Peñuelas Oscar, Muriel Alfonso, Frutos-Vivar Fernando, Fan Eddy, Raymondos Konstantinos, Rios Fernando, Nin Nicolás, Thille Arnaud W, González Marco, Villagomez Asisclo J, Davies Andrew R, Du Bin, Maggiore Salvatore M, Matamis Dimitrios, Abroug Fekri, Moreno Rui P, Kuiper Michael A, Anzueto Antonio, Ferguson Niall D, Esteban Andrés
1 Hospital Universitario de Getafe & Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain.
2 Unidad de Bioestadística Clinica Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigaciones Sanitarias (IRYCIS) & Centro de Investigación en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
J Intensive Care Med. 2018 Jan;33(1):16-28. doi: 10.1177/0885066616643529. Epub 2016 Apr 13.
Intensive care unit-acquired paresis (ICUAP) is associated with poor outcomes. Our objective was to evaluate predictors for ICUAP and the short-term outcomes associated with this condition.
A secondary analysis of a prospective study including 4157 mechanically ventilated adults in 494 intensive care units from 39 countries. After sedative interruption, patients were screened for ICUAP daily, which was defined as the presence of symmetric and flaccid quadriparesis associated with decreased or absent deep tendon reflexes. A multinomial logistic regression was used to create a predictive model for ICUAP. Propensity score matching was used to estimate the relationship between ICUAP and short-term outcomes (ie, weaning failure and intensive care unit [ICU] mortality).
Overall, 114 (3%) patients had ICUAP. Variables associated with ICUAP were duration of mechanical ventilation (relative risk ratio [RRR] per day, 1.10; 95% confidence interval [CI] 1.08-1.12), steroid therapy (RRR 1.8; 95% CI, 1.2-2.8), insulin therapy (RRR 1.8; 95% CI 1.2-2.7), sepsis (RRR 1.9; 95% CI: 1.2 to 2.9), acute renal failure (RRR 2.2; 95% CI 1.5-3.3), and hematological failure (RRR 1.9; 95% CI: 1.2-2.9). Coefficients were used to generate a weighted scoring system to predict ICUAP. ICUAP was significantly associated with both weaning failure (paired rate difference of 22.1%; 95% CI 9.8-31.6%) and ICU mortality (paired rate difference 10.5%; 95% CI 0.1-24.0%).
Intensive care unit-acquired paresis is relatively uncommon but is significantly associated with weaning failure and ICU mortality. We constructed a weighted scoring system, with good discrimination, to predict ICUAP in mechanically ventilated patients at the time of awakening.
重症监护病房获得性肌无力（ICUAP）与不良预后相关。我们的目的是评估ICUAP的预测因素以及与该病症相关的短期预后。
对一项前瞻性研究进行二次分析，该研究纳入了来自39个国家494个重症监护病房的4157例接受机械通气的成年人。在停用镇静剂后，每天对患者进行ICUAP筛查，其定义为存在对称性弛缓性四肢瘫且伴有深部腱反射减弱或消失。采用多项逻辑回归建立ICUAP预测模型。倾向评分匹配用于评估ICUAP与短期预后（即撤机失败和重症监护病房[ICU]死亡率）之间的关系。
总体而言，114例（3%）患者发生ICUAP。与ICUAP相关的变量包括机械通气时间（每天相对风险比[RRR]为1.10；95%置信区间[CI]为1.08 - 1.12）、类固醇治疗（RRR为1.8；95% CI为1.2 - 2.8）、胰岛素治疗（RRR为1.8；95% CI为1.2 - 2.7）、脓毒症（RRR为1.9；95% CI为1.2至2.9）、急性肾衰竭（RRR为2.2；95% CI为1.5 - 3.3）和血液系统功能衰竭（RRR为1.9；95% CI为1.2 - 2.9）。系数用于生成加权评分系统以预测ICUAP。ICUAP与撤机失败（配对率差为22.1%；95% CI为9.8 - 31.6%）和ICU死亡率（配对率差为10.5%；95% CI为0.1 - 24.0%）均显著相关。
重症监护病房获得性肌无力相对少见，但与撤机失败和ICU死亡率显著相关。我们构建了一个具有良好区分度的加权评分系统，用于预测机械通气患者苏醒时的ICUAP。
