nach oben

Erschienen in:

22.01.2020 | Original

Five-year impact of ICU-acquired neuromuscular complications: a prospective, observational study

verfasst von: Nathalie Van Aerde, Philippe Meersseman, Yves Debaveye, Alexander Wilmer, Jan Gunst, Michael P. Casaer, Frans Bruyninckx, Pieter J. Wouters, Rik Gosselink, Greet Van den Berghe, Greet Hermans

Erschienen in: Intensive Care Medicine | Ausgabe 6/2020

Einloggen, um Zugang zu erhalten

Abstract

Purpose

To assess the independent association between ICU-acquired neuromuscular complications and 5-year mortality and morbidity. To explore the optimal threshold of the Medical Research Council (MRC) sum score, assessing weakness, for the prediction of 5-year outcomes.

Methods

Sub-analyses of a prospective, 5-year follow-up study including 883 EPaNIC patients (Early versus Late Parenteral Nutrition in Intensive Care) (Clinicaltrials.gov:NCT00512122), systematically screened in ICU for neuromuscular complications with MRC sum score (‘MRC-cohort’, N = 600), electrophysiology on day 8 ± 1 to quantify compound muscle action potential (‘CMAP-cohort’, N = 689), or both (‘MRC&CMAP-cohort’, N = 415). Associations between ICU-acquired neuromuscular complications and 5-year mortality, hand-grip strength (HGF, %predicted), 6-min-walk distance (6-MWD, %predicted) and physical function of the SF-36 quality-of-life questionnaire (PF-SF-36) at 5-years were assessed with Cox regression and linear regression, adjusted for confounders. The optimal threshold for MRC at ICU discharge to predict 5-year outcomes was determined by martingale residual plots (survival) and scatterplots (morbidity).

Results

Both lower MRC sum score at ICU discharge, indicating less strength [HR, per-point-increase: 0.946 (95% CI 0.928–0.968), p = 0.001], and abnormal CMAP, indicating nerve/muscle dysfunction [HR: 1.568 (95% CI 1.165–2.186), p = 0.004], independently associated with increased 5-year mortality. In the MRC&CMAP-cohort, MRC [HR: 0.956 (95% CI 0.934–0.980), p = 0.001] but not CMAP [HR: 1.478 (95% CI 0.875–2.838), p = 0.088] independently associated with 5-year mortality. Among 205 survivors, low MRC independently associated with low HGF [0.866 (95% CI 0.237–1.527), p = 0.004], low 6-MWD [105.1 (95% CI 12.1–212.9), p = 0.043] and low PF-SF-36 [− 0.119 (95% CI − 0.186 to − 0.057), p = 0.002], whereas abnormal CMAP did not correlate with these morbidity endpoints. Exploratory analyses suggested that MRC ≤ 55 best predicted poor long-term morbidity and mortality. Both MRC ≤ 55 and abnormal CMAP independently associated with 5-year mortality.

Conclusions

ICU-acquired neuromuscular complications may impact 5-year morbidity and mortality. MRC sum score, even if slightly reduced, may affect long-term mortality, strength, functional capacity and physical function, whereas abnormal CMAP only related to long-term mortality.

Nur mit Berechtigung zugänglich

Batt J, Herridge MS, dos Santos CC (2019) From skeletal muscle weakness to functional outcomes following critical illness: a translational biology perspective. Thorax 74:1091–1098PubMedCrossRef

Latronico N, Herridge M, Hopkins RO, Angus D, Hart N, Hermans G, Iwashyna T, Arabi Y, Citerio G, Ely EW (2017) The ICM research agenda on intensive care unit-acquired weakness. Intensive Care Med 43:1270–1281PubMedCrossRef

Hermans G, Van Mechelen H, Clerckx B, Vanhullebusch T, Mesotten D, Wilmer A, Casaer MP, Meersseman P, Debaveye Y, Van Cromphaut S, Wouters PJ, Gosselink R, Van den Berghe G (2014) Acute outcomes and 1-year mortality of intensive care unit-acquired weakness. A cohort study and propensity-matched analysis. Am J Respir Crit Care Med 190:410–420CrossRefPubMed

Hermans G, Van Mechelen H, Bruyninckx F, Vanhullebusch T, Clerckx B, Meersseman P, Debaveye Y, Casaer MP, Wilmer A, Wouters PJ, Vanhorebeek I, Gosselink R, Van den Berghe G (2015) Predictive value for weakness and 1-year mortality of screening electrophysiology tests in the ICU. Intensive Care Med 41:2138–2148PubMedCrossRef

Dinglas VD, Friedman LA, Colantuoni E, Mendez-Tellez PA, Shanholtz CB, Ciesla ND, Pronovost PJ, Needham DM (2017) Muscle weakness and 5-year survival in acute respiratory distress syndrome survivors. Crit Care Med 45:446PubMedPubMedCentralCrossRef

Herridge MS, Tansey CM, Matté A, Tomlinson G, Diaz-Granados N, Cooper A, Guest CB, Mazer CD, Mehta S, Stewart TE, Kudlow P, Cook D, Slutsky AS, Cheung AM, Group CCCT (2011) Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med 364:1293–1304CrossRef

Herridge MS, Moss M, Hough CL, Hopkins RO, Rice TW, Bienvenu OJ, Azoulay E (2016) Recovery and outcomes after the acute respiratory distress syndrome (ARDS) in patients and their family caregivers. Intensive Care Med 42:725–738PubMedCrossRef

Pfoh ER, Wozniak AW, Colantuoni E, Dinglas VD, Mendez-Tellez PA, Shanholtz C, Ciesla ND, Pronovost PJ, Needham DM (2016) Physical declines occurring after hospital discharge in ARDS survivors: a 5-year longitudinal study. Intensive Care Med 42:1557–1566PubMedCrossRef

Kress JP, Hall JB (2014) ICU-acquired weakness and recovery from critical illness. N Engl J Med 371:287–288PubMedCrossRef

10.

Puthucheary Z, Prescott H (2017) Skeletal muscle weakness is associated with both early and late mortality after ARDS. Crit Care Med 45:563PubMedPubMedCentralCrossRef

11.

Needham DM, Wozniak AW, Hough CL, Morris PE, Dinglas VD, Jackson JC, Mendez-Tellez PA, Shanholtz C, Ely EW, Colantuoni E, Hopkins RO, Network NIoHNA (2014) Risk factors for physical impairment after acute lung injury in a national, multicenter study. Am J Respir Crit Care Med 189:1214–1224PubMedPubMedCentralCrossRef

12.

Casaer MP, Mesotten D, Hermans G, Wouters PJ, Schetz M, Meyfroidt G, Van Cromphaut S, Ingels C, Meersseman P, Muller J, Vlasselaers D, Debaveye Y, Desmet L, Dubois J, Van Assche A, Vanderheyden S, Wilmer A, Van den Berghe G (2011) Early versus late parenteral nutrition in critically ill adults. N Engl J Med 365:506–517PubMedCrossRef

13.

Hermans G, Casaer MP, Clerckx B, Güiza F, Vanhullebusch T, Derde S, Meersseman P, Derese I, Mesotten D, Wouters PJ, Van Cromphaut S, Debaveye Y, Gosselink R, Gunst J, Wilmer A, Van den Berghe G, Vanhorebeek I (2013) Effect of tolerating macronutrient deficit on the development of intensive-care unit acquired weakness: a subanalysis of the EPaNIC trial. Lancet Respir Med 1:621–629PubMedCrossRef

14.

Hermans G, Van Aerde N, Meersseman P, Van Mechelen H, Debaveye Y, Wilmer A, Gunst J, Casaer MP, Dubois J, Wouters P (2019) Five-year mortality and morbidity impact of prolonged versus brief ICU stay: a propensity score matched cohort study. Thorax 74:1037–1045PubMedCrossRef

15.

ATS, ERS (2002) ATS/ERS Statement on respiratory muscle testing. Am J Respir Crit Care Med 166:518–624CrossRef

16.

Ware J, Snow K, Kosinski M, Gandek B (1993) SF-36 Health Survey: Manual & Interpretation Guide. Nimrod Press, Boston

17.

Ware J, Kosinski M, Gandek B (2005) SF-36 health survey : manual and interpretation guide. Lincoln, Boston

18.

Van der Schaaf M, Dettling DS, Beelen A, Lucas C, Dongelmans DA, Nollet F (2008) Poor functional status immediately after discharge from an intensive care unit. Disabil Rehabil 30:1812–1818PubMedCrossRef

19.

Collin C, Wade D, Davies S, Horne V (1988) The Barthel ADL Index: a reliability study. Int Disabil Stud 10:61–63PubMedCrossRef

20.

Lederer DJ, Bell SC, Branson RD, Chalmers JD, Marshall R, Maslove DM, Ost DE, Punjabi NM, Schatz M, Smyth AR (2019) Control of confounding and reporting of results in causal inference studies. Guidance for authors from editors of respiratory, sleep, and critical care journals. Ann Am Thorac Soc 16:22–28PubMedCrossRef

21.

De Jonghe B, Sharshar T, Lefaucheur JP, Authier FJ, Durand-Zaleski I, Boussarsar M, Cerf C, Renaud E, Mesrati F, Carlet J, Raphaël JC, Outin H, Bastuji-Garin S, GdRedEdNe R (2002) Paresis acquired in the intensive care unit: a prospective multicenter study. JAMA 288:2859–2867PubMedCrossRef

22.

Moss M, Yang M, Macht M, Sottile P, Gray L, McNulty M, Quan D (2014) Screening for critical illness polyneuromyopathy with single nerve conduction studies. Intensive Care Med 40:683–690PubMedCrossRef

23.

Kelmenson DA, Held N, Allen RR, Quan D, Burnham EL, Clark BJ, Ho PM, Kiser TH, Vandivier RW, Moss M (2017) Outcomes of ICU patients with a discharge diagnosis of critical illness polyneuromyopathy: a propensity-matched analysis. Crit Care Med 45:2055–2060PubMedPubMedCentralCrossRef

24.

Ali NA, O'Brien JM, Hoffmann SP, Phillips G, Garland A, Finley JC, Almoosa K, Hejal R, Wolf KM, Lemeshow S, Connors AF, Marsh CB, Consortium MCC (2008) Acquired weakness, handgrip strength, and mortality in critically ill patients. Am J Respir Crit Care Med 178:261–268CrossRef

25.

Hodgson C, Bellomo R, Berney S, Bailey M, Buhr H, Denehy L, Harrold M, Higgins A, Presneill J, Saxena M, Skinner E, Young P (2015) Early mobilization and recovery in mechanically ventilated patients in the ICU: a bi-national, multi-centre, prospective cohort study. Crit Care 19:81PubMedCrossRef

26.

Fan E, Cheek F, Chlan L, Gosselink R, Hart N, Herridge MS, Hopkins RO, Hough CL, Kress JP, Latronico N (2014) An official American thoracic society clinical practice guideline: the diagnosis of intensive care unit–acquired weakness in adults. Am J Respir Crit Care Med 190:1437–1446PubMedCrossRef

27.

Wieske L, Dettling-Ihnenfeldt DS, Verhamme C, Nollet F, van Schaik IN, Schultz MJ, Horn J, van der Schaaf M (2015) Impact of ICU-acquired weakness on post-ICU physical functioning: a follow-up study. Crit Care 19:196PubMedPubMedCentralCrossRef

28.

Thomas S, Mehrholz J (2018) Health-related quality of life, participation, and physical and cognitive function of patients with intensive care unit-acquired muscle weakness 1 year after rehabilitation in Germany: the GymNAST cohort study. BMJ open 8:e020163PubMedPubMedCentralCrossRef

29.

Fan E, Dowdy DW, Colantuoni E, Mendez-Tellez PA, Sevransky JE, Shanholtz C, Himmelfarb CR, Desai SV, Ciesla N, Herridge MS, Pronovost PJ, Needham DM (2014) Physical complications in acute lung injury survivors: a two-year longitudinal prospective study. Crit Care Med 42:849–859PubMedPubMedCentralCrossRef

30.

Needham DM, Dinglas VD, Morris PE, Jackson JC, Hough CL, Mendez-Tellez PA, Wozniak AW, Colantuoni E, Ely EW, Rice TW, Hopkins RO, Network NNA (2013) Physical and cognitive performance of patients with acute lung injury 1 year after initial trophic versus full enteral feeding. EDEN trial follow-up. Am J Respir Crit Care Med 188:567–576PubMedPubMedCentralCrossRef

31.

Semmler A, Okulla T, Kaiser M, Seifert B, Heneka MT (2013) Long-term neuromuscular sequelae of critical illness. J Neurol 260:151–157PubMedCrossRef

32.

Bohannon RW (2019) Minimal clinically important difference for grip strength: a systematic review. J Phys Therapy Sci 31:75–78CrossRef

33.

Chan KS, Pfoh ER, Denehy L, Elliott D, Holland AE, Dinglas VD, Needham DM (2015) Construct validity and minimal important difference of 6-minute walk distance in survivors of acute respiratory failure. Chest 147:1316–1326PubMedPubMedCentralCrossRef

34.

Davidson TA, Caldwell ES, Curtis JR, Hudson LD, Steinberg KP (1999) Reduced quality of life in survivors of acute respiratory distress syndrome compared with critically ill control patients. JAMA 281:354–360PubMedCrossRef

35.

Latronico N, Bolton CF (2011) Critical illness polyneuropathy and myopathy: a major cause of muscle weakness and paralysis. Lancet Neurol 10:931–941PubMedCrossRef

36.

Leijten FS, Harinck-de Weerd JE, Poortvliet DC, de Weerd AW (1995) The role of polyneuropathy in motor convalescence after prolonged mechanical ventilation. JAMA 274:1221–1225PubMedCrossRef

37.

Fletcher SN, Kennedy DD, Ghosh IR, Misra VP, Kiff K, Coakley JH, Hinds CJ (2003) Persistent neuromuscular and neurophysiologic abnormalities in long-term survivors of prolonged critical illness. Crit Care Med 31:1012–1016PubMedCrossRef

38.

Guarneri B, Bertolini G, Latronico N (2008) Long-term outcome in patients with critical illness myopathy or neuropathy: the Italian multicentre CRIMYNE study. J Neurol Neurosurg Psychiatry 79:838–841PubMedCrossRef

39.

Fan E, Herridge MS (2015) Finally, a time and place for electrophysiological testing in critically ill patients? Intensive Care Med 41:2221–2223PubMedCrossRef

40.

Intiso D, Amoruso L, Zarrelli M, Pazienza L, Basciani M, Grimaldi G, Iarossi A, Di Rienzo F (2011) Long-term functional outcome and health status of patients with critical illness polyneuromyopathy. Acta Neurol Scand 123:211–219PubMedCrossRef

41.

Koch S, Spuler S, Deja M, Bierbrauer J, Dimroth A, Behse F, Spies CD, Wernecke K-D, Weber-Carstens S (2011) Critical illness myopathy is frequent: accompanying neuropathy protracts ICU discharge. J Neurol Neurosurg Psychiatry 82:287–293PubMedCrossRef

42.

Koch S, Wollersheim T, Bierbrauer J, Haas K, Morgeli R, Deja M, Spies CD, Spuler S, Krebs M, Weber-Carstens S (2014) Long-term recovery In critical illness myopathy is complete, contrary to polyneuropathy. Muscle Nerve 50:431–436PubMedCrossRef

Titel: Five-year impact of ICU-acquired neuromuscular complications: a prospective, observational study
verfasst von: Nathalie Van Aerde
Philippe Meersseman
Yves Debaveye
Alexander Wilmer
Jan Gunst
Michael P. Casaer
Frans Bruyninckx
Pieter J. Wouters
Rik Gosselink
Greet Van den Berghe
Greet Hermans
Publikationsdatum: 22.01.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: Intensive Care Medicine / Ausgabe 6/2020
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-020-05927-5

Neu im Fachgebiet AINS

Mehr Frauen im OP – weniger postoperative Komplikationen

21.05.2024 Allgemeine Chirurgie Nachrichten

Ein Frauenanteil von mindestens einem Drittel im ärztlichen Op.-Team war in einer großen retrospektiven Studie aus Kanada mit einer signifikanten Reduktion der postoperativen Morbidität assoziiert.

„Übersichtlicher Wegweiser“: Lauterbachs umstrittener Klinik-Atlas ist online

17.05.2024 Klinik aktuell Nachrichten

Sie sei „ethisch geboten“, meint Gesundheitsminister Karl Lauterbach: mehr Transparenz über die Qualität von Klinikbehandlungen. Um sie abzubilden, lässt er gegen den Widerstand vieler Länder einen virtuellen Klinik-Atlas freischalten.

Delir bei kritisch Kranken – Antipsychotika versus Placebo

16.05.2024 Delir Nachrichten

Um die Langzeitfolgen eines Delirs bei kritisch Kranken zu mildern, wird vielerorts auf eine Akuttherapie mit Antipsychotika gesetzt. Eine US-amerikanische Forschungsgruppe äußert jetzt erhebliche Vorbehalte gegen dieses Vorgehen. Denn es gibt neue Daten zum Langzeiteffekt von Haloperidol bzw. Ziprasidon versus Placebo.

Klinikreform soll zehntausende Menschenleben retten

15.05.2024 Klinik aktuell Nachrichten

Gesundheitsminister Lauterbach hat die vom Bundeskabinett beschlossene Klinikreform verteidigt. Kritik an den Plänen kommt vom Marburger Bund. Und in den Ländern wird über den Gang zum Vermittlungsausschuss spekuliert.

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

hier abonnieren

Die Highlights vom Kongress des American College of Cardiology 2024

Springer Medizin

Five-year impact of ICU-acquired neuromuscular complications: a prospective, observational study