Department of Anesthesia, Critical Care & Pain Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA.
Phys Ther. 2012 Dec;92(12):1546-55. doi: 10.2522/ptj.20110403. Epub 2012 Sep 13.
Paresis acquired in the intensive care unit (ICU) is common in patients who are critically ill and independently predicts mortality and morbidity. Manual muscle testing (MMT) and handgrip dynamometry assessments have been used to evaluate muscle weakness in patients in a medical ICU, but similar data for patients in a surgical ICU (SICU) are limited.
The purpose of this study was to evaluate the predictive value of strength measured by MMT and handgrip dynamometry at ICU admission for in-hospital mortality, SICU length of stay (LOS), hospital LOS, and duration of mechanical ventilation.
This investigation was a prospective, observational study.
One hundred ten patients were screened for eligibility for testing in the SICU of a large, academic medical center. The Acute Physiology and Chronic Health Evaluation (APACHE) II score, diagnoses, and laboratory data were collected. Measurements were obtained by MMT quantified with the sum (total) score on the Medical Research Council Scale and by handgrip dynamometry. Outcome data, including in-hospital mortality, SICU LOS, hospital LOS, and duration of mechanical ventilation, were collected for all participants.
One hundred seven participants were eligible for testing; 89% were tested successfully at a median of 3 days (25th-75th percentiles=3-6 days) after admission. Sedation was the most frequent barrier to testing (70.6%). Manual muscle testing was identified as an independent predictor of mortality, SICU LOS, hospital LOS, and duration of mechanical ventilation. Grip strength was not independently associated with these outcomes.
This study did not address whether muscle weakness translates to functional outcome impairment.
In contrast to handgrip strength, MMT reliably predicted in-hospital mortality, duration of mechanical ventilation, SICU LOS, and hospital LOS.
在重症监护病房（ICU）获得的弛缓性瘫痪在重病患者中很常见，并且独立预测死亡率和发病率。在医学 ICU 中，已经使用手动肌肉测试（MMT）和握力测力计评估肌肉无力，但在外科 ICU（SICU）中类似的数据有限。
本研究旨在评估 ICU 入院时 MMT 和握力测力计测量的力量对院内死亡率、SICU 住院时间（LOS）、医院 LOS 和机械通气时间的预测价值。
这是一项前瞻性、观察性研究。
筛选了一家大型学术医疗中心 SICU 的 110 名符合条件的患者进行测试。收集急性生理学和慢性健康评估（APACHE）II 评分、诊断和实验室数据。通过 MMT 进行测量，使用 Medical Research Council 量表的总和（总）评分进行量化，并通过握力测力计进行测量。为所有参与者收集了包括院内死亡率、SICU LOS、医院 LOS 和机械通气时间在内的结局数据。
有 107 名参与者符合测试条件；89%的人在入院后中位数 3 天（25-75%分位值=3-6 天）成功接受了测试。镇静是测试最常见的障碍（70.6%）。MMT 被确定为死亡率、SICU LOS、医院 LOS 和机械通气时间的独立预测因素。握力与这些结果没有独立关联。
本研究没有解决肌肉无力是否会转化为功能结局损伤的问题。
与握力相比，MMT 可靠地预测了院内死亡率、机械通气时间、SICU LOS 和医院 LOS。
