Bhakti K Patel1, Anne S Pohlman1, Jesse B Hall1, John P Kress2. 1. Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL. 2. Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL. Electronic address: jkress@medicine.bsd.uchicago.edu.
Abstract
BACKGROUND:ICU-acquired weakness (ICU-AW) has immediate and long-term consequences for critically ill patients. Strategies for the prevention of weakness include modification of known risk factors, such as hyperglycemia and immobility. Intensive insulin therapy (IIT) has been proposed to prevent critical illness polyneuropathy. However, the effect of insulin and early mobilization on clinically apparent weakness is not well known. METHODS: This is a secondary analysis of all patients with mechanical ventilation (N = 104) previously enrolled in a randomized controlled trial of early occupational and physical therapy vs conventional therapy, which evaluated the end point of functional independence. Every patient had IIT and blinded muscle strength testing on hospital discharge to determine the incidence of clinically apparent weakness. The effects of insulin dose and early mobilization on the incidence of ICU-AW were assessed. RESULTS: On logistic regression analyses, early mobilization and increasing insulin dose prevented the incidence of ICU-AW (OR, 0.18, P = .001; OR, 0.001, P = .011; respectively) independent of known risk factors for weakness. Early mobilization also significantly reduced insulin requirements to achieve similar glycemic goals as compared with control patients (0.07 units/kg/d vs 0.2 units/kg/d, P < .001). CONCLUSIONS: The duel effect of early mobilization in reducing clinically relevant ICU-AW and promoting euglycemia suggests its potential usefulness as an alternative to IIT.
RCT Entities:
BACKGROUND:ICU-acquired weakness (ICU-AW) has immediate and long-term consequences for critically illpatients. Strategies for the prevention of weakness include modification of known risk factors, such as hyperglycemia and immobility. Intensive insulin therapy (IIT) has been proposed to prevent critical illness polyneuropathy. However, the effect of insulin and early mobilization on clinically apparent weakness is not well known. METHODS: This is a secondary analysis of all patients with mechanical ventilation (N = 104) previously enrolled in a randomized controlled trial of early occupational and physical therapy vs conventional therapy, which evaluated the end point of functional independence. Every patient had IIT and blinded muscle strength testing on hospital discharge to determine the incidence of clinically apparent weakness. The effects of insulin dose and early mobilization on the incidence of ICU-AW were assessed. RESULTS: On logistic regression analyses, early mobilization and increasing insulin dose prevented the incidence of ICU-AW (OR, 0.18, P = .001; OR, 0.001, P = .011; respectively) independent of known risk factors for weakness. Early mobilization also significantly reduced insulin requirements to achieve similar glycemic goals as compared with control patients (0.07 units/kg/d vs 0.2 units/kg/d, P < .001). CONCLUSIONS: The duel effect of early mobilization in reducing clinically relevant ICU-AW and promoting euglycemia suggests its potential usefulness as an alternative to IIT.
Authors: Grant V Bochicchio; Jin Sung; Manjari Joshi; Kelly Bochicchio; Steven B Johnson; Walter Meyer; Thomas M Scalea Journal: J Trauma Date: 2005-05
Authors: J W Kennedy; M F Hirshman; E V Gervino; J V Ocel; R A Forse; S J Hoenig; D Aronson; L J Goodyear; E S Horton Journal: Diabetes Date: 1999-05 Impact factor: 9.461
Authors: Margaret S Herridge; Catherine M Tansey; Andrea Matté; George Tomlinson; Natalia Diaz-Granados; Andrew Cooper; Cameron B Guest; C David Mazer; Sangeeta Mehta; Thomas E Stewart; Paul Kudlow; Deborah Cook; Arthur S Slutsky; Angela M Cheung Journal: N Engl J Med Date: 2011-04-07 Impact factor: 91.245
Authors: Mark C Pohlman; William D Schweickert; Anne S Pohlman; Celerina Nigos; Amy J Pawlik; Cheryl L Esbrook; Linda Spears; Megan Miller; Mietka Franczyk; Deanna Deprizio; Gregory A Schmidt; Amy Bowman; Rhonda Barr; Kathryn McCallister; Jesse B Hall; John P Kress Journal: Crit Care Med Date: 2010-11 Impact factor: 7.598
Authors: Jose Garnacho-Montero; Rosario Amaya-Villar; Jose Luis García-Garmendía; Juan Madrazo-Osuna; Carlos Ortiz-Leyba Journal: Crit Care Med Date: 2005-02 Impact factor: 7.598
Authors: Timothy D Girard; John P Kress; Barry D Fuchs; Jason W W Thomason; William D Schweickert; Brenda T Pun; Darren B Taichman; Jan G Dunn; Anne S Pohlman; Paul A Kinniry; James C Jackson; Angelo E Canonico; Richard W Light; Ayumi K Shintani; Jennifer L Thompson; Sharon M Gordon; Jesse B Hall; Robert S Dittus; Gordon R Bernard; E Wesley Ely Journal: Lancet Date: 2008-01-12 Impact factor: 79.321
Authors: Jean-Louis Vincent; Yahya Shehabi; Timothy S Walsh; Pratik P Pandharipande; Jonathan A Ball; Peter Spronk; Dan Longrois; Thomas Strøm; Giorgio Conti; Georg-Christian Funk; Rafael Badenes; Jean Mantz; Claudia Spies; Jukka Takala Journal: Intensive Care Med Date: 2016-04-13 Impact factor: 17.440