• Bernard De Jonghe, Tarek Sharshar, Jean-Pascal Lefaucheur, François-Jérome Authier, Isabelle Durand-Zaleski, Mohamed Boussarsar, Charles Cerf, Estelle Renaud, Francine Mesrati, Jean Carlet, Jean-Claude Raphaël, Hervé Outin, Sylvie Bastuji-Garin, and Groupe de Réflexion et d'Etude des Neuromyopathies en Réanimation.
• Service de Réanimation Médicale, Centre Hospitalier de Poissy-Saint-Germain en Laye, 10 rue du Champ-Gaillard, 78300 Poissy, France. bdejonghe@chi-poissy-st-germain.fr
• JAMA. 2002 Dec 11;288(22):2859-67.

ContextAlthough electrophysiologic and histologic neuromuscular abnormalities are common in intensive care unit (ICU) patients, the clinical incidence of ICU-acquired neuromuscular disorders in patients recovering from severe illness remains unknown.ObjectivesTo assess the clinical incidence, risk factors, and outcomes of ICU-acquired paresis (ICUAP) during recovery from critical illness in the ICU and to determine the electrophysiologic and histologic patterns in patients with ICUAP.DesignProspective cohort study conducted from March 1999 to June 2000.SettingThree medical and 2 surgical ICUs in 4 hospitals in France.ParticipantsAll consecutive ICU patients without preexisting neuromuscular disease who underwent mechanical ventilation for 7 or more days were screened daily for awakening. The first day a patient was considered awake was day 1. Patients with severe muscle weakness on day 7 were considered to have ICUAP.Main Outcome MeasuresIncidence and duration of ICUAP, risk factors for ICUAP, and comparative duration of mechanical ventilation between ICUAP and control patients.ResultsAmong the 95 patients who achieved satisfactory awakening, the incidence of ICUAP was 25.3% (95% confidence interval [CI], 16.9%-35.2%). All ICUAP patients had a sensorimotor axonopathy, and all patients who underwent a muscle biopsy had specific muscle involvement not related to nerve involvement. The median duration of ICUAP after day 1 was 21 days. Mean (SD) duration of mechanical ventilation after day 1 was significantly longer in patients with ICUAP compared with those without (18.2 [36.3] vs 7.6 [19.2] days; P =.03). Independent predictors of ICUAP were female sex (odds ratio [OR], 4.66; 95% CI, 1.19-18.30), the number of days with dysfunction of 2 or more organs (OR, 1.28; 95% CI, 1.11-1.49), duration of mechanical ventilation (OR, 1.10; 95% CI, 1.00-1.22), and administration of corticosteroids (OR, 14.90; 95% CI, 3.20-69.80) before day 1.ConclusionsIdentified using simple bedside clinical criteria, ICUAP was frequent during recovery from critical illness and was associated with a prolonged duration of mechanical ventilation. Our findings suggest an important role of corticosteroids in the development of ICUAP.

26 keywords...

hide…