10.1007/s10877-022-00957-4] [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: 06/09/2022] [Accepted: 11/27/2022] [Indexed: 12/24/2022]
Abstract
The arterial pressure line (A-line) is primarily inserted through the radial artery. However, accidental removal due to joint movement can be problematic in the intensive care unit (ICU). This study aimed to evaluate the safety and effectiveness of A-line insertion in the ICU through the distal radial approach (DRA), which is used in cardiac catheterization. This single-center, prospective, comparative study included 200 patients (≥ 20 years) who were brought to our hospital for emergency care and required A-line insertion. Patients were quasi-randomized to the traditional radial approach (TRA) or DRA. Data were recorded at the time of A-line insertion, administration, and removal. We evaluated the vessel diameter, number of punctures, success of the procedure, presence of complications, such as infection during management, and time taken for hemostasis after catheter removal. The primary endpoint was the accidental removal rate. Due to incomplete information, data were collected for 193 patients (96 TRA and 97 DRA). Successful procedures were observed in 95 of the 96 patients with TRA and 94 of the 97 patients with DRA. Guidewire use during insertion was significantly more common in the DRA group (P < 0.01) and post-puncture splint fixation was significantly more common in the TRA group (P < 0.01). Accidental removal, the primary endpoint, was observed in 10 patients with TRAs and 11 patients with DRAs, with no significant difference between the two groups (P > 0.99). DRA is as safe and effective as the TRA, suggesting that it is useful as a new A-line insertion site.
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17
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Attwell C, Sauterel L, Jöhr J, Piquilloud L, Kuntzer T, Diserens K. Early detection of ICU-acquired weakness in septic shock patients ventilated longer than 72 h. BMC Pulm Med 2022; 22:466. [PMID: 36474276 PMCID: PMC9724444 DOI: 10.1186/s12890-022-02193-7] [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: 04/21/2022] [Accepted: 10/18/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE ICU-acquired weakness, comprising Critical Illness Polyneuropathy (CIP) and Myopathy (CIM) is associated with immobilization and prolonged mechanical ventilation. This study aims to assess feasibility of early detection of CIP and CIM by peroneal nerve test (PENT) and sensory sural nerve action potential (SNAP) screening in patients with septic shock and invasively ventilated for more than 72 h. METHODS We performed repetitive PENT screening from 72 h after intubation until detecting a pathological response. We tested SNAPs in pathological PENT to differentiate CIP from CIM. We performed muscle strength examination in awake patients and recorded time from intubation to first in-bed and out-of-bed mobilization. RESULTS Eighteen patients were screened with PENT and 88.9% had abnormal responses. Mean time between intubation and first screening was 94.38 (± 22.41) hours. Seven patients (38.9%) had CIP, two (11.1%) had CIM, one (5.6%) had CIP and CIM, six (33.3%) had a pathological response on PENT associated with ICU-acquired weakness (but no SNAP could be performed to differentiate between CIP and CIM) and two patients had (11.1%) had no peripheral deficit. In patients where it could be performed, muscle strength testing concorded with electrophysiological findings. Twelve patients (66.7%) had out-of-bed mobilization 10.8 (± 7.4) days after admission. CONCLUSION CIP and CIM are frequent in septic shock patients and can be detected before becoming symptomatic with simple bedside tools. Early detection of CIP and CIM opens new possibilities for their timely management through preventive measures such as passive and active mobilization.
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Affiliation(s)
- Caroline Attwell
- grid.8515.90000 0001 0423 4662Acute Neuro-Rehabilitation Unit, Lausanne University Hospital, Lausanne, Switzerland
| | - Laurent Sauterel
- grid.8515.90000 0001 0423 4662Lausanne University Hospital, Lausanne, Switzerland
| | - Jane Jöhr
- grid.8515.90000 0001 0423 4662Acute Neuro-Rehabilitation Unit, Lausanne University Hospital, Lausanne, Switzerland
| | - Lise Piquilloud
- grid.8515.90000 0001 0423 4662Adult Intensive Care Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Thierry Kuntzer
- grid.8515.90000 0001 0423 4662Nerve-Muscle Unit, Neurology Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Karin Diserens
- grid.8515.90000 0001 0423 4662Acute Neuro-Rehabilitation Unit, Lausanne University Hospital, Lausanne, Switzerland
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18
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Liu Y, Wang D, Li T, Yang F, Li Z, Bai X, Wang Y. The role of NLRP3 inflammasome in inflammation-related skeletal muscle atrophy. Front Immunol 2022; 13:1035709. [PMID: 36405697 PMCID: PMC9668849 DOI: 10.3389/fimmu.2022.1035709] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 10/13/2022] [Indexed: 04/04/2024] Open
Abstract
Skeletal muscle atrophy is a common complication in survivors of sepsis, which affects the respiratory and motor functions of patients, thus severely impacting their quality of life and long-term survival. Although several advances have been made in investigations on the pathogenetic mechanism of sepsis-induced skeletal muscle atrophy, the underlying mechanisms remain unclear. Findings from recent studies suggest that the nucleotide-binding and oligomerisation domain (NOD)-like receptor family pyrin domain containing 3 (NLRP3) inflammasome, a regulator of inflammation, may be crucial in the development of skeletal muscle atrophy. NLRP3 inhibitors contribute to the inhibition of catabolic processes, skeletal muscle atrophy and cachexia-induced inflammation. Here, we review the mechanisms by which NLRP3 mediates these responses and analyse how NLRP3 affects muscle wasting during inflammation.
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Affiliation(s)
- Yukun Liu
- Department of Plastic and Cosmetic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dongfang Wang
- Trauma Center/Department of Emergency and Traumatic Surgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tianyu Li
- Trauma Center/Department of Emergency and Traumatic Surgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fan Yang
- Trauma Center/Department of Emergency and Traumatic Surgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhanfei Li
- Trauma Center/Department of Emergency and Traumatic Surgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiangjun Bai
- Trauma Center/Department of Emergency and Traumatic Surgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuchang Wang
- Trauma Center/Department of Emergency and Traumatic Surgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Yang Z, Wang X, Wang F, Peng Z, Fan Y. A systematic review and meta-analysis of risk factors for intensive care unit acquired weakness. Medicine (Baltimore) 2022; 101:e31405. [PMID: 36316900 PMCID: PMC9622703 DOI: 10.1097/md.0000000000031405] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The aim of this meta-analysis is to systematically evaluate and summarize the risk factors of intensive care unit acquired weakness (ICU-AW), to provide evidence-based evidence for the formulation of prevention strategies for ICU-AW. METHODS PubMed, EMBASE, Web of Science, CBM (China Biology Medicine, China), Chinese National Knowledge Infrastructure, Chinese WANFANG, and VIP will be searched to define relevant risk factors for ICU-AW. The databases search period is from January 1, 2005 to August 13, 2021. The Newcastle Ottawa Scale (NOS) is used to evaluate the quality of the included studies. RevMan 5.3 analysis software will be used for meta-analysis. RESULTS This systematic review and meta-analysis included a total of 12 cohort studies, including 9 international journals and 3 Chinese journals, with a total of 1950 patients, of which 856 had ICU-AW. The results showed that the significant risk factors for ICU-AW included female (odds ratio [OR] = 1.34, 95% confidence interval [CI]: 1.06-1.71; P = .02), mechanical ventilation days (OR = 3.04, 95% CI: 1.82-4.26; P < .00001), age (OR = 6.33, 95% CI: 5.05-7.61; P < .00001), length of intensive care unit (ICU) stay (OR = 3.78, 95% CI: 2.06-5.51; P < .0001), infectious disease (OR = 1.67, 95% CI: 1.20-2.33; P = .002), renal replacement therapy (OR = 1.59, 95% CI: 1.11-2.28; P = .01), use of aminoglucoside drugs (OR = 2.51, 95% CI: 1.54-4.08; P = .0002), sepsis related organ failure assessment (SOFA) score (OR = 1.07, 95% CI: 0.24-1.90; P = .01), hyperglycemia (OR = 2.95, 95% CI: 1.70-5.11; P = .0001). CONCLUSION This meta-analysis provides comprehensive evidence-based on the assessment of the risk factors for ICU-AW, their multifactorial etiology was confirmed. This study indicated that female, mechanical ventilation days, age, length of ICU stay, infectious disease, renal replacement therapy, use of aminoglucoside drugs, SOFA score, and hyperglycemia are independent risk factors for ICU-AW. We have not found consistent evidence that corticosteroids, neuromuscular blockers, sepsis have any effect on ICU-AW risk.
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Affiliation(s)
- Zi Yang
- Clinical Nursing Teaching Department, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
- School of Nursing, Harbin Medical University, Harbin, China
| | - Xiaohui Wang
- Department of Critical Care Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Faying Wang
- Clinical Nursing Teaching Department, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
- School of Nursing, Harbin Medical University, Harbin, China
| | - Zeyu Peng
- Clinical Nursing Teaching Department, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
- School of Nursing, Harbin Medical University, Harbin, China
| | - Yuying Fan
- Clinical Nursing Teaching Department, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
- School of Nursing, Harbin Medical University, Harbin, China
- *Correspondence: Yuying Fan, Harbin Medical University, Heilongjiang Province, 150081, China (e-mail: )
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Zhang F, Xia Q, Zhang L, Wang H, Bai Y, Wu W. A bibliometric and visualized analysis of early mobilization in intensive care unit from 2000 to 2021. Front Neurol 2022; 13:848545. [PMID: 35923825 PMCID: PMC9339903 DOI: 10.3389/fneur.2022.848545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 06/27/2022] [Indexed: 12/02/2022] Open
Abstract
Background Early mobilization in the intensive care unit (ICU) is a hotspot. This study aims to provide a bibliometric perspective of the progress in this field. Methods We extracted publications on ICU early mobilization published in the Web of Science Core Collection database from 2000 to 2021. VOSviewer was used to construct co-occurrence and co-citation relationships for authors, references, and keywords; Citespace was used to visualize knowledge mapping of subject categories, countries, and keywords with the strongest citation bursts. Results A total of 4,570 publications were analyzed, with a steady increase in publications in the field of ICU early mobilization. From a macro perspective, research on ICU early mobilization involves multidisciplinary involvement, including critical care medicine, neurology, and nursing; as for the meso perspective, the United States is the major contributor. Needham DM and Schweickert WD are the key researchers in this field. Moreover, the core journal is Critical Care Medicine, with the most publications and citations. The microscopic level, dominated by references and keywords, illustrates that the hotspot and frontier of research on ICU early mobilization focus on ICU-acquired weakness, delirium, the prognosis of critical illness, and severe COVID-19. Conclusion This study presents a research landscape of ICU early mobilization from different perspectives. These findings will contribute to a better understanding of the current state of research in critical care medicine and provide the available information for future research ideas.
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Affiliation(s)
- Fan Zhang
- Department of Nephrology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qian Xia
- Intensive Care Unit, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lianlian Zhang
- Intensive Care Unit, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hui Wang
- Department of Anorectal, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yan Bai
- Department of Cardiology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wenyan Wu
- Intensive Care Unit, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Wenyan Wu
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Zhao K, Li X, Zhang M, Tong F, Chen H, Wang X, Xiu N, Liu Z, Wang Y. microRNA-181a Promotes Mitochondrial Dysfunction and Inflammatory Reaction in a Rat Model of Intensive Care Unit-Acquired Weakness by Inhibiting IGFBP5 Expression. J Neuropathol Exp Neurol 2022; 81:553-564. [PMID: 35472240 DOI: 10.1093/jnen/nlac024] [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: 11/12/2022] Open
Abstract
This study investigated mechanisms by which microRNA (miR)-181a orchestrates mitochondrial dysfunction and inflammation in a rat model of intensive care unit-acquired weakness (ICU-AW). Expression of miR-181a and insulin-like growth factor binding protein 5 (IGFBP5) was detected and then miR-181a was overexpressed or inhibited and IGFBP5 was overexpressed in the ICU-AW rats. The expression of UCP-3, metaphase chromosome protein 1 (MCP1), mitochondrial DNA (mtDNA), inflammatory factors, phosphorylation (p)-JAK1, p-STAT1, and p-STAT2 were measured in skeletal muscle tissues; binding of miR-181a to IGFBP5 was evaluated by a dual-luciferase reporter assay. The results demonstrated high expression of miR-181a and low expression of IGFBP5 in ICU-AW versus control rats; IGFBP5 was identified as a target gene of miR-181a. Further experiments demonstrated that ICU-AW rats suffered from marked loss of grip strength and decreased adenosine triphosphate production, mtDNA content, and UCP-3 mRNA expression in skeletal muscles; this was accompanied by elevated TNF-α, IL-6, IL-1β, MCP1, p-JAK1, p-STAT1, and p-STAT2 levels. Importantly, miR-181a suppression alleviated strength loss, inflammatory reaction, and mitochondrial dysfunction and diminished the phosphorylation levels of JAK1, STAT1, and STAT2 whereas IGFBP5 upregulation rescued the effect of miR-181a overexpression in ICU-AW rats. These results indicate that miR-181a promotes mitochondrial dysfunction and inflammation by activating the JAK/STAT pathway via IGFBP5 in ICU-AW model rats.
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Affiliation(s)
- Kun Zhao
- Intensive Care Unit, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Xuan Li
- Intensive Care Unit, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Manli Zhang
- Intensive Care Unit, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Fei Tong
- Intensive Care Unit, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Hui Chen
- Intensive Care Unit, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Xia Wang
- Intensive Care Unit, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Nan Xiu
- Intensive Care Unit, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Zhikuan Liu
- Intensive Care Unit, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Yi Wang
- Department of Ultrasound, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China (YW)
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Kawasaki disease shock syndrome with acute respiratory distress syndrome in a child: a case report and literature review. BMC Pulm Med 2022; 22:220. [PMID: 35668424 PMCID: PMC9168351 DOI: 10.1186/s12890-022-02007-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 05/25/2022] [Indexed: 12/18/2022] Open
Abstract
Background Kawasaki disease (KD) is an acute systemic vasculitis that may involve multiple organs. KD shock syndrome (KDSS) is a rare complication of KD. Pulmonary involvement is rare in KD; reports of patients with KD who develop KDSS and acute respiratory distress syndrome (ARDS) are extremely rare. Case presentation A 2-year-old girl was brought to the emergency department with fever, cough and tachypnea. The patient was diagnosed with KDSS and ARDS. Extracorporeal membrane oxygenation (ECMO) and continuous blood purification were performed because of her critical condition. The patient eventually recovered completely. One year after discharge, there has been no coronary artery dilatation or pulmonary fibrosis. Conclusion KDSS patients may develop ARDS due to fluid resuscitation and the release of inflammatory mediators. Early aggressive management and comprehensive treatment may improve prognosis.
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Yamashita M, Kamiya K, Matsunaga A, Kitamura T, Hamazaki N, Ichikawa T, Uchida S, Noda T, Yanagi N, Maekawa E, Yamaoka-Tojo M, Ako J, Miyaji K. Features of trunk muscle wasting during acute care and physical function recovery with aortic disease. J Cachexia Sarcopenia Muscle 2022; 13:1054-1063. [PMID: 35178890 PMCID: PMC8978005 DOI: 10.1002/jcsm.12935] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 01/02/2022] [Accepted: 01/17/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Low skeletal muscle area or density, such as myosteatosis, identified on computed tomography (CT) is associated with poor prognosis in patients with cardiovascular diseases. However, there is a lack of evidence regarding the clinical process of skeletal muscle decline as a short-term change during acute care settings. This study focused on the use of routine CT imaging for aortic disease management and investigated the changes in skeletal muscle before and after acute care. METHODS This prospective study included 123 patients who underwent abdominal CT before and after acute care. The all-abdominal and each abdominal muscle areas were divided into eight parts (e.g. rectus abdominis, psoas, and erector spine), and their areas and densities were measured at the third lumbar vertebra level after the patients were discharged and de-identified with blinding to avoid measurement bias. Short physical performance battery (SPPB) was measured at the start and end of in-hospital cardiac rehabilitation. A generalized linear model with patients as random effects was made to investigate skeletal muscle loss during acute care. Multivariate linear regression analysis was also used to assess the relationship between the change in skeletal muscle during acute care and SPPB during in-hospital cardiac rehabilitation. RESULTS The median age of the patients was 70 (interquartile: 58-77) years, and 69.9% (86/123) were men. The median day between acute care from the day of surgery or hospital admission and follow-up CT was 7 (interquartile: 3-8) days. Overall muscle density declined after acute care (estimate value: -3.640, 95% confidence interval [CI]: -4.538 to -2.741), and each abdominal muscle density consistently declined (interaction: F value = 0.099, P = 0.998). In contrast, there was no significant change in the overall muscle area (estimate value: -0.863, 95% CI: -2.925 to 1.200). Changes in the muscle area were different for each skeletal muscle (interaction: F value = 2.142, P = 0.037), and only the erector spine muscle significantly declined (estimate value: -1.836, 95% CI: -2.507 to -1.165). After adjusting for confounding factors, a greater decline in muscle density was associated with lower recovery score on SPPB (β = 0.296, 95% CI: 0.066 to 0.400). CONCLUSIONS Muscle density consistently declined after acute care, especially the erector spine muscles, which also significantly decreased in size. A higher decline in muscle density was associated with a slower recovery of physical function during in-hospital cardiac rehabilitation in patients with aortic diseases.
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Affiliation(s)
- Masashi Yamashita
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan.,Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan.,Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Japan
| | - Atsuhiko Matsunaga
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan.,Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Japan
| | - Tadashi Kitamura
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Nobuaki Hamazaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Takafumi Ichikawa
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Shota Uchida
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan
| | - Takumi Noda
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan
| | - Naoya Yanagi
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Minako Yamaoka-Tojo
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan.,Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kagami Miyaji
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
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Cross-sectional area of erector spinae muscles is associated with activities of daily living at discharge in middle- to older-aged patients with coronavirus disease 2019. Exp Gerontol 2022; 163:111774. [PMID: 35341940 PMCID: PMC8949841 DOI: 10.1016/j.exger.2022.111774] [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: 01/05/2022] [Revised: 03/05/2022] [Accepted: 03/19/2022] [Indexed: 11/23/2022]
Abstract
Objectives Measurement of skeletal muscle wasting using computed tomography (CT) is widely known to be useful in predicting prognosis. Although some reports have been found in patients with coronavirus disease 2019 (COVID-19), few reports have focused on the ability to perform activities of daily living (ADLs). This study retrospectively investigated the relationship between the erector spinae muscle area measured from CT images and ADL at the time of hospital discharge in patients with COVID-19. Methods Among patients aged 40 years or older, 271 patients (median age, 65 years; 180/271 male patients) who had CT cross-sectional images of the 12th thoracic vertebral level on admission were included. The Katz index was used to assess ADLs, and patients who were not completely independent were defined as dependent. Multivariable logistic and Poisson regression analyses were applied to examine the relationship between the cross-sectional area of the erector spinae muscles and the onset of ADL dependence at discharge. Results A total of 75 (27.7%) patients became dependent on ADL at the time of hospital discharge. Decreased erector spinae muscle area was significantly related to dependent ADL at discharge (adjusted odds ratio: 0.886, 95% confidence interval: 0.805–0.975). In addition, the erector spinae muscle area was significantly related to the number of ADL items for which independence was not achieved (adjusted incidence rate ratio: 0.959, P < 0.001). Conclusions The cross-sectional area of the erector spinae muscles from the thoracic CT image was associated with the ability to perform basic ADL at hospital discharge.
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25
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Premraj L, Kannapadi NV, Briggs J, Seal SM, Battaglini D, Fanning J, Suen J, Robba C, Fraser J, Cho SM. Mid and long-term neurological and neuropsychiatric manifestations of post-COVID-19 syndrome: A meta-analysis. J Neurol Sci 2022; 434:120162. [PMID: 35121209 PMCID: PMC8798975 DOI: 10.1016/j.jns.2022.120162] [Citation(s) in RCA: 342] [Impact Index Per Article: 171.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/30/2021] [Accepted: 01/18/2022] [Indexed: 11/04/2022]
Abstract
IMPORTANCE Neurological and neuropsychiatric symptoms that persist or develop three months after the onset of COVID-19 pose a significant threat to the global healthcare system. These symptoms are yet to be synthesized and quantified via meta-analysis. OBJECTIVE To determine the prevalence of neurological and neuropsychiatric symptoms reported 12 weeks (3 months) or more after acute COVID-19 onset in adults. DATA SOURCES A systematic search of PubMed, EMBASE, Web of Science, Google Scholar and Scopus was conducted for studies published between January 1st, 2020 and August 1st, 2021. The systematic review was guided by Preferred Reporting Items for Systematic Review and Meta-Analyses. STUDY SELECTION Studies were included if the length of follow-up satisfied the National Institute for Healthcare Excellence (NICE) definition of post-COVID-19 syndrome (symptoms that develop or persist ≥3 months after the onset of COVID-19). Additional criteria included the reporting of neurological or neuropsychiatric symptoms in individuals with COVID-19. DATA EXTRACTION AND SYNTHESIS Two authors independently extracted data on patient characteristics, hospital and/or ICU admission, acute-phase COVID-19 symptoms, length of follow-up, and neurological and neuropsychiatric symptoms. MAIN OUTCOME(S) AND MEASURE(S) The primary outcome was the prevalence of neurological and neuropsychiatric symptoms reported ≥3 months post onset of COVID-19. We also compared post-COVID-19 syndrome in hospitalised vs. non-hospitalised patients, with vs. without ICU admission during the acute phase of infection, and with mid-term (3 to 6 months) and long-term (>6 months) follow-up. RESULTS Of 1458 articles, 19 studies, encompassing a total of 11,324 patients, were analysed. Overall prevalence for neurological post-COVID-19 symptoms were: fatigue (37%, 95% CI: 24%-50%), brain fog (32%, 9%-55%), memory issues (27%, 18%-36%), attention disorder (22%, 10%-34%), myalgia (18%, 4%-32%), anosmia (12%, 7%-17%), dysgeusia (11%, 4%-17%) and headache (10%, 1%-21%). Neuropsychiatric conditions included sleep disturbances (31%, 18%-43%), anxiety (23%, 13%-33%) and depression (12%, 7%-21%). Neuropsychiatric symptoms substantially increased in prevalence between mid- and long-term follow-up. Compared to non-hospitalised patients, patients hospitalised for acute COVID-19 had reduced frequency of anosmia, anxiety, depression, dysgeusia, fatigue, headache, myalgia, and sleep disturbance at three (or more) months post-infection. Conversely, hospital admission was associated with higher frequency of memory issues (OR: 1.9, 95% CI: 1.4-2.3). Cohorts with >20% of patients admitted to the ICU during acute COVID-19 experienced higher prevalence of fatigue, anxiety, depression, and sleep disturbances than cohorts with <20% of ICU admission. CONCLUSIONS AND RELEVANCE Fatigue, cognitive dysfunction (brain fog, memory issues, attention disorder) and sleep disturbances appear to be key features of post-COVID-19 syndrome. Psychiatric manifestations (sleep disturbances, anxiety, and depression) are common and increase significantly in prevalence over time. Randomised controlled trials are necessary to develop intervention strategy to reduce disease burden.
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Affiliation(s)
- Lavienraj Premraj
- Griffith University School of Medicine, Gold Coast, Australia; Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
| | - Nivedha V Kannapadi
- Division of Neurosciences Critical Care, Department of Neurology, Neurosurgery, Anaesthesiology and Critical Care Medicine and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - Jack Briggs
- Griffith University School of Medicine, Gold Coast, Australia
| | - Stella M Seal
- William H. Welch Medical Library, Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - Denise Battaglini
- Anaesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy; Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Jonathon Fanning
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; Faculty of Medicine University of Queensland, Brisbane, QLD, Australia; St Andrew's War Memorial Hospital, UnitingCare, Spring Hill, QLD, Australia; Nuffield Department of Population Health, University of Oxford, UK
| | - Jacky Suen
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; Faculty of Medicine University of Queensland, Brisbane, QLD, Australia
| | - Chiara Robba
- Anaesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy; Department of Surgical Science and Integrated Diagnostic, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, University of Genoa, Genoa, Italy
| | - John Fraser
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; Faculty of Medicine University of Queensland, Brisbane, QLD, Australia; St Andrew's War Memorial Hospital, UnitingCare, Spring Hill, QLD, Australia
| | - Sung-Min Cho
- Division of Neurosciences Critical Care, Department of Neurology, Neurosurgery, Anaesthesiology and Critical Care Medicine and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, United States of America.
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Qin ES, Hough CL, Andrews J, Bunnell AE. Intensive Care Unit-Acquired Weakness and the COVID-19 Pandemic: A Clinical Review. PM R 2022; 14:227-238. [PMID: 35014183 DOI: 10.1002/pmrj.12757] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 12/08/2021] [Accepted: 12/28/2021] [Indexed: 01/08/2023]
Abstract
Patients with severe cases of coronavirus disease 2019 (COVID-19) often become critically ill requiring intensive care unit (ICU) management. These individuals are at risk for developing ICU-acquired weakness (ICUAW), a multifactorial condition in which polyneuropathy, myopathy, and/or disuse muscle atrophy result in motor weakness. This weakness is thought to contribute to the long-term functional disability frequently observed in survivors of critical illness. This review discusses the current evidence regarding the epidemiology, pathophysiology, evaluation, risk factors, and rehabilitation-specific management of ICUAW in patients with COVID-19. Due to the novelty of COVID-19, the exact prevalence of ICUAW is not well delineated among COVID-19 patients. However, ICUAW has been reported in this population with retrospective studies showing weakness occurring in up to 45.5% of patients with severe COVID-19. There are multiple risk factors for developing ICUAW among COVID-19 patients which include premorbid health status, sepsis, multiple organ failure, mechanical ventilation, immobilization, neuromuscular blockade, corticosteroid use, and glycemic control. ICUAW is more likely to occur after prolonged mechanical ventilation and long hospital stays and can be diagnosed with manual muscle and electrodiagnostic testing. While the long-term sequela of COVID-19 after ICU stays is not fully studied, increasing evidence indicates significant risk for this population developing long-term functional impairments. Establishing post-acute rehabilitation programs for COVID-19 survivors will be important for recovery of endurance, mobility, and function. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Evelyn S Qin
- Department of Rehabilitation Medicine, Harborview Medical Center, University of Washington, Seattle, WA
| | - Catherine L Hough
- Department of Pulmonary and Critical Care Medicine, Oregon Health Science University, Portland, OR
| | - James Andrews
- Department of Medicine, University of Washington, Seattle, WA 325 9th Ave., Seattle, WA, USA
| | - Aaron E Bunnell
- Department of Rehabilitation Medicine, Harborview Medical Center, University of Washington, Seattle, WA
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Efficacy of Acupuncture Combined with Rehabilitation Training for Intensive Care Unit-Acquired Muscle Weakness: A Protocol for a Randomized, Sham-Procedure-Controlled Clinical Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:3539651. [PMID: 34721629 PMCID: PMC8550834 DOI: 10.1155/2021/3539651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/22/2021] [Indexed: 01/20/2023]
Abstract
To evaluate the efficacy of acupuncture combined with rehabilitation training in patients with intensive care unit (ICU)-acquired muscle weakness (ICUAW), a single-blinded, randomized, sham-controlled clinical trial is designed for execution. In total, 56 participants with ICUAW will be randomly assigned to the treatment and control groups with 28 participants in each group. The participants will be treated with acupunctures or sham procedures at LI15, LI11, ST36, GB34, and ST31, 5 times per week for a total of 20 sessions in 4 weeks while they will receive rehabilitation training. Patients will be followed up every month for 3 months after treatment. The primary outcomes include changes in quadriceps femoris muscle area, thickness, vastus intermediate muscle thickness, subcutaneous tissue thickness, and ultrasonic intensities of the rectus femoris. The secondary outcomes consist of the modified Barthel index score and the Medical Research Council total score. Participants' mechanical ventilation, the rate of detachment at the second week, the 28-day survival rate, and the occurrence of adverse reactions will be measured, and any side effects will be reported and recorded. Patient outcomes between the treatment and control groups will be compared and statistically tested. We anticipate that the therapeutic regimen of acupuncture combined with rehabilitation training would be more effective than the rehabilitation training alone for the treatment of the ICUAW. The findings of this study could help develop a better strategy for the treatment of the ICUAW disease and explore a clinical application of an acupuncture technique. Trial registration: Chinese Clinical Trial Register ChiCTR2000038779. Registered 30 September, 2020, https://www.chictr.org.cn/showproj.aspx?proj=62284.
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Popoola M, Dingle M, MacLaren J, Dyson J. What are the barriers to nurses mobilising adult patients in intensive care units? An integrative review. Aust Crit Care 2021; 35:595-603. [PMID: 34756801 DOI: 10.1016/j.aucc.2021.09.002] [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: 05/26/2021] [Revised: 08/08/2021] [Accepted: 09/05/2021] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES There is a need for early mobilisation of patients in intensive care units to prevent acquired weaknesses which can have a long-term impact on health and quality of life. This need is not always fulfilled. We therefore sought to conduct an integrative review of international evidence to answer the question: What are the barriers to nurses mobilising adult patients in intensive care units? REVIEW METHOD USED We conducted a systematic search and thematic analysis. We were able to present a descriptive quantitative synthesis of the survey articles included. DATA SOURCES We searched CINAHL, MEDLINE, and PsycINFO databases between and including 2010 and 2020 using search terms synonymous with "intensive care unit" and "nurse" and "early mobilisation" and "barrier using Boolean operators" and "truncation". We completed backwards and forwards citation searches on included studies. RESULTS We included seven articles which we synthesised into three themes and 13 subthemes as follows: (i) organisational barriers (subthemes were staffing levels, time and workload, resources, and care coordination), (ii) individual barriers (subthemes were self and team safety, knowledge and training, beliefs about the consequences of early mobilisation, stress, and other barriers), and (iii) patient-related barriers (subthemes were medical instability/physical status, patient safety, neurological deficits and sedation, and nonconcordance of patients). CONCLUSION Nurses' barriers were wide ranging, and interventions to improve concordance with early mobilisation need to be tailored to address this group's specific barriers.
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Affiliation(s)
| | - Maria Dingle
- City, University of London, Northampton Square, London, EC1V 0HB, UK.
| | - Julie MacLaren
- City, University of London, Northampton Square, London, EC1V 0HB, UK.
| | - Judith Dyson
- Birmingham City University, Westbourne Road, Edgbaston, Birmingham, B15 3TN, UK.
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Kanova M, Kohout P. Tryptophan: A Unique Role in the Critically Ill. Int J Mol Sci 2021; 22:ijms222111714. [PMID: 34769144 PMCID: PMC8583765 DOI: 10.3390/ijms222111714] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 10/21/2021] [Accepted: 10/26/2021] [Indexed: 02/06/2023] Open
Abstract
Tryptophan is an essential amino acid whose metabolites play key roles in diverse physiological processes. Due to low reserves in the body, especially under various catabolic conditions, tryptophan deficiency manifests itself rapidly, and both the serotonin and kynurenine pathways of metabolism are clinically significant in critically ill patients. In this review, we highlight these pathways as sources of serotonin and melatonin, which then regulate neurotransmission, influence circadian rhythm, cognitive functions, and the development of delirium. Kynurenines serve important signaling functions in inter-organ communication and modulate endogenous inflammation. Increased plasma kynurenine levels and kynurenine-tryptophan ratios are early indicators for the development of sepsis. They also influence the regulation of skeletal muscle mass and thereby the development of polyneuromyopathy in critically ill patients. The modulation of tryptophan metabolism could help prevent and treat age-related disease with low grade chronic inflammation as well as post intensive care syndrome in all its varied manifestations: cognitive decline (including delirium or dementia), physical impairment (catabolism, protein breakdown, loss of muscle mass and tone), and mental impairment (depression, anxiety or post-traumatic stress disorder).
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Affiliation(s)
- Marcela Kanova
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Ostrava, 708 52 Ostrava, Czech Republic
- Institute of Physiology and Pathophysiology, Faculty of Medicine, University of Ostrava, 703 00 Ostrava, Czech Republic
- Correspondence: or (M.K.); (P.K.); Tel.: +420-597-372-702 (M.K.); +420-261-083-802 (P.K.)
| | - Pavel Kohout
- Department of Internal Medicine, 3rd Faculty of Medicine, Charles University Prague and Teaching Thomayer Hospital, 140 59 Prague, Czech Republic
- Correspondence: or (M.K.); (P.K.); Tel.: +420-597-372-702 (M.K.); +420-261-083-802 (P.K.)
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Association between Thyroid Dysfunction and Intensive Care Unit-Acquired Weakness: A Case-Control Study. Crit Care Res Pract 2021; 2021:8889036. [PMID: 34621547 PMCID: PMC8492238 DOI: 10.1155/2021/8889036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 06/20/2021] [Accepted: 09/20/2021] [Indexed: 11/18/2022] Open
Abstract
Background Thyroid disorders may decrease the threshold for developing myopathy. Nonthyroidal illness syndrome (NTIS) is a common form of thyroid dysfunction in critically ill patients who are prone to the development of intensive care unit-acquired weakness (ICUAW). We therefore tested the hypothesis that patients with abnormalities in thyroid function are at a higher risk of developing ICUAW. Methods We assessed blood samples from patients admitted to the ICU for ≥7 days for thyroid functions. Patients were classified into 4 categories (euthyroid, hyperthyroid, hypothyroid, and NTIS). Patients were then evaluated daily for ICUAW development. Patients with ICUAW were considered as cases, whereas patients who did not develop ICUAW served as controls. We compared demographic and clinical variables, such as APACHE II score; length of ICU stay; free T3 (FT3), free T4, and thyroid-stimulating hormone levels; incidence of the four categories of thyroid function; and other risk factors for ICUAW. Logistic regression was used to determine independent risk factors for ICUAW. Results This case-control study included 114 patients: 57 cases (ICUAW) and 57 controls. FT3 levels were significantly lower in the cases (2.13 ± 0.96 mU/L) than in controls (2.69 ± 1.07 mU/L; P=0.004). There were no significant differences between cases and controls regarding the incidence of all categories of thyroid function. In univariate analysis, five independent variables had P < 0.25 (sepsis, vasopressors, mechanical ventilation duration, NTIS, and FT3 levels). Among these variables, multiple regression showed that only FT3 level (CI = 0.157-0.82, P=0.015) was an independent risk factor. Conclusion The study revealed an inverse association between ICUAW incidence and FT3 levels.
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LaRosa N. ICU survivorship: What PAs need to know. JAAPA 2021; 34:25-29. [PMID: 34448773 DOI: 10.1097/01.jaa.0000769652.38853.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The number of people surviving critical illnesses is larger than ever. Many of these patients will rely on physician assistants (PAs) to facilitate their care after discharge from the ICU. As a result, PAs must be able to recognize and treat the numerous short- and long-term challenges this vulnerable population faces, especially given the recent surge of critically ill patients resulting from the COVID-19 pandemic.
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Affiliation(s)
- Nicolette LaRosa
- Nicolette LaRosa practices in medical critical care at the Hospital of the University of Pennsylvania in Philadelphia. The author has disclosed no potential conflicts of interest, financial or otherwise
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Hsu YT, Turner K, Lee SP. Post-acute physical therapy for a patient with critical illness associated with COVID-19: A case report. Physiother Theory Pract 2021; 38:3226-3232. [PMID: 34455906 DOI: 10.1080/09593985.2021.1972499] [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: 10/20/2022]
Abstract
BACKGROUND : The COVID-19 pandemic is expected to bring a surge of survivors in need of post-acute rehabilitation. Preliminary research and clinical guidelines suggest patients recovering from critical illness associated with COVID-19 will present compromised function similar to acute respiratory distress syndrome (ARDS) and ICU-acquired weakness (ICUAW). However, information regarding physical therapy and progressions of physiological and functional outcomes is currently limited. This case report describes the course of recovery of a patient without significant preexisting medical conditions. CASE DESCRIPTION : The patient RW (male, age 56) tested positive for COVID-19, and was admitted to ICU for 29 days. After weaning off mechanical ventilation after 2 months of hospitalization, he was transferred to our post-acute rehabilitation facility to recover from the residual effects. Physical therapy evaluation showed that while the patient was cognitively alert, he exhibited impaired general strength and activity intolerance due to severe exertional dyspnea. The patient received physical therapy aimed at improving his functional capacity. During his 16-day stay, the patient was able to significantly improve his capacities (i.e. 600% increase in 30-second chair stand test, 69.5% improvement in walking distance in 6-minute walk test, and 132.4% longer time to exhaustion during level ground ambulation). Dyspnea remained the main factor that limited his activities. DISCUSSION : This case demonstrated that post-acute physical therapy appeared to be effective and safe in improving function after critical illness due to COVID-19 for this patient. Physical therapists are encouraged to closely monitor respiratory parameters such as heart rate, oxygen saturation, and levels of dyspnea during treatment for patient response and decisions regarding activity progression.
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Affiliation(s)
- Ya-Ting Hsu
- Encompass Health Rehabilitation Hospital of Henderson, Henderson, NV, USA
| | - Kristen Turner
- Encompass Health Rehabilitation Hospital of Henderson, Henderson, NV, USA
| | - Szu-Ping Lee
- Department of Physical Therapy, University of Nevada, Las Vegas, Las Vegas, NV, USA.,Department of Physical Therapy, Asia University, Wufeng, Taichung, Taiwan
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Use of Organ Dysfunction as a Primary Outcome Variable Following Cecal Ligation and Puncture: Recommendations for Future Studies. Shock 2021; 54:168-182. [PMID: 31764625 DOI: 10.1097/shk.0000000000001485] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Outcomes variables for research on sepsis have centered on mortality and changes in the host immune response. However, a recent task force (Sepsis-3) revised the definition of sepsis to "life-threatening organ dysfunction caused by a dysregulated host response to infection." This new definition suggests that human studies should focus on organ dysfunction. The appropriate criteria for organ dysfunction in either human sepsis or animal models are, however, poorly delineated, limiting the potential for translation. Further, in many systems, the difference between "dysfunction" and "injury" may not be clear. In this review, we identify criteria for organ dysfunction and/or injury in human sepsis and in rodents subjected to cecal ligation and puncture (CLP), the most commonly used animal model of sepsis. We further examine instances where overlap between human sepsis and CLP is sufficient to identify translational endpoints. Additional verification may demonstrate that these endpoints are applicable to other animals and to other sepsis models, for example, pneumonia. We believe that the use of these proposed measures of organ dysfunction will facilitate mechanistic studies on the pathobiology of sepsis and enhance our ability to develop animal model platforms to evaluate therapeutic approaches to human sepsis.
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Hernández-Socorro CR, Saavedra P, López-Fernández JC, Lübbe-Vazquez F, Ruiz-Santana S. Novel High-Quality Sonographic Methods to Diagnose Muscle Wasting in Long-Stay Critically Ill Patients: Shear Wave Elastography, Superb Microvascular Imaging and Contrast-Enhanced Ultrasound. Nutrients 2021; 13:nu13072224. [PMID: 34209526 PMCID: PMC8308272 DOI: 10.3390/nu13072224] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/24/2021] [Accepted: 06/25/2021] [Indexed: 01/05/2023] Open
Abstract
Novel ultrasound (US) methods are required to assess qualitative changes in the quadriceps rectus femoris (QRF) muscle when evaluating mechanically ventilated, long-stay ICU patients with suspected neuromuscular acquired weakness (ICUAW). Our aim was to analyze novel US muscle assessment methods in these patients versus healthy controls by carrying out a prospective observational study. Shear wave elastography (SWE) showed, with a receiver operating characteristic (ROC) curve of 0.972 (95% confidence interval (CI) = 0.916–1.000), that patients increased muscle stiffness associated with muscle fibrosis when diagnosed with ICUAW. We also performed, for the first time, superb microvascular imaging (SMI), which is an innovative US technique designed for imaging microvascularization unseen with color Doppler US, and observed that 53.8% of cases had significantly lower QRF muscle microvascular angiogenic activity than controls (p < 0.001). Finally, we used contrast-enhanced ultrasound (CEUS) to analyze maximum and minimum QRF muscle perfusion and obtained a ROC curve of 0.8, but when used as markers for SMI, their diagnostic capacity increased to 0.988 (CI = 0.965–1) and 0.932 (CI = 0.858–1), respectively. These findings show, for the first time, that these novel sonographic muscle methods should be used for their diagnostic capacity when assessing sarcopenic processes associated with this group of critically ill patients.
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Affiliation(s)
- Carmen Rosa Hernández-Socorro
- Department of Radiology, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain
- Correspondence: ; Tel.:+34-928-310570
| | - Pedro Saavedra
- Department of Mathematics, Universidad de Las Palmas de Gran Canaria, 35010 Las Palmas de Gran Canaria, Spain;
| | - Juan Carlos López-Fernández
- Department of Neurology, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain;
| | - Federico Lübbe-Vazquez
- Department of Intensive Care, Hospital Universitario de Gran Canaria Dr. Negrín, Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain;
| | - Sergio Ruiz-Santana
- Department of Intensive Care, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain;
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Cheung K, Rathbone A, Melanson M, Trier J, Ritsma BR, Allen MD. Pathophysiology and management of critical illness polyneuropathy and myopathy. J Appl Physiol (1985) 2021; 130:1479-1489. [PMID: 33734888 PMCID: PMC8143786 DOI: 10.1152/japplphysiol.00019.2021] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 12/19/2022] Open
Abstract
Critical illness-associated weakness (CIAW) is an umbrella term used to describe a group of neuromuscular disorders caused by severe illness. It can be subdivided into three major classifications based on the component of the neuromuscular system (i.e. peripheral nerves or skeletal muscle or both) that are affected. This includes critical illness polyneuropathy (CIP), critical illness myopathy (CIM), and an overlap syndrome, critical illness polyneuromyopathy (CIPNM). It is a common complication observed in people with critical illness requiring intensive care unit (ICU) admission. Given CIAW is found in individuals experiencing grave illness, it can be challenging to study from a practical standpoint. However, over the past 2 decades, many insights into the pathophysiology of this condition have been made. Results from studies in both humans and animal models have found that a profound systemic inflammatory response and factors related to bioenergetic failure as well as microvascular, metabolic, and electrophysiological alterations underlie the development of CIAW. Current management strategies focus on early mobilization, achieving euglycemia, and nutritional optimization. Other interventions lack sufficient evidence, mainly due to a dearth of large trials. The goal of this Physiology in Medicine article is to highlight important aspects of the pathophysiology of these enigmatic conditions. It is hoped that improved understanding of the mechanisms underlying these disorders will lead to further study and new investigations for novel pharmacologic, nutritional, and exercise-based interventions to optimize patient outcomes.
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Affiliation(s)
- Kevin Cheung
- School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Alasdair Rathbone
- Department of Physical Medicine and Rehabilitation, Queen's University, Kingston, Ontario, Canada
| | - Michel Melanson
- Division of Neurology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Jessica Trier
- Department of Physical Medicine and Rehabilitation, Queen's University, Kingston, Ontario, Canada
| | - Benjamin R Ritsma
- Department of Physical Medicine and Rehabilitation, Queen's University, Kingston, Ontario, Canada
| | - Matti D Allen
- Department of Physical Medicine and Rehabilitation, Queen's University, Kingston, Ontario, Canada
- School of Kinesiology, Faculty of Arts and Sciences, Queen's University, Kingston, Ontario, Canada
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Musheyev B, Borg L, Janowicz R, Matarlo M, Boyle H, Singh G, Ende V, Babatsikos I, Hou W, Duong TQ. Functional status of mechanically ventilated COVID-19 survivors at ICU and hospital discharge. J Intensive Care 2021; 9:31. [PMID: 33789772 PMCID: PMC8011060 DOI: 10.1186/s40560-021-00542-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/02/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND A significant number of COVID-19 patients have been treated using invasive mechanical ventilation (IMV). The ability to evaluate functional status of COVID-19 survivors early on at ICU and hospital discharge may enable identification of patients who may need medical and rehabilitation interventions. METHODS The modified "Mental Status", ICU Mobility, and Barthel Index scores at ICU and hospital discharge were tabulated for 118 COVID-19 survivors treated with invasive mechanical ventilation (IMV). These functional scores were compared with pre-admission functional status, discharge durable medical equipment, discharge medical follow-up recommendation, duration on IMV, duration post-IMV, demographics, comorbidities, laboratory tests, and vital signs at ICU and hospital discharge. RESULTS The majority of COVID-19 IMV patients were not functionally independent at hospital discharge (22% discharged with cane or rolling walker, 49% discharged with durable medical equipment, and 14% admitted to a rehabilitation facility), although 94% of these patients were functionally independent prior to COVID-19 illness. Half of the patients were discharged with supplemental oxygen equipment. The most prevalent medical follow-up recommendations were cardiology, vascular medicine, pulmonology, endocrinology, and neurology with many patients receiving multiple medical follow-up recommendations. Functional status improved from ICU discharge to hospital discharge (p < 0.001). Worse functional status at hospital discharge was associated with longer IMV duration, older age, male sex, higher number of comorbidities, and the presence of pre-existing comorbidities including hypertension, diabetes, chronic obstructive pulmonary disease, and immunosuppression (p < 0.05, ANOVA). CONCLUSIONS The majority of IMV COVID-19 survivors were not functionally independent at discharge and required significant follow-up medical care. The COVID-19 circumstance has placed constraints on access to in-hospital rehabilitation. These findings underscore the need for prospective studies to ascertain the short- and long-term sequela in COVID-19 survivors.
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Affiliation(s)
- Benjamin Musheyev
- Department of Radiology, Montefiore Medical Center and Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY, 10467, USA
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Lara Borg
- Department of Physical and Occupational Therapy, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Rebeca Janowicz
- Department of Physical and Occupational Therapy, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Michael Matarlo
- Department of Physical and Occupational Therapy, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Hayle Boyle
- Department of Physical and Occupational Therapy, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Gurinder Singh
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Victoria Ende
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Ioannis Babatsikos
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Wei Hou
- Department of Family, Population and Preventative Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Tim Q Duong
- Department of Radiology, Montefiore Medical Center and Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY, 10467, USA.
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Abstract
Traumatic injury remains the leading cause of death among individuals younger than age 45 years. Hemorrhage is the primary preventable cause of death in trauma patients. Management of hemorrhage focuses on rapidly controlling bleeding and addressing the lethal triad of hypothermia, acidosis, and coagulopathy. The principles of damage control surgery are rapid control of hemorrhage, temporary control of contamination, resuscitation in the intensive care unit to restore normal physiology, and a planned, delayed definitive operative procedure. Damage control resuscitation focuses on 3 key components: fluid restriction, permissive hypotension, and fixed-ratio transfusion. Rapid recognition and control of hemorrhage and implementation of resuscitation strategies to control damage have significantly improved mortality and morbidity rates. In addition to describing the basic principles of damage control surgery and damage control resuscitation, this article explains specific management considerations for and potential complications in patients undergoing damage control interventions in an intensive care unit.
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Affiliation(s)
- Shannon Gaasch
- Shannon Gaasch is Senior Nurse Practitioner II, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201 (Shannon. )
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Tiwari D, Naidoo K, Chatiwala N, Bartlo PL, Triola A, Ong B, Gore S. Exploratory Analysis of Physical Therapy Process of Care and Psychosocial Impact of the COVID-19 Pandemic on Physical Therapists. Phys Ther 2021; 101:6159688. [PMID: 33693829 PMCID: PMC7989178 DOI: 10.1093/ptj/pzab088] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 01/20/2021] [Accepted: 02/26/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the physical therapy process of care, clinical practices, and the self-reported psychosocial impact of working during the 2020 pandemic on physical therapists and physical therapist assistants. METHODS An electronic survey including closed and open-ended questions was distributed to physical therapists employed in a range of health care settings across the United States. RESULTS Physical therapy use and process of care varied across settings. Feasibility of performing an assessment was the main driver for selection of outcome measures. Interventions were mainly geared toward improving respiratory function and deconditioning. Prone patient positioning, now commonplace, was used infrequently by therapists in acute care prior to coronavirus disease 2019 (COVID-19). Similarly, outpatient and home care settings noted an increase in the use of respiratory-driven interventions such as incentive spirometry and breathing exercises. Qualitative data analysis revealed both physical barriers (personal protective equipment [PPE]) and social barriers to care. Therapists noted challenges in discharge planning and patient/family education due to the impact of social isolation. They also noted difficulty maintaining productivity standards because of additional time spent in changing PPE and following safety measures. Participants dealt with rapid changes in their role, changing productivity standards, and needing to increase their knowledge in a short amount of time. CONCLUSION Physical therapy use varied widely across settings. Despite some concern for personal health, respondents felt that the COVID-19 pandemic increased a sense of togetherness among team members and promoted greater appreciation for life and work. IMPACT This exploration of the process of care and current clinical practices across settings provides important knowledge about the role of physical therapists and physical therapist assistants in the care of patients with COVID-19. Gaining an understanding of the psychosocial impact of the pandemic among therapists could assist in creating solutions to better support clinicians' well-being.
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Affiliation(s)
| | | | | | | | | | - Brandon Ong
- MGH Institute of Health Professions Boston, MA
| | - Shweta Gore
- Address all correspondence to Shweta Gore PT, DPT, PhD, Board Certified Geriatric Clinical Specialist, American Board of Physical Therapy Specialties, Physical Therapy Department, MGH Institute of Health Professions, 36, 1 Ave, Boston, MA-02129, @shwetagore81,
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Role of rehabilitation in a COVID-19 survivor with intensive care unit-acquired weakness: A case report. Turk J Phys Med Rehabil 2021; 67:115-119. [PMID: 33948553 PMCID: PMC8088800 DOI: 10.5606/tftrd.2021.7457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 02/04/2021] [Indexed: 11/21/2022] Open
Abstract
Intensive care unit-acquired weakness (ICU-AW) is a catastrophic and debilitating clinical condition that causes generalized weakness and predisposes to adverse short- and long-term outcomes. Novel coronavirus disease-2019 (COVID-19) has been a global pandemic since November 2019. Each additional ICU admission for COVID-19 stresses intensive care unit (ICU) and hospital capacity. Accurately designed, timely rehabilitation procedures may reduce the patient burden of ICUs and hospitals. In this article, we describe a COVID-19 survivor who developed acute respiratory distress syndrome (ARDS) and ICU-AW. Early pulmonary rehabilitation in the ICU and long-term rehabilitation maintenance after the ICU and hospital discharge resulted in a positive outcome.
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Rudra RT, Lin D, Miller B, Du P, Zhang S. Investigating inpatient rehabilitation outcomes of patients with intensive care unit-acquired weakness, and identifying comorbidities associated with unfavorable outcomes. PM R 2021; 14:190-197. [PMID: 33528114 DOI: 10.1002/pmrj.12565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 01/15/2021] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Data are consistent on the benefits of inpatient rehabilitation for intensive care unit-acquired weaknesses (ICUAW), including critical illness myopathy, critical illness polyneuropathy, critical illness polyneuromyopathy, and disuse atrophy. This study focuses on the effects of inpatient rehabilitation on patients with ICUAW, specifically those with a clinical pattern of proximal muscle weakness and sensory sparing. OBJECTIVES To evaluate the impact of inpatient rehabilitation on patients with ICUAW versus other medically complex patients, and to identify comorbidities associated with poor rehabilitation outcomes. DESIGN Retrospective cohort study. SETTING Institutional, inpatient rehabilitation hospital. PATIENTS Two hundred seventy adult patients (≥18 years) divided into two groups: diagnosis of ICUAW (N = 55) or otherwise medically complex (N = 215), and admitted under the care of one physiatrist. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES For all patients we compared functional independence measure (FIM) gain, FIM efficiency, rehabilitation length of stay (RLOS), discharge disposition, and major medical comorbidities. RESULTS Patients with ICUAW had significantly greater FIM gain (P = .015) and RLOS (P = .02). There was no significant difference in FIM efficiency (P = .15). Patients with ICUAW had a significantly lower odds of acute hospital transfer (odds ratio [OR] = 0.52, with 95% confidence interval [CI] 0.47, 0.58) and skilled nursing facility discharge (OR = 0.19, with 95% CI 0.038, 0.95). However, patients with ICUAW did have a higher percent of acute hospital transfers than other medically complex patients (P = .017). In addition, patients with ICUAW were more medically complex, as evidenced by a significantly higher Charlson Comorbidity Index (P < .001), prevalence of anemia (P < .001), atrial fibrillation (P = .009), obstructive sleep apnea (P = .018), and bacteremia (P = .041). CONCLUSIONS Patients with ICUAW with a clinical pattern of proximal muscle weakness and sensory sparing benefit from inpatient rehabilitation as evidenced by FIM gain and high home discharge rate. However, they have multiple medical comorbidities, which require judicious medical management and may contribute to a longer RLOS.
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Affiliation(s)
- Renuka T Rudra
- Department of Physical Medicine and Rehabilitation, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Dan Lin
- Department of Public Health Sciences, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Benjamin Miller
- College of Medicine, Penn State University, Hershey, Pennsylvania, USA
| | - Ping Du
- Department of Public Health Sciences, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Shangming Zhang
- Department of Physical Medicine and Rehabilitation, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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Wernhart S, Hedderich J, Wunderlich S, Schauerte K, Weihe E, Dellweg D, Siemon K. The Feasibility of High-Intensity Interval Training in Patients with Intensive Care Unit-Acquired Weakness Syndrome Following Long-Term Invasive Ventilation. SPORTS MEDICINE-OPEN 2021; 7:11. [PMID: 33527199 PMCID: PMC7849616 DOI: 10.1186/s40798-021-00299-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 01/11/2021] [Indexed: 12/17/2022]
Abstract
Background Intensive care unit-acquired weakness syndrome (ICUAWS) can be a consequence of long-term mechanical ventilation. Despite recommendations of early patient mobilisation, little is known about the feasibility, safety and benefit of interval training in early rehabilitation facilities (ERF) after long-term invasive ventilation. Methods and Results We retrospectively analysed two established training protocols of bicycle ergometry in ERF patients after long-term (> 7 days) invasive ventilation (n = 46). Patients conducted moderate continuous (MCT, n = 24, mean age 70.3 ± 10.1 years) or high-intensity interval training (HIIT, n = 22, mean age 63.6 ± 12.6 years). The intensity of training was monitored with the BORG CR10 scale (intense phases ≥ 7/10 and moderate phases ≤ 4/10 points). The primary outcome was improvement (∆-values) of six-minute-walk-test (6 MWT), while the secondary outcomes were improvement of vital capacity (VCmax), forced expiratory volume in 1 s (FEV1), maximal inspiratory pressure (PImax) and functional capabilities (functional independence assessment measure, FIM/FAM and Barthel scores) after 3 weeks of training. No adverse events were observed. There was a trend towards a greater improvement of 6 MWT in HIIT than MCT (159.5 ± 64.9 m vs. 120.4 ± 60.4 m; p = .057), despite more days of invasive ventilation (39.6 ± 16.8 days vs. 26.8 ± 16.2 days; p = .009). VCmax (∆0.5l ± 0.6 vs. ∆0.5l ± 0.3; p = .462), FEV1 (∆0.2l ± 0.3 vs. ∆0.3l ± 0.2; p = .218) PImax (∆0.8 ± 1.1 kPa vs. ∆0.7 ± 1.3pts; p = .918) and functional status (FIM/FAM: ∆29.0 ± 14.8pts vs. ∆30.9 ± 16.0pts; p = .707; Barthel: ∆28.9 ± 16.0 pts vs. ∆25.0 ± 10.5pts; p = .341) improved in HIIT and MCT. Conclusions We demonstrate the feasibility and safety of HIIT in the early rehabilitation of ICUAWS patients. Larger trials are necessary to find adequate dosage of HIIT in ICUAWS patients. Supplementary Information The online version contains supplementary material available at 10.1186/s40798-021-00299-6.
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Affiliation(s)
- Simon Wernhart
- Department of Cardiology, Fachkrankenhaus Kloster Grafschaft, Annostrasse 1, 57392, Schmallenberg, Germany. .,Department of Cardiology and Vascular Medicine, West German Heart- and Vascular Center, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.
| | - Jürgen Hedderich
- Medistat-Biomedical Statistics, Medistat GmbH, Kronshagen, 24119, Germany
| | - Svenja Wunderlich
- Department of Pneumology, Fachkrankenhaus Kloster Grafschaft, Schmallenberg, 57392, Germany
| | - Kunigunde Schauerte
- Department of Pneumology, Fachkrankenhaus Kloster Grafschaft, Schmallenberg, 57392, Germany
| | - Eberhard Weihe
- Institute of Anatomy and Cell Biology of the Philipps-University Marburg, Marburg, 35037, Germany
| | - Dominic Dellweg
- Department of Pneumology, Fachkrankenhaus Kloster Grafschaft, Schmallenberg, 57392, Germany
| | - Karsten Siemon
- Department of Pneumology, Fachkrankenhaus Kloster Grafschaft, Schmallenberg, 57392, Germany
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Prevent deterioration and long-term ventilation: intensive care following thoracic surgery. Curr Opin Anaesthesiol 2021; 34:20-24. [PMID: 33315639 DOI: 10.1097/aco.0000000000000944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Patients with indication for lung surgery besides the pulmonary pathology often suffer from independent comorbidities affecting several other organ systems. Preventing patients from harmful complications due to decompensation of underlying organ insufficiencies perioperatively is pivotal. This review draws attention to the peri- and postoperative responsibility of the anaesthetist and intensivist to prevent patients undergoing lung surgery deterioration. RECENT FINDINGS During the last decades we had to accept that 'traditional' intensive care medicine implying deep sedation, controlled ventilation, liberal fluid therapy, and broad-spectrum antimicrobial therapy because of several side-effects resulted in prolongation of hospital length of stay and a decline in quality of life. Modern therapy therefore should focus on the convalescence of the patient and earliest possible reintegration in the 'life-before.' Avoidance of sedative and anticholinergic drugs, early extubation, prophylactic noninvasive ventilation and high-flow nasal oxygen therapy, early mobilization, well-adjusted fluid balance and reasonable use of antibiotics are the keystones of success. SUMMARY A perioperative interprofessional approach and a change in paradigms are the prerequisites to improve outcome and provide treatment for elder and comorbid patients with an indication for thoracic surgery.
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Imamura M, Mirisola AR, Ribeiro FDQ, De Pretto LR, Alfieri FM, Delgado VR, Battistella LR. Rehabilitation of patients after COVID-19 recovery: An experience at the Physical and Rehabilitation Medicine Institute and Lucy Montoro Rehabilitation Institute. Clinics (Sao Paulo) 2021; 76:e2804. [PMID: 34133481 PMCID: PMC8183312 DOI: 10.6061/clinics/2021/e2804] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/15/2021] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES As patients recovering from the novel coronavirus disease 2019 (COVID-19) present with physical, respiratory, cognitive, nutritional, and swallowing-related impairments and mental health complications, their rehabilitation needs are complex. This study aimed to describe the demographic, clinical, and functional status after the discharge of COVID-19 survivors who underwent intensive multidisciplinary inpatient rehabilitation at the Physical and Rehabilitation Medicine Institute of the University of Sao Paulo Medical School General Hospital and Lucy Montoro Rehabilitation Institute. We determined the most important factors related to the length of inpatient rehabilitation treatment and present the functional outcomes. METHODS This was a retrospective study based on electronic medical records. In addition to the severity of COVID-19 and length of hospital stay for the management of COVID-19 and comorbidities, we collected sociodemographic data including age, sex, height, and weight. Functional assessments were performed using the Functional Independence Measure (FIM); Short Physical Performance Battery; Montreal Cognitive Assessment; Depression, Anxiety and Stress Scale; Revised Impact of Events Scale; bioelectrical impedance; Functional Oral Intake Scale; oropharyngeal dysphagia classification; and nutritional assessment. RESULTS There was a significant improvement in FIM before and after inpatient rehabilitation treatment (p<0.0001). Muscle strength and walking capacity were significantly improved (p<0.01). The most important factors related to the length of inpatient rehabilitation treatment were improvement in FIM scores (Spearman's r=0.71) and gain in lean mass (Spearman's r=0.79). CONCLUSIONS Rehabilitation of patients after COVID-19 recovery improves their functional status and should be considered in the post-acute phase for selected patients with COVID-19.
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Affiliation(s)
- Marta Imamura
- Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Centro de Pesquisa Clinica, Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Corresponding author. E-mail:
| | - Aline Rossetti Mirisola
- Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Fernando de Quadros Ribeiro
- Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Lucas Ramos De Pretto
- Centro de Pesquisa Clinica, Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Centro de Lasers e Aplicacoes, Instituto de Pesquisas Energeticas e Nucleares (IPEN-CNEN/SP), Sao Paulo, SP, BR
| | - Fábio Marcon Alfieri
- Centro de Pesquisa Clinica, Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Vinicius Ramos Delgado
- Centro de Pesquisa Clinica, Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Linamara Rizzo Battistella
- Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Cares-Marambio K, Montenegro-Jiménez Y, Torres-Castro R, Vera-Uribe R, Torralba Y, Alsina-Restoy X, Vasconcello-Castillo L, Vilaró J. Prevalence of potential respiratory symptoms in survivors of hospital admission after coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis. Chron Respir Dis 2021; 18:14799731211002240. [PMID: 33729021 PMCID: PMC7975482 DOI: 10.1177/14799731211002240] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/19/2021] [Accepted: 02/20/2021] [Indexed: 12/23/2022] Open
Abstract
Knowledge on the sequelae of Coronavirus Disease 2019 (COVID-19) remains limited due to the relatively recent onset of this pathology. However, the literature on other types of coronavirus infections prior to COVID-19 reports that patients may experience persistent symptoms after discharge. To determine the prevalence of respiratory symptoms in survivors of hospital admission after COVID-19 infection. A living systematic review of five databases was performed in order to identify studies which reported the persistence of respiratory symptoms in COVID-19 patients after discharge. Two independent researchers reviewed and analysed the available literature, and then extracted and assessed the quality of those articles. Of the 1,154 reports returned by the initial search nine articles were found, in which 1,816 patients were included in the data synthesis. In the pooled analysis, we found a prevalence of 0.52 (CI 0.38-0.66, p < 0.01, I2 = 97%), 0.37 (CI 0.28-0.48, p < 0.01, I2 = 93%), 0.16 (CI 0.10-0.23, p < 0.01, I2 = 90%) and 0.14 (CI 0.06-0.24, p < 0.01, I2 = 96%) for fatigue, dyspnoea, chest pain, and cough, respectively. Fatigue, dyspnoea, chest pain, and cough were the most prevalent respiratory symptoms found in 52%, 37%, 16% and 14% of patients between 3 weeks and 3 months, after discharge in survivors of hospital admission by COVID-19, respectively.
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Affiliation(s)
- Kevin Cares-Marambio
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | | | - Rodrigo Torres-Castro
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
- International Physiotherapy Research Network (PhysioEvidence)
| | - Roberto Vera-Uribe
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
- International Physiotherapy Research Network (PhysioEvidence)
| | - Yolanda Torralba
- Department of Pulmonary Medicine, Hospital Clínic–Institut
d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona,
Barcelona, Spain
- Biomedical Research Network in Respiratory Diseases (CIBERES),
Madrid, Spain
| | - Xavier Alsina-Restoy
- Department of Pulmonary Medicine, Hospital Clínic–Institut
d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona,
Barcelona, Spain
| | - Luis Vasconcello-Castillo
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
- International Physiotherapy Research Network (PhysioEvidence)
| | - Jordi Vilaró
- International Physiotherapy Research Network (PhysioEvidence)
- Blanquerna School of Health Sciences, Global Research on Wellbeing
(GRoW) Research Group, Universitat Ramon Llull, Barcelona, Spain
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Mendes RMG, Nunes ML, Sousa MCBC, Gonçalves RBR, Fernandes PN, Gomes AJO. Validation of the ICU Mobility Scale for Nursing Use: Portuguese Multicentric Observational Study. J Nurs Meas 2020; 29:80-93. [PMID: 33334844 DOI: 10.1891/jnm-d-19-00062] [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: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Mobilization of critical patients should be precocious and the inclusion of nursing in this task can be decisive in paradigm shift. The purpose of this study was to validate the Portuguese version of the intensive care unit Mobility Scale for nursing use. METHODS Prospective multicenter observational study. Patients' mobility was evaluated by rehabilitation nurses in order to determine interobserver agreement. The validation criteria was tested by determining the correlation between the evaluation results of mobility, strength, and functionality levels at discharge. RESULTS Good interobserver agreement (R = 0.98; K = 0.76). Positive correlation with muscle strength (R = 0.77) and functionality (R = 0.85) levels at discharge. CONCLUSIONS Based on the correlations observed the scale is a valid instrument for nurses and could be a useful tool for routine use. More research is recommended to make the results more robust.
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Schefold JC, Wollersheim T, Grunow JJ, Luedi MM, Z'Graggen WJ, Weber-Carstens S. Muscular weakness and muscle wasting in the critically ill. J Cachexia Sarcopenia Muscle 2020; 11:1399-1412. [PMID: 32893974 PMCID: PMC7749542 DOI: 10.1002/jcsm.12620] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/10/2020] [Accepted: 08/23/2020] [Indexed: 12/17/2022] Open
Affiliation(s)
- Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tobias Wollersheim
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Julius J Grunow
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Markus M Luedi
- Department of Anaesthesiology and Pain Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Werner J Z'Graggen
- Department of Neurology and Neurosurgery, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Steffen Weber-Carstens
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
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Schwab KE, To AQ, Chang J, Ronish B, Needham DM, Martin JL, Kamdar BB. Actigraphy to Measure Physical Activity in the Intensive Care Unit: A Systematic Review. J Intensive Care Med 2020; 35:1323-1331. [PMID: 31331220 PMCID: PMC7449762 DOI: 10.1177/0885066619863654] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE In the intensive care unit (ICU), prolonged inactivity is common, increasing patients' risk for adverse outcomes, including ICU-acquired weakness. Hence, interventions to minimize inactivity are gaining popularity, highlighting actigraphy, a measure of activity involving a wristwatch-like accelerometer, as a method to inform these efforts. Therefore, we performed a systematic review of studies that used actigraphy to measure patient activity in the ICU setting. DATA SOURCES We searched PubMed, EMBASE, CINAHL, Cochrane Library, and ProQuest from inception until December 2016. STUDY SELECTION Two reviewers independently screened studies for inclusion. A study was eligible for inclusion if it was published in a peer-reviewed journal and used actigraphy to measure activity in ≥5 ICU patients. DATA EXTRACTION Two reviewers independently performed data abstraction and risk of bias assessment. Abstracted actigraphy-based activity data included total activity time and activity counts. RESULTS Of 16 studies (607 ICU patients) identified, 14 (88%) were observational, 2 (12%) were randomized control trials, and 5 (31%) were published after 2009. Mean patient activity levels per 15 to 60 second epoch ranged from 25 to 37 daytime and 2 to 19 nighttime movements. Actigraphy was evaluated in the context of ICU and post-ICU outcomes in 11 (69%) and 5 (31%) studies, respectively, and demonstrated potential associations between actigraphy-based activity levels and delirium, sedation, pain, anxiety, time to extubation, and length of stay. CONCLUSION Actigraphy has demonstrated that patients are profoundly inactive in the ICU with actigraphy-based activity levels potentially associated with important measures, such as delirium, sedation, and length of stay. Larger and more rigorous studies are needed to further evaluate these associations and the overall utility of actigraphy in the ICU setting.
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Affiliation(s)
- Kristin E. Schwab
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - An Q. To
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - Jennifer Chang
- Department of Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - Bonnie Ronish
- Division of Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT, USA
| | - Dale M. Needham
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA
| | - Jennifer L. Martin
- Department of Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Biren B. Kamdar
- Division of Pulmonary, Critical Care and Sleep Medicine, UC San Diego (UCSD) School of Medicine, University of California, San Diego, CA, USA
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Yuan C, Timmins F, Thompson DR. Post-intensive care syndrome: A concept analysis. Int J Nurs Stud 2020; 114:103814. [PMID: 33220570 DOI: 10.1016/j.ijnurstu.2020.103814] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 10/20/2020] [Accepted: 10/22/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Post-intensive care syndrome is a term used to describe new or worsening multidimensional impairments in physical, psychological cognitive and social status arising from critical illness and persisting beyond hospital discharge. It is associated with high morbidity among patients discharged from intensive care units. However, due to its complexities, which encompass physical, psychological, cognitive and social impairments, the exact nature of this condition has not been fully conceptualized. The aim of this analysis therefore was to define the concept of post-intensive care syndrome. This conceptual clarity provides a general definition that is essential for practitioners and researchers to gain a comprehensive understanding of the syndrome and provide for accurate measurement of its incidence and prevalence. DESIGN The Walker and Avant approach to concept analysis guided this investigation. DATA SOURCE An electronic search of the literature using PubMed, CINHAL, PsycArticles, Academic search complete, Science Direct, MEDLINE and Health Source databases informed the analysis. The search included both quantitative and qualitative studies related to post-intensive care syndrome published in English between 2010 and 2020. RESULTS Of the 3948 articles identified, 24 ultimately met the inclusion criteria. Analysis identified the defining attributes of post-intensive care syndrome as: (1) new or worsening multidimensional impairments; (2) physical dysfunction; (3) psychological disorder; (4) cognitive impairment; (5) failed social reconstruction; and (6) persistent impaired multidimensional symptoms extending beyond intensive care and hospital discharge. Antecedents were divided into two categories: pre-existing and those related to the intensive care admission. Consequences were identified as both positive (for example the establishment of coping processes) and adverse (for example decreased quality of life and caregiver burden). CONCLUSION Post-intensive care syndrome affects more than half of patients discharged from intensive care units. This operational definition and conceptual understanding of this syndrome will help improve understanding and inform the design of preventative strategies to improve long-term consequences of the syndrome. Future research and standardized instrument development will serve to better understand the scope and characteristics of this syndrome and inform the development of possible preventative interventions.
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Affiliation(s)
- Chu Yuan
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.
| | - Fiona Timmins
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - David R Thompson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
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Kemp HI, Corner E, Colvin LA. Chronic pain after COVID-19: implications for rehabilitation. Br J Anaesth 2020; 125:436-440. [PMID: 32560913 PMCID: PMC7261464 DOI: 10.1016/j.bja.2020.05.021] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 01/08/2023] Open
Affiliation(s)
- Harriet I Kemp
- Pain Research Group, Imperial College London, London, UK.
| | - Eve Corner
- Department of Clinical Sciences, Brunel University London, London, UK
| | - Lesley A Colvin
- Division of Population Health & Genomics, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
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50
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Li Z, Cai Y, Zhang Q, Zhang P, Sun R, Jiang H, Wan J, Wu F, Wang X, Tao X. Intensive care unit acquired weakness: A protocol for an overview of systematic reviews and meta-analysis. Medicine (Baltimore) 2020; 99:e21926. [PMID: 32846861 PMCID: PMC7447417 DOI: 10.1097/md.0000000000021926] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 07/28/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Intensive care unit-acquired weakness (ICU-AW) is an acquired neuromuscular lesion and a common occurrence in patients who are critically ill. There are already systematic reviews on ICU-AW. Therefore, we provide a protocol for an overview of systematic reviews to improve the effectiveness of the construction of an evidence-based practice for prevention of ICU-AW. METHODS We will search the PubMed, CINAHL, EMBASE, and the Cochrane Library for the relevant systematic review or meta-analyses about ICU-AW. Study selection, data extraction, and the quality assessment of the included studies will be performed independently by 2 reviewers. And the methodological quality, report quality and evidence quality will be evaluated by Assessment of Multiple Systematic Reviews-2 tool, Preferred Reporting Items for Systematic Reviews and Meta Analyses Statement checklist and Grading of Recommendations Assessment, Development and Evaluation system, respectively. RESULTS This overview of systematic reviews and meta-analysis will collect the evidence published about the ICU-AW. CONCLUSION We hope that our research will contribute to clinicians and public decision making about the ICU-AW. REGISTRATION NUMBER INPLASY202070067.
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Affiliation(s)
- Zheng Li
- Graduate College, Wannan Medical College, Wuhu
| | - Yitong Cai
- School of Nursing, Lanzhou University, Lanzhou
| | - Qian Zhang
- School of Nursing, Lanzhou University, Lanzhou
| | - Peng Zhang
- The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Ruixiang Sun
- The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Haijiao Jiang
- The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | | | - Fang Wu
- Graduate College, Wannan Medical College, Wuhu
| | - Xiaoye Wang
- The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Xiubin Tao
- Graduate College, Wannan Medical College, Wuhu
- The First Affiliated Hospital of Wannan Medical College, Wuhu, China
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