Klawitter Felix, Schaller Stefan J, Söhle Martin, Reuter Daniel A, Ehler Johannes
Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsmedizin Rostock, Rostock, Deutschland.
Klinik für Anästhesiologie m. S. operative Intensivmedizin (CVK/CCM), Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland.
Anaesthesiologie. 2022 Aug;71(8):618-625. doi: 10.1007/s00101-022-01089-9. Epub 2022 Feb 2.
Intensive care unit-acquired weakness (ICU-AW) is one of the most frequent causes of neuromuscular dysfunction in intensive care medicine. To date no evidence-based recommendations exist for the diagnostics, monitoring or further intensive care treatment.
To evaluate the current clinical practice of diagnostics, monitoring and treatment strategies of ICU-AW on intensive care units in Germany.
We conducted an online survey with a self-designed questionnaire and invited 448 members of the Scientific Working Group for Intensive Care Medicine (WAKI) and the Scientific Working Group for Neuroanesthesia (WAKNA) to participate.
A total of 68/448 (15.2%) questionnaires were analyzed. Of the participants 13.4% (9/67) stated that a structured diagnostic approach for the detection of ICU-AW is applied in their units. The clinical examination was the preferred method for screening (60/68; 88.2%) and follow-up (57/65; 87.7%). Scores, such as the Medical Research Council sum score (MRC-SS) seem to be less important for the screening (7/68; 10.3%) and follow-up assessment (7/65; 10.8%). Mobilization with physiotherapy (45/68; 66.2%) is the most common strategy applied to treat ICU-AW. A lack of physiotherapists (64/68; 94.1%) and intensive care nurses (57/68; 83.8%) are the main deficits identified in the care of patients with ICU-AW. The majority of the study participants (62/68; 91.2%) would welcome evidence-based guidelines for diagnostics, monitoring and treatment approaches in ICU-AW.
To date comprehensive recommendations for diagnostics, monitoring, prevention and treatment of ICU-AW are still lacking in German intensive care units. The introduction of new diagnostic approaches could help to detect ICU-AW and therefore to initiate earlier preventive and treatment approaches.
重症监护病房获得性肌无力（ICU-AW）是重症监护医学中神经肌肉功能障碍最常见的病因之一。迄今为止，对于其诊断、监测或进一步的重症监护治疗尚无循证推荐。
评估德国重症监护病房对ICU-AW的诊断、监测及治疗策略的当前临床实践。
我们使用自行设计的问卷进行了一项在线调查，并邀请了重症监护医学科学工作组（WAKI）和神经麻醉科学工作组（WAKNA）的448名成员参与。
共分析了68/448份（15.2%）问卷。13.4%（9/67）的参与者表示其所在科室采用了用于检测ICU-AW的结构化诊断方法。临床检查是筛查（60/68；88.2%）和随访（57/65；87.7%）的首选方法。医学研究委员会总评分（MRC-SS）等评分对于筛查（7/68；10.3%）和随访评估（7/65；10.8%）似乎不太重要。物理治疗辅助活动（45/68；66.2%）是治疗ICU-AW最常用的策略。缺乏物理治疗师（64/68；94.1%）和重症监护护士（57/68；83.8%）是在ICU-AW患者护理中发现的主要不足。大多数研究参与者（62/68；91.2%）欢迎有关ICU-AW诊断、监测和治疗方法的循证指南。
迄今为止，德国重症监护病房仍缺乏针对ICU-AW诊断、监测、预防和治疗的全面推荐。引入新的诊断方法有助于检测ICU-AW，从而更早地启动预防和治疗措施。
