Care and treatments related to intensive care unit-acquired muscle weakness: A cohort study.

Autor: Raurell-Torredà M; Department of Fundamental and Medical Surgical Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Spain., Arias-Rivera S; University Hospital of Getafe, CIBER Respiratory Diseases, Carlos III Institute of Health, Madrid, Spain., Martí JD; Clinic University Hospital, Barcelona, Spain., Frade-Mera MJ; 12 Octubre University Hospital, Madrid, Spain; Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, Complutense University of Madrid, Spain., Zaragoza-García I; Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, Complutense University of Madrid, Spain; Care Research Group (Invecuid), 12 de Octubre Hospital Institute of Health Research (imas12), Madrid, Spain. Electronic address: izaragoz@ucm.es., Gallart E; Vall Hebron University Hospital, Barcelona, Spain., Velasco-Sanz TR; San Carlos University Hospital, Madrid, Spain; Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, Complutense University of Madrid, Spain., San José-Arribas A; Sant Pau University School of Nursing (Santa Creu i Sant Pau Hospital), Barcelona, Spain., Blazquez-Martínez E; Bellvitge University Hospital, Hospitalet de Llobregat, Spain.
Jazyk: angličtina
Zdroj: Australian critical care : official journal of the Confederation of Australian Critical Care Nurses [Aust Crit Care] 2021 Sep; Vol. 34 (5), pp. 435-445. Date of Electronic Publication: 2021 Mar 02.
DOI: 10.1016/j.aucc.2020.12.005
Abstrakt: Background: Intensive care unit-acquired muscle weakness (ICUAW) has an incidence of 40-46%. Early mobilisation is known to be a protective factor.
Objective: The aim of the study was to identify the incidence of ICUAW in Spain and to evaluate variables likely to contribute to the development of ICUAW.
Methods: A 4-month, prospective observational multicentre cohort study was conducted on patients receiving invasive mechanical ventilation for at least 48 h. Data were collected from ICU day 3 until ICU discharge. The primary outcome was presence of ICUAW (diagnosed using the Medical Research Council [MRC] scale). The secondary outcome was nurse-patient ratio, physiotherapist availability, analgesia, sedation and delirium management, glycaemic control, and daily level of mobility during the ICU stay as per the ICU Mobility Scale. A logistic regression model was constructed based exclusively on days 3-5 of the ICU stay.
Results: The data of 642 patients were analysed from 80 ICUs, accounting for 35% of all ICUs in Spain. The incidence of ICUAW was 58% (275 of 474 patients; 95% confidence interval [CI] [53-62]). The predictors for ICUAW were older age (odds ratio [OR] = 1.01; 95% CI [1.00-1.03]) and more days with renal replacement therapy (OR = 1.01; 95% CI [1.00-1.02]). The protective factors for ICUAW were male gender (OR = 0.58; 95% CI [0.38-0.89]), higher Barthel Index (showing prehospital functional independence) (OR = 0.97; 95% CI [0.95-0.99]), more days of being awake and cooperative (defined by a feasible MRC assessment) (OR = 0.98; 95% CI [0.97-0.99]), presence of delirium (OR = 0.98; 95% CI [0.97-0.99]), and more days with active mobilisation (ICU Mobility Scale ≥ 4) (OR = 0.98; 95% CI [0.97-0.99]).
Conclusions: The risk factors for ICUAW were functional dependence before admission, female gender, older age, and more days on renal replacement therapy. The protective factors for ICUAW were feasibility of MRC assessment, the presence of delirium, and being actively mobilised during the first 5 days in the ICU.
Competing Interests: Conflict of Interest The authors declare that there is no conflict of interest regarding the publication of this article.
(Copyright © 2020 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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