Paresis Acquired in the Intensive Care Unit: A Prospective Multicenter Study

• Published in: JAMA : the journal of the American Medical Association Vol. 288; no. 22; pp. 2859 - 2867
• Main Authors: De Jonghe, Bernard, Sharshar, Tarek, Lefaucheur, Jean-Pascal, Authier, François-Jérome, Durand-Zaleski, Isabelle, Boussarsar, Mohamed, Cerf, Charles, Renaud, Estelle, Mesrati, Francine, Carlet, Jean, Raphaël, Jean-Claude, Outin, Hervé, Bastuji-Garin, Sylvie, for the Groupe de Réflexion et d'Etude des Neuromyopathies en Réanimation
• Format: Journal Article
• Language: English
• Published: Chicago, IL American Medical Association 11-12-2002
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Critical Illness; Diseases of striated muscles. Neuromuscular diseases; Electrophysiology; Female; France - epidemiology; Glucocorticoids - therapeutic use; Humans; Iatrogenic Disease - epidemiology; Incidence; Intensive care medicine; Intensive Care Units - statistics & numerical data; Logistic Models; Male; Medical sciences; Middle Aged; Miscellaneous; Multivariate Analysis; Muscular system; Neurological disorders; Neurology; Paresis - epidemiology; Paresis - etiology; Paresis - physiopathology; Prospective Studies; Respiration, Artificial; Risk Factors; Studies; France; Human; Neuromuscular diseases; Nervous system diseases; Intensive care; Motor system disorder; Artificial ventilation; Incidence; Striated muscle disease; Risk factor; Paresis; Complication; Neurological disorder; Mechanical ventilation
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.288.22.2859

CONTEXT Although 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. OBJECTIVES To 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. DESIGN Prospective cohort study conducted from March 1999 to June 2000. SETTING Three medical and 2 surgical ICUs in 4 hospitals in France. PARTICIPANTS All 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 MEASURES Incidence and duration of ICUAP, risk factors for ICUAP, and comparative
duration of mechanical ventilation between ICUAP and control patients. RESULTS Among 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. CONCLUSIONS Identified 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.