1
|
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.
Collapse
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.
| |
Collapse
|
2
|
van der Knaap N, de Vreeze F, van Rosmalen F, Wintjens MSJN, van Santen S, Linden DEJ, Staals J, van Mook WNKA, Jansen JFA, van der Horst ICC, van Bussel BCT, Ariës MJH. The incidence of neurological complications in mechanically ventilated COVID-19 ICU patients: An observational single-center cohort study in three COVID-19 periods. Clin Neurol Neurosurg 2024; 241:108311. [PMID: 38704879 DOI: 10.1016/j.clineuro.2024.108311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/07/2024] [Accepted: 04/29/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Neurological complications in COVID-19 patients admitted to an intensive care unit (ICU) have been previously reported. As the pandemic progressed, therapeutic strategies were tailored to new insights. This study describes the incidence, outcome, and types of reported neurological complications in invasively mechanically ventilated (IMV) COVID-19 patients in relation to three periods during the pandemic. METHODS IMV COVID-19 ICU patients from the Dutch Maastricht Intensive Care COVID (MaastrICCht) cohort were included in a single-center study (March 2020 - October 2021). Demographic, clinical, and follow-up data were collected. Electronic medical records were screened for neurological complications during hospitalization. Three distinct periods (P1, P2, P3) were defined, corresponding to periods with high hospitalization rates. ICU survivors with and without reported neurological complications were compared in an exploratory analysis. RESULTS IMV COVID-19 ICU patients (n=324; median age 64 [IQR 57-72] years; 238 males (73.5%)) were stratified into P1 (n=94), P2 (n=138), and P3 (n=92). ICU mortality did not significantly change over time (P1=38.3%; P2=41.3%; P3=37.0%; p=.787). The incidence of reported neurological complications during ICU admission gradually decreased over the periods (P1=29.8%; P2=24.6%; P3=18.5%; p=.028). Encephalopathy/delirium (48/324 (14.8%)) and ICU-acquired weakness (32/324 (9.9%)) were most frequently reported and associated with ICU treatment intensity. ICU survivors with neurological complications (n=53) were older (p=.025), predominantly male (p=.037), and had a longer duration of IMV (p<.001) and ICU stay (p<.001), compared to survivors without neurological complications (n=132). A multivariable analysis revealed that only age was independently associated with the occurrence of neurological complications (ORadj=1.0541; 95% CI=1.0171-1.0925; p=.004). Health-related quality-of-life at follow-up was not significantly different between survivors with and without neurological complications (n = 82, p=.054). CONCLUSIONS A high but decreasing incidence of neurological complications was reported during three consecutive COVID-19 periods in IMV COVID-19 patients. Neurological complications were related to the intensity of ICU support and treatment, and associated with prolonged ICU stay, but did not lead to significantly worse reported health-related quality-of-life at follow-up.
Collapse
Affiliation(s)
- Noa van der Knaap
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Radiology & Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; Research Institute of Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands
| | - Fleur de Vreeze
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Frank van Rosmalen
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - Marieke S J N Wintjens
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands; Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Susanne van Santen
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - David E J Linden
- Research Institute of Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands; Department of Neurology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Julie Staals
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands; Department of Neurology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Walther N K A van Mook
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Jacobus F A Jansen
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; Research Institute of Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Iwan C C van der Horst
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - Bas C T van Bussel
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Marcel J H Ariës
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; Research Institute of Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.
| |
Collapse
|
3
|
Paranhos DB, Annoni R, Schujmann DS, Fernandes LFRM. Functional Dependence Prior to ICU Admission is Associated with Worse Clinical and Functional Outcomes in Individuals with COVID-19: A Prospective Observational Study. J Intensive Care Med 2024; 39:439-446. [PMID: 37915228 DOI: 10.1177/08850666231211754] [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: 11/03/2023]
Abstract
Objectives: To determine whether low functional capacity (FC) prior to intensive care unit (ICU) admission due to coronavirus disease 2019 (COVID-19) might be associated with worse clinical outcomes. To monitor FC until discharge from the ICU. To identify associations between physical outcomes and decreased FC at discharge from the ICU. Design: Prospective observational study conducted from March to August 2021. Setting: ICU for adult patients with COVID-19. Participants: Adults (≥18 years) with COVID-19. Interventions: Not applicable. Main outcome measures: Clinical and demographic data were obtained from medical records. At ICU admission, evaluation was made of FC using the Barthel index (BI), and of the level of mobility using the ICU mobility scale. At ICU discharge, FC and mobility level were reassessed, and muscle strength was measured using the Medical Research Council (MRC) scale and the handgrip test. Results: The study was performed with 108 individuals. At the initial assessment, 73.1% of the patients were functionally independent. Length of hospital stay (odds ratio [OR] = 1.05; 95%confidence interval [CI] = 1.00-1.10) and death (OR = 5.27; 95%CI = 1.37-20.28) were related to functional status prior to ICU admission. Between ICU admission and discharge, the BI evaluation indicated a functional decline of 22.5 points. Low mobility level (P = .003) and low muscle strength assessed by the MRC scale (P < .001), measured at ICU discharge, were associated with a greater decrease of FC during the ICU stay. Conclusions: Patients with COVID-19 who were functionally dependent prior to ICU admission presented worse clinical outcomes, with low functional status being associated with longer hospitalization and higher mortality. However, irrespective of the initial functionality status, the surviving individuals suffered from functional decline at ICU discharge. Greater functional decline during the ICU stay was associated with lower muscle strength and lower mobility level at ICU discharge.
Collapse
Affiliation(s)
- Darlisson B Paranhos
- Master's Program in Physiotherapy, Federal University of Triângulo Mineiro and Federal University of Uberlândia, Uberaba, Brazil
| | - Raquel Annoni
- Department of Physiotherapy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Debora S Schujmann
- Department of Physical Therapy, Speech Therapy and Occupational Therapy, School of Medicine, University of São Paulo, Sao Paulo, Brazil
| | - Luciane F R M Fernandes
- Department of Applied Physiotherapy, Federal University of Triângulo Mineiro, Uberaba, Brazil
| |
Collapse
|
4
|
Ding L, Gu Z, Chen H, Wang P, Song Y, Zhang X, Li M, Chen J, Han H, Cheng J, Tong Z. Phototherapy for age-related brain diseases: Challenges, successes and future. Ageing Res Rev 2024; 94:102183. [PMID: 38218465 DOI: 10.1016/j.arr.2024.102183] [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: 08/05/2023] [Revised: 12/16/2023] [Accepted: 01/01/2024] [Indexed: 01/15/2024]
Abstract
Brain diseases present a significant obstacle to both global health and economic progress, owing to their elusive pathogenesis and the limited effectiveness of pharmaceutical interventions. Phototherapy has emerged as a promising non-invasive therapeutic modality for addressing age-related brain disorders, including stroke, Alzheimer's disease (AD), and Parkinson's disease (PD), among others. This review examines the recent progressions in phototherapeutic interventions. Firstly, the article elucidates the various wavelengths of visible light that possess the capability to penetrate the skin and skull, as well as the pathways of light stimulation, encompassing the eyes, skin, veins, and skull. Secondly, it deliberates on the molecular mechanisms of visible light on photosensitive proteins, within the context of brain disorders and other molecular pathways of light modulation. Lastly, the practical application of phototherapy in diverse clinical neurological disorders is indicated. Additionally, this review presents novel approaches that combine phototherapy and pharmacological interventions. Moreover, it outlines the limitations of phototherapeutics and proposes innovative strategies to improve the treatment of cerebral disorders.
Collapse
Affiliation(s)
- Ling Ding
- Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health), Institute of Aging, Key Laboratory of Alzheimer's Disease of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Mental Disorders, The Affiliated Wenzhou Kangning Hospital, School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang 325035, PR China
| | - Ziqi Gu
- Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health), Institute of Aging, Key Laboratory of Alzheimer's Disease of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Mental Disorders, The Affiliated Wenzhou Kangning Hospital, School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang 325035, PR China
| | - Haishu Chen
- Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health), Institute of Aging, Key Laboratory of Alzheimer's Disease of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Mental Disorders, The Affiliated Wenzhou Kangning Hospital, School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang 325035, PR China
| | - Panpan Wang
- Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health), Institute of Aging, Key Laboratory of Alzheimer's Disease of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Mental Disorders, The Affiliated Wenzhou Kangning Hospital, School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang 325035, PR China
| | - Yilan Song
- Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health), Institute of Aging, Key Laboratory of Alzheimer's Disease of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Mental Disorders, The Affiliated Wenzhou Kangning Hospital, School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang 325035, PR China
| | - Xincheng Zhang
- Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health), Institute of Aging, Key Laboratory of Alzheimer's Disease of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Mental Disorders, The Affiliated Wenzhou Kangning Hospital, School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang 325035, PR China
| | - Mengyu Li
- Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health), Institute of Aging, Key Laboratory of Alzheimer's Disease of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Mental Disorders, The Affiliated Wenzhou Kangning Hospital, School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang 325035, PR China
| | - Jinhan Chen
- Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health), Institute of Aging, Key Laboratory of Alzheimer's Disease of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Mental Disorders, The Affiliated Wenzhou Kangning Hospital, School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang 325035, PR China
| | - Hongbin Han
- Department of Radiology, Peking University Third Hospital, Beijing, China. Key Laboratory of Magnetic Resonance Imaging Equipment and Technique, NMPA key Laboratory for Evaluation of Medical Imaging Equipment and Technique, Institute of Medical Technology, Peking University Health Science Center, Beijing 100191, China.
| | - Jianhua Cheng
- Department of neurology, the first affiliated hospital of Wenzhou medical University, Wenzhou 325035, China.
| | - Zhiqian Tong
- Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health), Institute of Aging, Key Laboratory of Alzheimer's Disease of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Mental Disorders, The Affiliated Wenzhou Kangning Hospital, School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang 325035, PR China.
| |
Collapse
|
5
|
Tavares GS, Oliveira CC, Mendes LPS, Velloso M. Muscle strength and mobility of individuals with COVID-19 compared with non-COVID-19 in intensive care. Heart Lung 2023; 62:233-239. [PMID: 37603954 DOI: 10.1016/j.hrtlng.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/03/2023] [Accepted: 08/07/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Critical illness may affect muscle strength and mobility. OBJECTIVES To compare muscle strength, mobility, and in intensive care unit (ICU)-acquired weakness (ICUAW) prevalence among individuals with COVID-19 and other critical illnesses; to identify factors associated with muscle strength, mobility, and length of stay in COVID-19; and to determine the Perme Intensive Care Unit Mobility Score (PICUMS) cut-off point for ICUAW. METHODS We included individuals aged ≥18 in ICU who require mechanical ventilation. We excluded those diagnosed with neuromusculoskeletal diseases or who did not understand the study procedures. The Medical Research Council - sum score (MRC-SS) and the PICUMS were applied before ICU and hospital discharge. Analysis of covariance, Quade´s test, and Fisher's exact test compared groups. Partial correlations were analized between the MRC-SS and PICUMS with clinical variables. Regression models identified the predictors of hospital length of stay. The ROC curve verified the PICUMS related to ICUAW. Significance was set as P<.05. RESULTS 25 individuals were included in the COVID-19 group and 23 in the non-COVID-19 group. No between-groups difference was observed in MRC-SS and PICUMS at discharge from ICU or hospital. The MRC-SS and PICUMS at ICU discharge predicted the length of hospital stay in the COVID-19 group. The PICUMS cut-off related to ICUAW was 18. CONCLUSIONS Muscle strength, mobility, and ICUAW are similar between COVID-19 and non-COVID-19. However, muscle strength and mobility at ICU discharge are associated with the length of stay during COVID-19. A PICUMS<18 at ICU discharge may indicate impaired physical functioning due to ICUAW.
Collapse
Affiliation(s)
- Graziele S Tavares
- Postgraduate Research Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy, and Occupational Therapy, Federal University of Minas Gerais, Belo Horizonte, Brazil; Department of Physical Therapy, Hospital Metropolitano Dr. Célio de Castro, Belo Horizonte, Brazil
| | - Cristino C Oliveira
- Postgraduate Research Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy, and Occupational Therapy, Federal University of Minas Gerais, Belo Horizonte, Brazil; Postgraduate Research Program in Rehabilitation Sciences and Physical Function Performance, Faculty of Physical Therapy, Federal University of Juiz de Fora, Governador Valadares, Brazil
| | - Liliane P S Mendes
- Postgraduate Research Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy, and Occupational Therapy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Marcelo Velloso
- Postgraduate Research Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy, and Occupational Therapy, Federal University of Minas Gerais, Belo Horizonte, Brazil.
| |
Collapse
|
6
|
Bellaver P, Schaeffer AF, Leitao CB, Rech TH, Nedel WL. Association between neuromuscular blocking agents and the development of intensive care unit-acquired weakness (ICU-AW): A systematic review with meta-analysis and trial sequential analysis. Anaesth Crit Care Pain Med 2023; 42:101202. [PMID: 36804373 DOI: 10.1016/j.accpm.2023.101202] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 01/21/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND The present study aims to review the literature and synthesize evidence concerning the effects of the use of neuromuscular blocking agents (NMBA) regarding the development of intensive care unit-acquired weakness (ICU-AW). METHODS This study was registered in the PROSPERO database CRD42020142916. Systematic review in PubMed, Embase, and the Cochrane Central, Randomized clinical trials (RCTs), and cohort studies with adults that reported the use of NMBA and the development of ICU-AW were included. Pre-specified subgroup analyses were performed for presence of sepsis and type of NMBA used. The quality of evidence for intervention effects was summarized. The certainty of evidence was assessed using the GRADE approach. RESULTS We included 30 studies, four RCTs, 21 prospective and 5 retrospective cohorts, enrolling a total of 3839 patients. Most of the included studies were observational with high heterogeneity, whereas the RCTs had a high risk of bias. The use of NMBA increased the odds of developing ICU-AW (OR = 2.77 [95% CI 1.98-3.88], I2 = 62%), with low-quality of evidence. A trial sequential analysis showed the need to include 22,330 patients in order to provide evidence for either beneficial or harmful intervention effects. CONCLUSIONS This meta-analysis suggests that the use of NMBA might be implicated in the development of ICU-AW. However, there is not enough evidence to definitively conclude about the association between the use of NMBA and the development of ICU-AW, as these results are based mostly on observational studies with high heterogeneity.
Collapse
Affiliation(s)
- Priscila Bellaver
- Post-graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Intensive Care Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Ariell F Schaeffer
- Intensive Care Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Cristiane B Leitao
- Post-graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Intensive Care Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Tatiana H Rech
- Post-graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Intensive Care Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Wagner L Nedel
- Intensive Care Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Brazilian Research in Intensive Care Network - BRICNet, Brazil.
| |
Collapse
|
7
|
Ribeiro F, Alves PKN, Bechara LRG, Ferreira JCB, Labeit S, Moriscot AS. Small-Molecule Inhibition of MuRF1 Prevents Early Disuse-Induced Diaphragmatic Dysfunction and Atrophy. Int J Mol Sci 2023; 24:ijms24043637. [PMID: 36835047 PMCID: PMC9965746 DOI: 10.3390/ijms24043637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
In clinical conditions such as diaphragm paralysis or mechanical ventilation, disuse-induced diaphragmatic dysfunction (DIDD) is a condition that poses a threat to life. MuRF1 is a key E3-ligase involved in regulating skeletal muscle mass, function, and metabolism, which contributes to the onset of DIDD. We investigated if the small-molecule mediated inhibition of MuRF1 activity (MyoMed-205) protects against early DIDD after 12 h of unilateral diaphragm denervation. Wistar rats were used in this study to determine the compound's acute toxicity and optimal dosage. For potential DIDD treatment efficacy, diaphragm contractile function and fiber cross-sectional area (CSA) were evaluated. Western blotting investigated potential mechanisms underlying MyoMed-205's effects in early DIDD. Our results indicate 50 mg/kg bw MyoMed-205 as a suitable dosage to prevent early diaphragmatic contractile dysfunction and atrophy following 12 h of denervation without detectable signs of acute toxicity. Mechanistically, treatment did not affect disuse-induced oxidative stress (4-HNE) increase, whereas phosphorylation of (ser632) HDAC4 was normalized. MyoMed-205 also mitigated FoxO1 activation, inhibited MuRF2, and increased phospho (ser473) Akt protein levels. These findings may suggest that MuRF1 activity significantly contributes to early DIDD pathophysiology. Novel strategies targeting MuRF1 (e.g., MyoMed-205) have potential therapeutic applications for treating early DIDD.
Collapse
Affiliation(s)
- Fernando Ribeiro
- Department of Anatomy, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil
| | - Paula K. N. Alves
- Department of Anatomy, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil
| | - Luiz R. G. Bechara
- Department of Anatomy, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil
| | - Julio C. B. Ferreira
- Department of Anatomy, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil
| | - Siegfried Labeit
- DZHK Partner Site Mannheim-Heidelberg, Medical Faculty Mannheim, University of Heidelberg, 68169 Mannheim, Germany
- Myomedix GmbH, 69151 Neckargemünd, Germany
| | - Anselmo S. Moriscot
- Department of Anatomy, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil
- Correspondence: ; Tel.: +55-11-3091-0946
| |
Collapse
|
8
|
Núñez-Seisdedos MN, Valcárcel-Linares D, Gómez-González MT, Lázaro-Navas I, López-González L, Pecos-Martín D, Rodríguez-Costa I. Inspiratory muscle strength and function in mechanically ventilated COVID-19 survivors 3 and 6 months after intensive care unit discharge. ERJ Open Res 2023; 9:00329-2022. [PMID: 36659933 PMCID: PMC9571163 DOI: 10.1183/23120541.00329-2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/03/2022] [Indexed: 01/24/2023] Open
Abstract
Background Knowledge regarding the long-term impact of invasive mechanical ventilation on the inspiratory muscles and functional outcomes in COVID-19 survivors is limited. Methods In this single-centre prospective cohort study, we evaluated invasively ventilated patients with COVID-19 pneumonia 3 and 6 months post-intensive care unit (ICU) discharge. Outcomes included: maximal inspiratory pressure (MIP), ultrasound parameters for diaphragm function, 6-min walk distance (6MWD), dyspnoea and quality of life. We evaluated associations between MIP and duration of mechanical ventilation with follow-up outcomes. Results 50 COVID-19 survivors discharged from ICU between 15 October 2020 and 1 April 2021 were enrolled. Overall, survivors showed a recovery trajectory over time. However, impaired MIP remained in 24 (48%) and 12 (24%) at 3 and 6 months, respectively. Diaphragm dysfunction was not observed. At 3 months, 23 (46%) had impaired functional capacity versus 10 (20%) at 6 months. Dyspnoea persisted in 44 (88%) patients at 3 months and 38 (76%) at 6 months. Quality of life was slightly decreased at 3 months with further improvements at 6 months. MIP was correlated to 6MWD, 6MWD % predicted, dyspnoea across follow-up, and quality of life at 3 months. The duration of invasive ventilation was correlated with 6MWD and 6MWD % predicted. Conclusion In invasively ventilated COVID-19 survivors, inspiratory muscle strength impairments persisted 6 months after ICU discharge, while maintaining normal diaphragm function. Decreased functional capacity, dyspnoea and slightly reduced health status were observed. Early screening of survivors is of utmost importance to identify those with impairments and at risk of delayed or incomplete recovery.
Collapse
Affiliation(s)
- Maria Natividad Núñez-Seisdedos
- Physiotherapy Department, Ramón y Cajal University Hospital, Madrid, Spain,Corresponding author: Maria Natividad Núñez-Seisdedos ()
| | | | | | - Irene Lázaro-Navas
- Physiotherapy Department, Ramón y Cajal University Hospital, Madrid, Spain
| | | | | | | |
Collapse
|
9
|
Tsolaki V, Zakynthinos GE, Papadonta ME, Bardaka F, Fotakopoulos G, Pantazopoulos I, Makris D, Zakynthinos E. Neuromuscular Blockade in the Pre- and COVID-19 ARDS Patients. J Pers Med 2022; 12:jpm12091538. [PMID: 36143323 PMCID: PMC9504585 DOI: 10.3390/jpm12091538] [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: 08/15/2022] [Revised: 09/03/2022] [Accepted: 09/15/2022] [Indexed: 11/24/2022] Open
Abstract
Acute respiratory distress syndrome (ARDS) accounts for a quarter of mechanically ventilated patients, while during the pandemic, it overwhelmed the capacity of intensive care units (ICUs). Lung protective ventilation (low tidal volume, positive-end expiratory pressure titrated to lung mechanics and oxygenation, permissive hypercapnia) is a non-pharmacological approach that is the gold standard of management. Among the pharmacological treatments, the use of neuromuscular blocking agents (NMBAs), although extensively studied, has not yet been well clarified. The rationale is to minimize the risk for lung damage progression, in the already-injured pulmonary parenchyma. By abolishing rigorous spontaneous efforts, NMBAs may decrease the generation of high transpulmonary pressures that could aggravate patients’ self-inflicted lung injury. Moreover, NMBAs can harmonize the patient–ventilator interaction. Recent randomized controlled trials reported contradictory results and changed the clinical practice in a bidirectional way. NMBAs have not been documented to improve long-term survival; thus, the current guidance suggests their use only in patients in whom a lung protective ventilation protocol cannot be applied, due to asynchrony or increased respiratory efforts. In the present review, we discuss the published data and additionally the clinical practice in the “war” conditions of the COVID-19 pandemic, concerning NMBA use in the management of patients with ARDS.
Collapse
Affiliation(s)
- Vasiliki Tsolaki
- Critical Care Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece
- Correspondence: ; Tel.: +30-2413502964
| | - George E. Zakynthinos
- Critical Care Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece
- Third Department of Cardiology, Sotiria General Hospital, 11527 Athens, Greece
| | - Maria-Eirini Papadonta
- Critical Care Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece
| | - Fotini Bardaka
- Critical Care Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece
| | - George Fotakopoulos
- Neurosurgical Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece
| | - Ioannis Pantazopoulos
- Emergency Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece
| | - Demosthenes Makris
- Critical Care Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece
| | - Epaminondas Zakynthinos
- Critical Care Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece
| |
Collapse
|