OBJECTIVES: To determine the incidence and outcomes of intensive care unit-acquired neuromyopathy and to investigate the role of methylprednisolone in survivors of persistent acute lung injury. DESIGN: Secondary analysis of completed randomized placebo-controlled trial. SETTING: Twenty-five hospitals in the NHLBI ARDS Network. PATIENTS AND PARTICIPANTS: Patients enrolled in the ARDS Network study ofmethylprednisolone versus placebo for persistent ARDS who survived 60 days or to hospital discharge. MEASUREMENTS AND RESULTS: One hundred and twenty-eight study patients survived 60 days. Forty-three (34%) of these patients had evidence by chart review of ICU-acquired neuromyopathy, which was associated with prolonged mechanical ventilation, return to mechanical ventilation, and delayed return to home after critical illness. Treatment with methylprednisolone was not significantly associated with an increase in risk of neuromyopathy (OR 1.5; 95% CI 0.7-3.2). CONCLUSIONS: ICU-acquired-neuromyopathy is common among survivors of persistent ARDS and is associated with poorer clinical outcomes. We did not find a significant association between methylprednisolone treatment and neuromyopathy. Limitations of this study preclude definitive conclusions about the causal relationship between corticosteroids and ICU-acquired neuromuscular dysfunction.
RCT Entities:
OBJECTIVES: To determine the incidence and outcomes of intensive care unit-acquired neuromyopathy and to investigate the role of methylprednisolone in survivors of persistent acute lung injury. DESIGN: Secondary analysis of completed randomized placebo-controlled trial. SETTING: Twenty-five hospitals in the NHLBI ARDS Network. PATIENTS AND PARTICIPANTS: Patients enrolled in the ARDS Network study of methylprednisolone versus placebo for persistent ARDS who survived 60 days or to hospital discharge. MEASUREMENTS AND RESULTS: One hundred and twenty-eight study patients survived 60 days. Forty-three (34%) of these patients had evidence by chart review of ICU-acquired neuromyopathy, which was associated with prolonged mechanical ventilation, return to mechanical ventilation, and delayed return to home after critical illness. Treatment with methylprednisolone was not significantly associated with an increase in risk of neuromyopathy (OR 1.5; 95% CI 0.7-3.2). CONCLUSIONS:ICU-acquired-neuromyopathy is common among survivors of persistent ARDS and is associated with poorer clinical outcomes. We did not find a significant association between methylprednisolone treatment and neuromyopathy. Limitations of this study preclude definitive conclusions about the causal relationship between corticosteroids and ICU-acquired neuromuscular dysfunction.
Authors: Kenneth P Steinberg; Leonard D Hudson; Richard B Goodman; Catherine Lee Hough; Paul N Lanken; Robert Hyzy; B Taylor Thompson; Marek Ancukiewicz Journal: N Engl J Med Date: 2006-04-20 Impact factor: 91.245
Authors: Naeem A Ali; James M O'Brien; Stephen P Hoffmann; Gary Phillips; Allan Garland; James C W Finley; Khalid Almoosa; Rana Hejal; Karen M Wolf; Stanley Lemeshow; Alfred F Connors; Clay B Marsh Journal: Am J Respir Crit Care Med Date: 2008-05-29 Impact factor: 21.405
Authors: R I Thiele; H Jakob; E Hund; S Tantzky; S Keller; M Kamler; U Herold; S Hagl Journal: Thorac Cardiovasc Surg Date: 2000-06 Impact factor: 1.827
Authors: Greet Hermans; Alexander Wilmer; Wouter Meersseman; Ilse Milants; Pieter J Wouters; Herman Bobbaers; Frans Bruyninckx; Greet Van den Berghe Journal: Am J Respir Crit Care Med Date: 2006-11-30 Impact factor: 21.405
Authors: Robert D Stevens; David W Dowdy; Robert K Michaels; Pedro A Mendez-Tellez; Peter J Pronovost; Dale M Needham Journal: Intensive Care Med Date: 2007-07-17 Impact factor: 17.440
Authors: Massimo Antonelli; Elie Azoulay; Marc Bonten; Jean Chastre; Giuseppe Citerio; Giorgio Conti; Daniel De Backer; François Lemaire; Herwig Gerlach; Goran Hedenstierna; Michael Joannidis; Duncan Macrae; Jordi Mancebo; Salvatore M Maggiore; Alexandre Mebazaa; Jean-Charles Preiser; Jerôme Pugin; Jan Wernerman; Haibo Zhang Journal: Intensive Care Med Date: 2010-01-28 Impact factor: 17.440