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Pongsuwun K, Puwarawuttipanit W, Nguantad S, Samart B, Saikaew K, Ruksakulpiwat S. Factor Impacting Quality of Life Among Sepsis Survivors During and After Hospitalization: A Systematic Review of Current Empirical Evidence. J Multidiscip Healthc 2024; 17:3791-3802. [PMID: 39131747 PMCID: PMC11316489 DOI: 10.2147/jmdh.s477873] [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: 06/05/2024] [Accepted: 07/26/2024] [Indexed: 08/13/2024] Open
Abstract
Background There remains a gap in understanding post-sepsis outcomes, particularly regarding the factors that influence the quality of life (QOL) among sepsis survivors during and after hospitalization. Objective To determine factors impacting QOL among sepsis survivors during and after hospitalization based on the evaluation and synthesis of current evidence. Methods This review encompassed studies published from January 2020 to December 2024, sourced from Scopus, PubMed, Medline, ScienceDirect, CINAHL Plus with Full Text, and Web of Science. The process of identifying, screening, excluding, and including articles followed the guidelines set by the Preferred Reporting Items for Systematic Reviews (PRISMA). Data synthesis for theme generation was conducted using the convergent integrated analysis framework as recommended by the Joanna Briggs Institute. Results A total of 1164 records were identified from the databases. After removing 130 duplicates, 1034 articles remained for screening based on their titles and abstracts according to the inclusion and exclusion criteria. At this stage, 1021 articles did not meet the criteria and were excluded, leaving 13 articles eligible for full-text screening. During this phase, 5 articles were excluded for various reasons, resulting in eight studies being included in the systematic review. Data synthesis of these studies revealed seven themes related to factors impacting QOL among sepsis survivors during and after hospitalization: 1) Physical Health Dimension, 2) Mental Health Dimension, 3) Treatment During Hospitalization, 4) Spiritual Dimension, 5) Social Support, 6) Mortality, and 7) Blood Biomarkers. Conclusion This systematic review provides valuable insights into the factors affecting the quality of life among sepsis survivors during and after hospitalization. These findings enhance the current knowledge base and offer clinicians, researchers, and policymakers actionable insights to improve outcomes and well-being for sepsis survivors.
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Affiliation(s)
- Kewalin Pongsuwun
- Department of Medical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | | | - Sunisa Nguantad
- Department of Nursing Siriraj Hospital, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Khalinee Saikaew
- Department of Nursing Siriraj Hospital, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Suebsarn Ruksakulpiwat
- Department of Medical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
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Loss SH, Nunes DSL, Franzosi OS, Salazar GS, Teixeira C, Vieira SRR. Chronic critical illness: are we saving patients or creating victims? Rev Bras Ter Intensiva 2018; 29:87-95. [PMID: 28444077 PMCID: PMC5385990 DOI: 10.5935/0103-507x.20170013] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 09/05/2016] [Indexed: 12/15/2022] Open
Abstract
The technological advancements that allow support for organ dysfunction have led
to an increase in survival rates for the most critically ill patients. Some of
these patients survive the initial acute critical condition but continue to
suffer from organ dysfunction and remain in an inflammatory state for long
periods of time. This group of critically ill patients has been described since
the 1980s and has had different diagnostic criteria over the years. These
patients are known to have lengthy hospital stays, undergo significant
alterations in muscle and bone metabolism, show immunodeficiency, consume
substantial health resources, have reduced functional and cognitive capacity
after discharge, create a sizable workload for caregivers, and present high
long-term mortality rates. The aim of this review is to report on the most
current evidence in terms of the definition, pathophysiology, clinical
manifestations, treatment, and prognosis of persistent critical illness.
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Affiliation(s)
- Sergio Henrique Loss
- Programa de Pós-graduação em Ciências Médicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil.,Unidade de Terapia Intensiva, Hospital de Clínicas de Porto Alegre - Porto Alegre (RS), Brasil
| | - Diego Silva Leite Nunes
- Programa de Pós-graduação em Ciências Médicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | - Oellen Stuani Franzosi
- Programa de Pós-graduação em Ciências Médicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil.,Departamento de Nutrição, Hospital de Clínicas de Porto Alegre - Porto Alegre (RS), Brasil
| | | | - Cassiano Teixeira
- Faculdade de Medicina, Universidade Federal de Ciências da Saúde de Porto Alegre - Porto Alegre (RS), Brasil
| | - Silvia Regina Rios Vieira
- Programa de Pós-graduação em Ciências Médicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil.,Unidade de Terapia Intensiva, Hospital de Clínicas de Porto Alegre - Porto Alegre (RS), Brasil.,Departamento de Clínica Médica, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
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Howard R, Eriksson S, Hirsch N, Kitchen N, Kullmann D, Taylor C, Walker M. Disorders of Consciousness, Intensive Care Neurology and Sleep. Neurology 2016. [DOI: 10.1002/9781118486160.ch20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Taşkınlar H, Naycı A, Çömelekoğlu Ü, Polat G, Zorludemir S, Avlan D. Intestinal ischemia-reperfusion induced diaphragm contractility dysfunction: Electrophysiological and ultrastructural study in a neonatal rat model. J Pediatr Surg 2016; 51:354-9. [PMID: 26411723 DOI: 10.1016/j.jpedsurg.2015.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 06/20/2015] [Accepted: 08/15/2015] [Indexed: 11/19/2022]
Abstract
AIM To evaluate the remote effect of intestinal ischemia reperfusion (IR) injury mediated by tumor necrosis factor alpha (TNF-α) on diaphragm contractility functions and whether administration of NAC may counteract the possible detrimental effects in an experimental neonatal rat model. METHODS 40 Wistar rat pups were randomized into four groups; ten animals in each. Intestinal ischemia was conducted by obstructing mesentery of intestines by a silk loop. In the control group; only laparotomy was performed. After 1h ischemia, reperfusion was conducted for 1h in 1h group, 24h for 24h group and 24h for 24h+NAC group but administration of NAC (150mg/kg/day) intraperitoneally twice a day was performed. Inflammatory response was evaluated by tissue TNF-α level and contractility functions by mechanic activity studies of the diaphragm. Electrophysiology of the diaphragm and the phrenic nerve was conducted to determine neuropathy or myopathy and transmission electron microscopy was performed to evaluate ultrastructural changes in the phrenic nerve. RESULTS Diaphragm tissue TNF-α level significantly increased in 1h and 24h groups (P=0.004, P=0.0001; respectively). Diaphragm mechanic activation force and duration significantly decreased at 1h and 24h (P=0.004, P=0.02 and P=0.0001, P=0.0001; respectively). NAC administration significantly prevented decrease in the maximal contraction and the duration (P<0.001). Phrenic nerve compound action potential (CMAP) amplitude significantly decreased in 1h group (P<0.0001) and NAC administration significantly prevented this decrease when compared with 24h group (P<0.001). In diaphragmatic needle electromyography, the duration of motor unit potentials (MUP) was prolonged significantly when compared with control group. Contractility and electrophysiological studies were indicating primarily neuropathy in diaphragm dysfunction. Histopathology revealed axonal and myelin degeneration in the 1h and 24h group, but less injury in the NAC administered group. CONCLUSIONS Intestinal IR induced elevation of TNF-α level in the diaphragm. Impairment in the diaphragm contractility and neuropathic changes in the phrenic nerve occurred even in the first hour of reperfusion. NAC administration prevented these detrimental effects.
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Affiliation(s)
- Hakan Taşkınlar
- Mersin University, School of Medicine, Department of Pediatric Surgery, Mersin, Turkey.
| | - Ali Naycı
- Mersin University, School of Medicine, Department of Pediatric Surgery, Mersin, Turkey
| | - Ülkü Çömelekoğlu
- Mersin University, School of Medicine, Department of Biophysics, Mersin, Turkey
| | - Gürbüz Polat
- Mersin University, School of Medicine, Department of Biochemistry, Mersin, Turkey
| | - Suzan Zorludemir
- Çukurova University, School of Medicine, Department of Pathology, Adana, Turkey
| | - Dinçer Avlan
- Mersin University, School of Medicine, Department of Pediatric Surgery, Mersin, Turkey
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Abstract
OBJECTIVES To explore and describe the subjective experiences and long-term impact of severe sepsis on survivors of severe sepsis and their informal caregivers (e.g., spouse or family member) through qualitative research methods. DESIGN A qualitative exploratory study using semi-structured interviews with survivors of severe sepsis and their informal caregivers in the United Kingdom and United States. Participants also completed a demographic background form and sites provided medical history details. Transcripts were analyzed using a thematic analysis approach. SETTING Patients were recruited from a large National Health Service hospital in the United Kingdom and a level 1 trauma center hospital in the United States. Caregivers were recruited through eligible patients. Interviews were conducted either face to face in participant's homes or another convenient location or over the telephone. PATIENTS Patients who were 18 years old or older and had experienced an episode of severe sepsis in the previous 12 months were recruited by clinical staff in each hospital. Caregivers were family members or friends who had provided informal care for the patient after their episode of severe sepsis. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Thirty-nine interviews were conducted with 22 patients and 17 informal caregivers (of these 28 were conducted face-to-face and 11 by telephone). Five main themes were identified in the qualitative analysis: awareness and knowledge of severe sepsis; experience of hospitalization, ongoing impact of severe sepsis; impact on caregivers; and support after severe sepsis. Experiences varied depending on the patients' health prior to the severe sepsis, with the worst affected reporting lasting impacts on multiple aspects of their life. CONCLUSIONS The study extends what was understood about severe sepsis from the patients' and caregivers' perspectives from the previous limited literature. Caregivers as well as patients reported enduring impact. The study also identified problems of lack of awareness of diagnosis and understanding of severe sepsis by patients and caregivers and difficulties accessing appropriate healthcare providers and ancillary services after discharge from hospital.
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Klainbart S, Ranen E, Glikman G, Kelmer E, Bdolah-Abram T, Aroch I. Hindlimb lameness and gait abnormalities in bitches with pyometra. Vet Rec 2014; 175:46. [PMID: 24789856 DOI: 10.1136/vr.102376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The objective of this study was to assess the frequency of gait abnormalities and lameness (GAL) in bitches with pyometra, and their association with clinical and laboratory findings. The study included 79 bitches diagnosed with pyometra and 35 negative control intact bitches presented with other soft tissue surgical disorders. Dogs with a history of chronic lameness due to orthopaedic or neurological origin were excluded. A history of GAL was more frequent in the pyometra group (47 per cent) compared with the control group (20 per cent) (P=0.007). In the pyometra group, bitches presenting GAL had (P<0.04) higher frequencies of closed-cervix pyometra, anorexia and vomiting, as well as higher serum creatinine concentration and muscle enzymes activity, compared with those in without GAL. GAL signs resolved postovariohysterectomy in all but one bitch. The results suggest that GAL signs occur frequently in bitches with pyometra, especially in closed-cervix disease. Therefore, pyometra should be considered among the differential diagnoses when GAL occurs, especially when the clinical signs are non-specific and the reproductive history is unclear.
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Affiliation(s)
- S Klainbart
- Hebrew University Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, P.O. Box 12, Rehovot 761001, Israel
| | - E Ranen
- Hebrew University Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, P.O. Box 12, Rehovot 761001, Israel
| | - G Glikman
- Hebrew University Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, P.O. Box 12, Rehovot 761001, Israel 5/1 HaArugot St. Pardes-Hana 37082, Israel
| | - E Kelmer
- Hebrew University Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, P.O. Box 12, Rehovot 761001, Israel
| | - T Bdolah-Abram
- Hebrew University Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, P.O. Box 12, Rehovot 761001, Israel
| | - I Aroch
- Hebrew University Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, P.O. Box 12, Rehovot 761001, Israel
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Feng J, Jiang X, Fang S. A rare case of critical illness polyneuropathy and literature review. Pak J Med Sci 2014; 30:671-3. [PMID: 24949002 PMCID: PMC4048529 DOI: 10.12669/pjms.303.4543] [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: 10/28/2013] [Accepted: 02/20/2014] [Indexed: 11/15/2022] Open
Abstract
A 40- year-old Male was admitted to the first hospital of Jilin University with the complaint of 4 days of fever and headache and aggravation of weakness in his lower extremities accompanied with dysuria and disturbance of consciousness for one day. He had tachycardia, tachypnea and elevated white blood cell counts. General status of the patient got better day by day, while weakness and pain in his lower extremities had developed and gradually quadriplegia arose. When intensive care unit history, weaning difficulty from mechanical ventilator, clinical manifestations in intensive care unit associated with SIRS, symmetrical paresis pronounced in distal lower extremities, absence of deep tendon reflexes, evidence of distal sensory impairment, presence of electrophysiologic results indicating axonal sensorimotor polyneuropathy and muscle and nerve biopsy results were taken into consideration, he was diagnosed as critical illness polyneuropathy.
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Affiliation(s)
- Jiachun Feng
- Jiachun Feng, MD, PhD, Department of Neurology, the First Teaching Hospital of Jilin University, Changchun, China
| | - Xinmei Jiang
- Xinmei Jiang, MD, PhD, Department of Neurology, the First Teaching Hospital of Jilin University, Changchun, China
| | - Shaokuan Fang
- Shaokuan Fang MD, PhD, Department of Neurology, the First Teaching Hospital of Jilin University, Changchun, China
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ORWELIUS L, LOBO C, TEIXEIRA PINTO A, CARNEIRO A, COSTA-PEREIRA A, GRANJA C. Sepsis patients do not differ in health-related quality of life compared with other ICU patients. Acta Anaesthesiol Scand 2013; 57:1201-5. [PMID: 23895260 DOI: 10.1111/aas.12164] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2013] [Indexed: 12/26/2022]
Abstract
INTRODUCTION The aim of the present multicentre study is to assess health-related quality of life in patients with community-acquired sepsis, severe sepsis, or septic shock (CAS) 6 months after discharge from the intensive care unit (ICU) and to compare the health-related quality of life of the ICU survivors with CAS with ICU survivors with other ICU diagnoses. METHODS Prospective, multicentre study in nine combined medical and surgical ICUs in Portugal. Health-related quality of life was assessed 6 months after ICU stay, using EuroQol-5D (EQ-5D) mailed to patients. ICU-related factors were obtained from the local ICU database and the local database for the SACiUCI follow-up study. RESULTS A total of 313 (52%) surviving patients answered the questionnaire, and of these 91 (29%) were admitted for CAS. There were no significant differences in health-related quality of life between the two study groups. CONCLUSION Patients admitted to ICU for CAS did not perceived different health-related quality of life compared with ICU patients admitted for other diagnoses.
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Affiliation(s)
| | - C. LOBO
- Faculty of Medicine of Porto; CINTESIS - Center for Research in Health Technologies and Health Systems; Porto; Portugal
| | | | - A. CARNEIRO
- Intensive Care Unit; Hospital da Arrábida; Vila Nova de Gaia; Portugal
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Loss SH, Marchese CB, Boniatti MM, Wawrzeniak IC, Oliveira RP, Nunes LN, Victorino JA. Prediction of chronic critical illness in a general intensive care unit. Rev Assoc Med Bras (1992) 2013; 59:241-7. [PMID: 23680275 DOI: 10.1016/j.ramb.2012.12.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 10/29/2012] [Accepted: 12/03/2012] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To assess the incidence, costs, and mortality associated with chronic critical illness (CCI), and to identify clinical predictors of CCI in a general intensive care unit. METHODS This was a prospective observational cohort study. All patients receiving supportive treatment for over 20 days were considered chronically critically ill and eligible for the study. After applying the exclusion criteria, 453 patients were analyzed. RESULTS There was an 11% incidence of CCI. Total length of hospital stay, costs, and mortality were significantly higher among patients with CCI. Mechanical ventilation, sepsis, Glasgow score <15, inadequate calorie intake, and higher body mass index were independent predictors for CCI in the multivariate logistic regression model. CONCLUSIONS CCI affects a distinctive population in intensive care units with higher mortality, costs, and prolonged hospitalization. Factors identifiable at the time of admission or during the first week in the intensive care unit can be used to predict CCI.
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Affiliation(s)
- Sérgio H Loss
- Department of Critical Care Medicine, Hospital de Clínicas, Porto Alegre, RS, Brazil.
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Abstract
PURPOSE OF REVIEW Critical illness myopathy and neuropathy are common complications in the ICU, causing limb and respiratory muscle weakness. We review the most recent data concerning their presentation, diagnosis and treatment. RECENT FINDINGS Limb muscle strength can be reliably assessed by using the Medical Research Council scale or handgrip dynamometry. A Medical Research Council sum score below 48 or mean Medical Research Council score below 4 (antigravity strength) across all testable muscle groups, and a force value of less than 11 kg-force for men and less than 7 kg-force for women at dominant-hand dynamometry identify ICU-acquired weakness in previously healthy individuals admitted to an ICU for nonneuromuscular disorder. Clinical signs, together with measurements of the maximal inspiratory and expiratory pressures and vital capacity, are important to timely diagnose respiratory muscle weakness. Electrophysiological testing is usefully implemented in unconscious patients or in awake patients who do not improve despite appropriate treatments. Early physiotherapy in the ICU can increase the proportion of patients reaching an independent functional status following their ICU stay. Critical illness myopathy and neuropathy may occur outside the ICU; however, exact estimates are lacking. SUMMARY Systematic application of diagnostic criteria and early physiotherapy may help clinicians to timely diagnose critical illness myopathy and neuropathy and to reduce the associated morbidity.
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Neuromuscular medicine competency in physical medicine and rehabilitation residents: a method of development and assessment. Am J Phys Med Rehabil 2012; 92:258-66. [PMID: 23128327 DOI: 10.1097/phm.0b013e3182745ed9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This project endeavored to create an educational module including methodology to instruct physical medicine and rehabilitation residents in the evaluation and appropriate treatment of patients with neuromuscular disorders. It further sought to verify acquired competencies in neuromuscular rehabilitation through objective evaluation methodology. An American Association of Neuromuscular and Electrodiagnostic Medicine board-certified physician with 10 yrs of clinical experience in neuromuscular and general rehabilitation trained 19 residents using a standardized competency-based module. The residents were trained through clinical training, lectures, and review of self-assessment examination concepts from the American Academy of Physical Medicine & Rehabilitation syllabus provided in the Archives of Physical Medicine and Rehabilitation. After delivery of the educational module, knowledge acquisition and skill proficiency were measured in (1) completion of neuromuscular history and physical examination satisfactorily, (2) diagnosis and ability to design a patient care management plan via chart stimulated recall examinations, (3) physician-patient interaction via patient surveys, (4) physician-staff interaction via 360-degree global ratings, and (5) ability to write a comprehensive patient care report and to document a patient care management plan in accordance with Medicare guidelines via written patient reports. Assessment tools developed for this program address the basic competencies outlined by the Accreditation Council for Graduate Medical Education. To test the success of the standardized educational module, data were collected on an ongoing basis. The objective measures compared resident self-assessment examination scores in neuromuscular rehabilitation before and after the institution of the comprehensive neuromuscular competency module in the residency program. Nineteen (100%) of 19 residents successfully demonstrated proficiency in every segment of the evaluation module by the end of the postgraduate year 2 inpatient neuromuscular rehabilitation rotation. Furthermore, the residents' proficiency, as demonstrated by the evaluation after the implementation of the standardized educational module, positively correlated with an increase in the residents' self-assessment examination scores in neuromuscular rehabilitation compared with the residents' scores before the educational module implementation throughout all 3 yrs of training. Resident proficiency in the skills and knowledge pertaining to neuromuscular rehabilitation were objectively verified after completion of the standardized educational module. Validation of the assessment tool is evidenced by the collected data correlating with significantly improved self-assessment examination scores, as outlined in the "RESULTS" section. In addition, the clinical development tool was validated by the residents being individually observed performing history and physical examinations and being deemed competent by the American Association of Neuromuscular and Electrodiagnostic Medicine board-certified physical medicine and rehabilitation physician. The standardized educational module and evaluation methodology provide a potential framework for the definition of baseline competency in the clinical training area of neuromuscular rehabilitation.
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Abstract
A syndrome of generalized weakness, areflexia, and difficulty with weaning from a ventilator is a common clinical presentation in the critically ill patient, especially in the setting of sepsis, multiorgan failure, and hyperglycemia. At first believed to be a manifestation of nerve (critical illness neuropathy, CIN) or muscle (critical illness myopathy, CIM) dysfunction, our current conceptualization is as a spectrum (critical illness neuromuscular abnormalities, CINMA) that varies in extent and site(s) of involvement, but often a similar clinical presentation. Signs and symptoms of CINMA must be identified early to foster recovery and limit morbidity and mortality. The medical history is crucial in excluding preexisting neuromuscular conditions and electrodiagnostic testing helps to establish the diagnosis and prognostication. A stepwise approach to the management of a patient with CINMA is outlined, but avoiding potential medications, and ensuring supportive care are the primary interventions to consider. Recently intensive insulin therapy for hyperglycemia has been shown to lower the risk of CINMA and decrease the time of ventilatory support, but with a greater risk of hypoglycemia. Future therapeutic interventions will require a better understanding of disease pathogenesis, but may target proinflammatory cytokine and free-radical pathways, muscle gene expression, ion channel function, or proteolytic muscle protein mechanisms. Rehabilitation is an equally essential component in a patient's management. Although prognosis depends on the extent of the underlying muscle and nerve damage, mild persistent deficits are common and severe disability may be persistent.
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Abstract
OBJECTIVE To define the electrophysiologic tests to diagnose critical illness myopathy and critical illness polyneuropathy in intensive care unit patients. DESIGN Literature review. MEASUREMENTS AND MAIN RESULTS Critical illness myopathy and neuropathy are common complications in the critically ill patient. Myopathy and neuropathy are equally common, and often coexist. Electrophysiological alterations of peripheral nerves and muscle have an early onset in the first days of intensive care unit stay or shortly after sepsis, and precede the structural alterations. Conventional electrophysiologic evaluation can be performed easily on most intensive care unit patients, including patients with altered consciousness; in conjunction with direct muscle stimulation, it can differentiate myopathy from neuropathy, which might be important to define the long-term prognosis. However, electrophysiologic tests are not universally available; their interpretation requires special expertise; and their application is time consuming. A recently proposed simplified test of peroneal nerve stimulation could be used as a screening method to select patients who merit in-depth neurologic evaluation. CONCLUSIONS Early identification of neuromuscular alterations by means of electrophysiologic tests may be of value for targeted treatments and to anticipate the risk of short-term disability. Complete neurologic and electrophysiological evaluation is important to define the risk of long-term disability after intensive care unit discharge.
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Deciding in the dark: advance directives and continuation of treatment in chronic critical illness. Crit Care Med 2009; 37:919-25. [PMID: 19237897 DOI: 10.1097/ccm.0b013e31819613ce] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Chronic critical illness is a devastating syndrome for which treatment offers limited clinical benefit but imposes heavy burdens on patients, families, clinicians, and the health care system. We studied the availability of advance directives and appropriate surrogates to guide decisions about life-sustaining treatment for the chronically critically ill and the extent and timing of treatment limitation. DESIGN Prospective cohort study. SETTING Respiratory Care Unit (RCU) in a large, tertiary, urban, university-affiliated, hospital. PATIENTS Two hundred three chronically critically ill adults transferred to RCU after tracheotomy for failure to wean from mechanical ventilation in the intensive care unit. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We interviewed RCU caregivers and reviewed patient records to identify proxy appointments, living wills, or oral statements of treatment preferences, resuscitation directives, and withholding/withdrawal of mechanical ventilation, nutrition, hydration, renal replacement and vasopressors. Forty-three of 203 patients (21.2%) appointed a proxy and 33 (16.2%) expressed preferences in advance directives. Do not resuscitate directives were given for 71 patients (35.0%). Treatment was limited for 39 patients (19.2%). Variables significantly associated with treatment limitation were proxy appointment prior to study entry (time of tracheotomy/RCU transfer) (odds ratio = 6.7, 95% confidence interval [CI], 2.3-20.0, p = 0.0006) and palliative care consultation in the RCU (OR = 40.9, 95% CI, 13.1-127.4, p < 0.0001). Median (interquartile range) time to first treatment limitation was 39 (31.0-45.0) days after hospital admission and 13 (8.0-29.0) days after RCU admission. For patients dying after treatment limitation, median time from first limitation to death ranged from 3 days for mechanical ventilation and hydration to 7 days for renal replacement. CONCLUSIONS Most chronically critically ill patients fail to designate a surrogate decision-maker or express preferences regarding life-sustaining treatments. Despite burdensome symptoms and poor outcomes, limitation of such treatments was rare and occurred late, when patients were near death. Opportunities exist to improve communication and decision-making in chronic critical illness.
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Wu JY, Wu SG, Sun HY, Kuo PH, Yang PC. Critical illness polyneuromyopathy in a patient with disseminated cryptococcal infection. J Hosp Med 2009; 4:E3-6. [PMID: 19219922 DOI: 10.1002/jhm.375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Critical illness polyneuromyopathy is frequent in patients in intensive care units. We report a case of critical illness polyneuromyopathy in a patient with disseminated cryptococcal infection in an intensive care unit.
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Affiliation(s)
- Jenn-Yu Wu
- National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
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17
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Nanas S, Kritikos K, Angelopoulos E, Siafaka A, Tsikriki S, Poriazi M, Kanaloupiti D, Kontogeorgi M, Pratikaki M, Zervakis D, Routsi C, Roussos C. Predisposing factors for critical illness polyneuromyopathy in a multidisciplinary intensive care unit. Acta Neurol Scand 2008; 118:175-81. [PMID: 18355395 DOI: 10.1111/j.1600-0404.2008.00996.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To investigate risk factors of critical illness polyneuromyopathy (CIPM) in a general multidisciplinary intensive care unit (ICU). PATIENTS AND METHODS Prospective observational study in a 28-bed university multidisciplinary ICU. Four hundred and seventy-four (323 M/151 F, age 55 +/- 19) consecutive patients were prospectively evaluated. All patients were assigned admission Acute Physiology and Chronic Health Evaluation (APACHE II; 15 +/- 7) and Sequential Organ Failure Assessment (SOFA; 6 +/- 3) scores and were subsequently evaluated for newly developed neuromuscular weakness. Other potential causes of new-onset weakness after ICU admission were excluded before CIPM was diagnosed. RESULTS Forty-four (23.8%) of 185 patients developed generalized weakness that met the criteria for CIPM. Patients with CIPM had higher APACHE II (18.9 +/- 6.6 vs 15.6 +/- 6.4, P = 0.004) and SOFA scores (8.4 +/- 2.9 vs 7.1 +/- 2.9, P = 0.013). According to multivariate logistic regression analysis, the following risk factors were independently associated with the development of CIPM: severity of illness at the time of ICU admission, administration of aminoglycoside antibiotics and high blood glucose levels. Analysis according to severity of illness stratification revealed the emergence of Gram (-) bacteremia as the most important independent predisposing factor for CIPM development in less severely ill patients. CONCLUSIONS CIPM has a high incidence in the ICU setting. Our study revealed the association of aminoglycosides, hyperglycemia and illness severity with CIPM development, as well as the association between Gram (-) bacteremia and development of CIPM in less severely ill patient population.
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Affiliation(s)
- S Nanas
- National and Kapodistrian University, Medical School, First Critical Care Department, Evangelismos Hospital, Athens, Greece.
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Chronic Critical Illness. Intensive Care Med 2007. [DOI: 10.1007/978-0-387-49518-7_82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Stevens RD, Dowdy DW, Michaels RK, Mendez-Tellez PA, Pronovost PJ, Needham DM. Neuromuscular dysfunction acquired in critical illness: a systematic review. Intensive Care Med 2007; 33:1876-91. [PMID: 17639340 DOI: 10.1007/s00134-007-0772-2] [Citation(s) in RCA: 389] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2007] [Accepted: 06/15/2007] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To determine the prevalence, risk factors, and outcomes of critical illness neuromuscular abnormalities (CINMA). DESIGN Systematic review. DATA SOURCES AND STUDY SELECTION MEDLINE, EMBASE, CINAHL, and the Cochrane Library were searched for reports on adult ICU patients who were evaluated for CINMA clinically and electrophysiologically. Studies were included if they contained sufficient data to quantify the association between CINMA and relevant exposures and/or outcome variables. MEASUREMENTS AND RESULTS CINMA was diagnosed in 655 of 1421 [46% (95% confidence interval 43-49%)] adult ICU patients enrolled in 24 studies, all with inclusion criteria of sepsis, multi-organ failure, or prolonged mechanical ventilation. Diagnostic criteria for CINMA were not uniform, and few reports unequivocally differentiated between polyneuropathy, myopathy, and mixed types of CINMA. The risk of CINMA was associated with hyperglycemia (and inversely associated with tight glycemic control), the systemic inflammatory response syndrome, sepsis, multiple organ dysfunction, renal replacement therapy, and catecholamine administration. Across studies, there was no consistent relationship between CINMA and patient age, gender, severity of illness, or use of glucocorticoids, neuromuscular blockers, aminoglycosides, or midazolam. Unadjusted mortality was not increased in the majority of patients with CINMA, but mechanical ventilation and ICU and hospital stay were prolonged. CONCLUSIONS The risk of CINMA is nearly 50% in ICU patients with sepsis, multi-organ failure, or protracted mechanical ventilation. The association of CINMA with frequently cited CINMA risk factors (glucocorticoids, neuromuscular blockers) and with short-term survival is uncertain. Available data indicate glycemic control as a potential strategy to decrease CINMA risk.
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Affiliation(s)
- Robert D Stevens
- Department of Anesthesiology/Critical Care Medicine, Johns Hopkins University School of Medicine, 600 N Wolfe St, Meyer 8-140, Baltimore, MD 21287, USA.
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Cankayali I, Dogan YH, Solak I, Demirag K, Eris O, Demirgoren S, Moral AR. Neuromuscular deterioration in the early stage of sepsis in rats. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2007; 11:R1. [PMID: 17204135 PMCID: PMC2151871 DOI: 10.1186/cc5139] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2006] [Revised: 09/01/2006] [Accepted: 01/04/2007] [Indexed: 12/02/2022]
Abstract
Introduction Critical illness polyneuropathy (CIP) is a clinical condition frequently seen in patients being treated in critical care units in the final stage of sepsis. The etiopathology of CIP is still unclear, and the onset time of appearance of the electrophysiological findings has not been elucidated. The very little research that has been carried out on this topic is limited to clinical electrophysiological and histopathological studies. In this study, electrophysiological alterations in the early stage of experimentally induced sepsis were investigated in septic rats. Methods We conducted a prospective, randomized, controlled experimental study in an animal basic science laboratory with 30 male Sprague-Dawley rats, weighing 200 to 250 g. All of the rats were randomly assigned to one of two groups. In the sepsis group (n = 20), cecal ligation and puncture (CLP) was performed to induce experimental sepsis. In the sham-operated group (n = 10), laparotomy without CLP was performed. Before and 24 hours after CLP and laparotomy, the right sciatic nerve was stimulated from the sciatic notch and compound muscle action potentials (CMAPs) were recorded from the gastrocnemius muscle. Recordings of latency, amplitude, and duration of the CMAP were evaluated. Results CMAP durations before and 24 hours after surgery were 0.45 ± 0.05 ms and 0.48 ± 0.05 ms, respectively, in the sham-operated group and 0.46 ± 0.05 ms and 0.55 ± 0.01 ms, respectively, in the sepsis group. Latency measurements in the sham-operated group were 0.078 ± 0.010 ms and 0.080 ± 0.015 ms, respectively, whereas measurements were found to be prolonged in the sepsis group: 0.094 ± 0.015 ms and 0.149 ± 0.054 ms before and 24 hours after surgery, respectively (p < 0.05). CMAP amplitudes in the sham-operated group before and 24 hours after surgery were 8.41 ± 0.79 mV and 8.28 ± 1.92 mV, respectively, whereas in the sepsis group the amplitude measurements decreased to 7.60 ± 1.75 mV and 4.87 ± 3.44 mV, respectively (p < 0.05). Conclusion The results of the study indicate that electrophysiological alterations appear in the first 24 hours after experimental sepsis and are characterized by an increase in latency and a decrease in CMAP amplitude. The results also suggest that electrophysiological findings seen in patients with CIP might appear before clinical signs of CIP.
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Affiliation(s)
- Ilkin Cankayali
- Department of Anaesthesiology and Intensive Care Unit, Ege University, School of Medicine 35100, Izmir, Turkey
| | - Yusuf Hakan Dogan
- Department of Physiology, Ege University, School of Medicine 35100, Izmir, Turkey
| | - Ilhami Solak
- Department of General Surgery, Ege University, School of Medicine 35100, Izmir, Turkey
| | - Kubilay Demirag
- Department of Anaesthesiology and Intensive Care Unit, Ege University, School of Medicine 35100, Izmir, Turkey
| | - Oguz Eris
- Department of Anaesthesiology and Intensive Care Unit, Ege University, School of Medicine 35100, Izmir, Turkey
| | - Serdar Demirgoren
- Department of Physiology, Ege University, School of Medicine 35100, Izmir, Turkey
| | - Ali Resat Moral
- Department of Anaesthesiology and Intensive Care Unit, Ege University, School of Medicine 35100, Izmir, Turkey
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Atalay A, Karatas M, Turhan N, Ozturk TS, Emiroglu R, Haberal M. Bilateral Drop-Foot After Orthotopic Liver Transplant. Transplant Proc 2006; 38:1471-3. [PMID: 16797336 DOI: 10.1016/j.transproceed.2006.02.130] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2005] [Indexed: 02/06/2023]
Abstract
Patients may demonstrate various neuromuscular abnormalities after liver transplantation. We report a patient who developed bilateral drop foot after orthotopic liver transplantation. He was diagnosed with critical illness polyneuropathy. During follow-up, his complaints gradually recovered and his electrodiagnostic findings improved.
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Affiliation(s)
- A Atalay
- Department of Physical Medicine and Rehabilitation, Baskent University, Ankara, Turkey
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Weiss LD, Weiss JM, Johns JS, Strommen JA, Kim CT, Williams FH, Rashbaum IG. Neuromuscular rehabilitation and electrodiagnosis. 2. Peripheral neuropathy. Arch Phys Med Rehabil 2005; 86:S11-7. [PMID: 15761795 DOI: 10.1016/j.apmr.2004.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
UNLABELLED This self-directed learning module highlights peripheral neuropathies. It is part of the chapter on neuromuscular rehabilitation and electrodiagnosis in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article specifically focuses on diagnostic criteria and classifications of peripheral neuropathy, including diabetic, alcoholic, carcinomatous, human immunodeficiency virus-associated, and critical illness polyneuropathies. Treatment options are reviewed. The causes for difficult to obtain nerve conduction studies are highlighted. OVERALL ARTICLE OBJECTIVE To summarize the diagnosis, classification, and treatment of peripheral neuropathies.
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Affiliation(s)
- Lyn D Weiss
- Department of Physical Medicine and Rehabilitation, Nassau University Medical Center, 2201 Hempstead Tpke, East Meadow, NY 11554, USA.
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Granja C, Dias C, Costa-Pereira A, Sarmento A. Quality of life of survivors from severe sepsis and septic shock may be similar to that of others who survive critical illness. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2004; 8:R91-8. [PMID: 15025783 PMCID: PMC420036 DOI: 10.1186/cc2818] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2003] [Accepted: 01/27/2004] [Indexed: 11/25/2022]
Abstract
Introduction The objective of the present study was to compare the health-related quality of life (HR-QoL) of survivors from severe sepsis and septic shock with HR-QoL in others who survived critical illness not involving sepsis. Methods From March 1997 to March 2001, adult patients in an eight-bed medical/surgical intensive care unit (ICU) of a tertiary care hospital admitted with severe sepsis or septic shock (sepsis group; n = 305) were enrolled and compared with patients admitted without sepsis (control group; n = 392). Patients younger than 18 years (n = 48) and those whose ICU stay was 1 day or less (n = 453) were excluded. In addition, patients exhibiting nonsevere sepsis on admission were excluded (n = 87). Finally, patients who developed nonsevere sepsis or severe sepsis/septic shock after admission were also excluded (n = 88). Results In-hospital mortality rates were 34% in the sepsis group and 26% in the control group. There were no differences in sex, age, main activity (work status), and previous health state between groups. Survivors in the sepsis group had a significantly higher Acute Physiology and Chronic Health Evaluation II score on admission (17 versus 12) and stayed significantly longer in the ICU. A follow-up appointment was held 6 months after ICU discharge, and an EQ-5D (EuroQol five-dimension) questionnaire was administered. A total of 104 sepsis survivors and 133 survivors in the control group answered the EQ-5D questionnaire. Sepsis survivors reported significantly fewer problems only in the anxiety/depression dimension. Although there were no significant differences in the other dimensions of the EQ-5D, there was a trend towards fewer problems being reported by sepsis survivors. Conclusion Evaluation using the EQ-5D at 6 months after ICU discharge indicated that survivors from severe sepsis and septic shock have a similar HR-QoL to that of survivors from critical illness admitted without sepsis.
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Affiliation(s)
- Cristina Granja
- Department of Intensive Care, Hospital Pedro Hispano, Matosinhos, Portugal.
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Affiliation(s)
- Saif S M Razvi
- Department of Neurology, Institute of Neurological Sciences, Southern General Hospital, Glasgow, UK
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