Paresis acquired in the intensive care unit: a prospective multicenter study

Area of Science:

• Critical Care Medicine
• Neurology
• Intensive Care Unit (ICU) Studies

Background:

• Neuromuscular abnormalities are common in ICU patients, but the clinical incidence of ICU-acquired neuromuscular disorders during recovery is unknown.
• Understanding ICU-acquired paresis (ICUAP) is crucial for managing patients after severe illness.

Purpose of the Study:

• To determine the clinical incidence, risk factors, and outcomes of ICU-acquired paresis (ICUAP).
• To investigate the electrophysiologic and histologic patterns associated with ICUAP.

Main Methods:

• A prospective cohort study was conducted in French ICUs from March 1999 to June 2000.
• Consecutive ICU patients requiring mechanical ventilation for ≥7 days were assessed for severe muscle weakness on day 7 post-awakening to diagnose ICUAP.
• Incidence, duration, risk factors, and mechanical ventilation duration were compared between ICUAP and control groups.

Main Results:

• The incidence of ICUAP was 25.3% among 95 assessed patients.
• All ICUAP patients exhibited sensorimotor axonopathy, with muscle biopsy revealing specific muscle involvement.
• ICUAP was associated with a significantly longer duration of mechanical ventilation (18.2 vs 7.6 days post-awakening).
• Independent predictors of ICUAP included female sex, multi-organ dysfunction, duration of mechanical ventilation, and corticosteroid administration.

Conclusions:

• ICU-acquired paresis (ICUAP) is a frequent complication during recovery from critical illness, identified by clinical criteria.
• ICUAP is associated with prolonged mechanical ventilation.
• Corticosteroid administration appears to play a significant role in the development of ICUAP.