Oscar Peñuelas1, Alfonso Muriel2, Fernando Frutos-Vivar1, Eddy Fan3, Konstantinos Raymondos4, Fernando Rios5, Nicolás Nin6, Arnaud W Thille7, Marco González8, Asisclo J Villagomez9, Andrew R Davies10, Bin Du11, Salvatore M Maggiore12, Dimitrios Matamis13, Fekri Abroug14, Rui P Moreno15, Michael A Kuiper16, Antonio Anzueto17, Niall D Ferguson3, Andrés Esteban1. 1. 1 Hospital Universitario de Getafe & Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain. 2. 2 Unidad de Bioestadística Clinica Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigaciones Sanitarias (IRYCIS) & Centro de Investigación en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. 3. 3 Interdepartmental Division of Critical Care Medicine, and Departments of Medicine & Physiology, University of Toronto, Canada. 4. 4 Medizinische Hochschule Hannover, Germany. 5. 5 Hospital Nacional Alejandro Posadas, Buenos Aires, Argentina. 6. 6 Hospital Universitario de Montevideo, Uruguay. 7. 7 University Hospital of Poitiers, Poitiers, France. 8. 8 Clínica Medellín & Universidad Pontificia Bolivariana, Medellín, Colombia. 9. 9 Hospital Regional 1° de Octubre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), México DF, México. 10. 10 Alfred Hospital & Monash University, Melbourne, Australia. 11. 11 Peking Union Medical College Hospital, Beijing, Popular Republic of China. 12. 12 Policlinico "Agostino Gemelli", Università Cattolica Del Sacro Cuore, Roma, Italy. 13. 13 Papageorgiou Hospital, Thessaloniki, Greece. 14. 14 Hospital Fattouma Bourguina, Monastir, Tunisia. 15. 15 Hospital de São José, Centro Hospitalar de Lisboa Central, Lisbon, Portugal. 16. 16 Medical Center Leeuwarden (MCL), Leeuwarden, the Netherlands. 17. 17 South Texas Veterans Health Care System and University of Texas Health Science Center, San Antonio, Texas.
Abstract
BACKGROUND: Intensive care unit-acquired paresis (ICUAP) is associated with poor outcomes. Our objective was to evaluate predictors for ICUAP and the short-term outcomes associated with this condition. METHODS: A secondary analysis of a prospective study including 4157 mechanically ventilated adults in 494 intensive care units from 39 countries. After sedative interruption, patients were screened for ICUAP daily, which was defined as the presence of symmetric and flaccid quadriparesis associated with decreased or absent deep tendon reflexes. A multinomial logistic regression was used to create a predictive model for ICUAP. Propensity score matching was used to estimate the relationship between ICUAP and short-term outcomes (ie, weaning failure and intensive care unit [ICU] mortality). RESULTS: Overall, 114 (3%) patients had ICUAP. Variables associated with ICUAP were duration of mechanical ventilation (relative risk ratio [RRR] per day, 1.10; 95% confidence interval [CI] 1.08-1.12), steroid therapy (RRR 1.8; 95% CI, 1.2-2.8), insulin therapy (RRR 1.8; 95% CI 1.2-2.7), sepsis (RRR 1.9; 95% CI: 1.2 to 2.9), acute renal failure (RRR 2.2; 95% CI 1.5-3.3), and hematological failure (RRR 1.9; 95% CI: 1.2-2.9). Coefficients were used to generate a weighted scoring system to predict ICUAP. ICUAP was significantly associated with both weaning failure (paired rate difference of 22.1%; 95% CI 9.8-31.6%) and ICU mortality (paired rate difference 10.5%; 95% CI 0.1-24.0%). CONCLUSIONS: Intensive care unit-acquired paresis is relatively uncommon but is significantly associated with weaning failure and ICU mortality. We constructed a weighted scoring system, with good discrimination, to predict ICUAP in mechanically ventilated patients at the time of awakening.
BACKGROUND: Intensive care unit-acquired paresis (ICUAP) is associated with poor outcomes. Our objective was to evaluate predictors for ICUAP and the short-term outcomes associated with this condition. METHODS: A secondary analysis of a prospective study including 4157 mechanically ventilated adults in 494 intensive care units from 39 countries. After sedative interruption, patients were screened for ICUAP daily, which was defined as the presence of symmetric and flaccid quadriparesis associated with decreased or absent deep tendon reflexes. A multinomial logistic regression was used to create a predictive model for ICUAP. Propensity score matching was used to estimate the relationship between ICUAP and short-term outcomes (ie, weaning failure and intensive care unit [ICU] mortality). RESULTS: Overall, 114 (3%) patients had ICUAP. Variables associated with ICUAP were duration of mechanical ventilation (relative risk ratio [RRR] per day, 1.10; 95% confidence interval [CI] 1.08-1.12), steroid therapy (RRR 1.8; 95% CI, 1.2-2.8), insulin therapy (RRR 1.8; 95% CI 1.2-2.7), sepsis (RRR 1.9; 95% CI: 1.2 to 2.9), acute renal failure (RRR 2.2; 95% CI 1.5-3.3), and hematological failure (RRR 1.9; 95% CI: 1.2-2.9). Coefficients were used to generate a weighted scoring system to predict ICUAP. ICUAP was significantly associated with both weaning failure (paired rate difference of 22.1%; 95% CI 9.8-31.6%) and ICU mortality (paired rate difference 10.5%; 95% CI 0.1-24.0%). CONCLUSIONS: Intensive care unit-acquired paresis is relatively uncommon but is significantly associated with weaning failure and ICU mortality. We constructed a weighted scoring system, with good discrimination, to predict ICUAP in mechanically ventilated patients at the time of awakening.
Entities:
Keywords:
intensive care unit-acquired paresis; mechanical ventilation; mortality; weaning
Authors: Sabrina Eggmann; Gere Luder; Martin L Verra; Irina Irincheeva; Caroline H G Bastiaenen; Stephan M Jakob Journal: PLoS One Date: 2020-03-04 Impact factor: 3.240
Authors: Esther Witteveen; Luuk Wieske; Juultje Sommers; Jan-Jaap Spijkstra; Monique C de Waard; Henrik Endeman; Saskia Rijkenberg; Wouter de Ruijter; Mengalvio Sleeswijk; Camiel Verhamme; Marcus J Schultz; Ivo N van Schaik; Janneke Horn Journal: J Intensive Care Med Date: 2018-05-01 Impact factor: 3.510