Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Critical Care Medicine, Fu Xing Hospital, Capital Medical University, Beijing, China.
Muscle Nerve. 2021 Jul;64(1):77-82. doi: 10.1002/mus.27248. Epub 2021 Apr 21.
INTRODUCTION/AIMS: Intensive care unit-acquired weakness (ICUAW) is a severe neuromuscular complication of critical illness. Serum lactate is a useful biomarker in critically ill patients. The relationship between serum lactate level and ICUAW remains controversial. This study evaluated whether hyperlactacidemia (lactate level >2 mmol/L) was an independent risk factor for ICUAW in critically ill adult patients.
An observational cohort study was performed in a general multidisciplinary intensive care unit (ICU). Sixty-eight consecutive adult critically ill patients without preexisting neuromuscular disease or a poor pre-ICU functional status whose length of ICU stay was 7 or more days were evaluated. Patients were screened daily for signs of awakening. Muscle strength assessment using the Medical Research Council score was performed on the first day a patient was considered awake. Patients with clinical muscle weakness were considered to have ICUAW.
Among the 68 patients who achieved a satisfactory state of consciousness, the diagnosis of ICUAW was made in 30 patients (44.1%). After multivariate analysis, hyperlactacidemia (P = .02), Acute Physiology and Chronic Health Evaluation II score (P = .04), duration of mechanical ventilation (P = .02), and the use of norepinephrine (P = .04) were found to be significantly associated with the development of ICUAW in critically ill patients.
This study shows a number of risk factors to be significantly associated with the development of ICUAW in critically ill adults. These factors should be considered when building early prediction models or designing prevention strategies for ICUAW in future studies.
介绍/目的：重症监护病房获得性肌无力（ICUAW）是危重病患者严重的神经肌肉并发症。血清乳酸是危重病患者有用的生物标志物。血清乳酸水平与 ICUAW 的关系仍存在争议。本研究评估了高乳酸血症（乳酸水平>2mmol/L）是否是危重病成年患者 ICUAW 的独立危险因素。
在一个多学科综合重症监护病房（ICU）进行了一项观察性队列研究。评估了 68 例连续的无预先存在的神经肌肉疾病或 ICU 前功能状态较差且 ICU 入住时间超过 7 天的成年危重病患者。每天筛查患者有无觉醒迹象。患者被认为清醒后的第一天，使用 Medical Research Council 评分评估肌肉力量。有临床肌肉无力的患者被认为患有 ICUAW。
在 68 例达到满意意识状态的患者中，30 例（44.1%）诊断为 ICUAW。多变量分析后，高乳酸血症（P=0.02）、急性生理学和慢性健康评估 II 评分（P=0.04）、机械通气时间（P=0.02）和去甲肾上腺素的使用（P=0.04）与危重病患者 ICUAW 的发生显著相关。
本研究表明，一些危险因素与危重病成人 ICUAW 的发生显著相关。在未来的研究中，应考虑这些因素来构建 ICUAW 的早期预测模型或设计预防策略。
