Sharshar Tarek, Bastuji-Garin Sylvie, Stevens Robert D, Durand Marie-Christine, Malissin Isabelle, Rodriguez Pablo, Cerf Charles, Outin Hervé, De Jonghe Bernard
Department of Intensive Care Medicine, Raymond Poincaré Hospital, University Versailles Saint-Quentin en Yvelines, Garches, France.
Crit Care Med. 2009 Dec;37(12):3047-53. doi: 10.1097/CCM.0b013e3181b027e9.
To assess whether the presence and severity of intensive care unit-acquired paresis are associated with intensive care unit and in-hospital mortality.
Prospective, observational study.
Two medical, one surgical, and one medico-surgical intensive care units in two university hospitals and one university-affiliated hospital.
A total of 115 consecutive patients were enrolled after > 7 days of mechanical ventilation.
None.
The Medical Research Council score (from 0-60) was used to evaluate upper and lower limb strength at time of awakening, identified as the ability to follow five commands. Intensive care unit-acquired paresis was defined as a Medical Research Council score <48. Patients were followed-up until hospital discharge. The primary end point was hospital mortality. At awakening, median Medical Research Council score was 41 (interquartile range, 21-52), and 75 (65%) patients had intensive care unit-acquired paresis. Hospital non-survivors had a significantly lower Medical Research Council score at awakening (21 [11-43]) vs. 41 [28-53]; p = .008) and a significantly higher rate of intensive care unit-acquired paresis (85.1% vs. 58.4%; p = .02) compared to survivors. After multivariate risk adjustment, intensive care unit-acquired paresis was independently associated with higher hospital and intensive care unit mortality (odds ratio for hospital mortality, 2.02; 95% confidence interval, 1.03-8.03; p = .048). Each Medical Research Council point decrease was associated with a significantly higher hospital mortality (odds ratio, 1.03; 95% confidence interval, 1.01-1.05; p = .033).
Both the presence and severity of intensive care unit-acquired paresis at the time of awakening are associated with increased intensive care unit and hospital mortality; the mechanisms underlying this association need further study.
评估重症监护病房获得性肌无力的存在及严重程度是否与重症监护病房及住院死亡率相关。
前瞻性观察性研究。
两所大学医院和一所大学附属医院的两个内科、一个外科及一个内科-外科重症监护病房。
115例机械通气超过7天的连续患者入组。
无。
采用医学研究委员会评分（0 - 60分）评估苏醒时的上肢和下肢力量，苏醒定义为能够听从五条指令。重症监护病房获得性肌无力定义为医学研究委员会评分<48分。对患者进行随访直至出院。主要终点为住院死亡率。苏醒时，医学研究委员会评分中位数为41分（四分位间距，21 - 52分），75例（65%）患者存在重症监护病房获得性肌无力。与幸存者相比，医院非幸存者苏醒时医学研究委员会评分显著更低（21分[11 - 43分] vs. 41分[28 - 53分]；p = 0.008），重症监护病房获得性肌无力发生率显著更高（85.1% vs. 58.4%；p = 0.02）。经过多因素风险调整后，重症监护病房获得性肌无力与更高的医院及重症监护病房死亡率独立相关（住院死亡率的比值比，2.02；95%置信区间，1.03 - 8.03；p = 0.048）。医学研究委员会评分每降低1分，住院死亡率显著升高（比值比，1.03；95%置信区间，1.01 - 1.05；p = 0.033）。
苏醒时重症监护病房获得性肌无力的存在及严重程度均与重症监护病房及医院死亡率升高相关；这种关联的潜在机制需要进一步研究。
