Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, University Complutense of Madrid, Madrid, Spain.
Invecuid, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.
PLoS One. 2023 Jun 7;18(6):e0286598. doi: 10.1371/journal.pone.0286598. eCollection 2023.
To assess the incidence and determinants of ICU-acquired muscle weakness (ICUAW) in adult patients with enteral nutrition (EN) during the first 7 days in the ICU and mechanical ventilation for at least 48 hours.
A prospective, nationwide, multicentre cohort study in a national ICU network of 80 ICUs. ICU patients receiving invasive mechanical ventilation for at least 48 hours and EN the first 7 days of their ICU stay were included. The primary outcome was incidence of ICUAW. The secondary outcome was analysed, during days 3-7 of ICU stay, the relationship between demographic and clinical data to contribute to the onset of ICUAW, identify whether energy and protein intake can contribute independently to the onset of ICUAW and degree of compliance guidelines for EN.
319 patients were studied from 69 ICUs in our country. The incidence of ICUAW was 153/222 (68.9%; 95% CI [62.5%-74.7%]). Patients without ICUAW showed higher levels of active mobility (p = 0.018). The logistic regression analysis showed no effect on energy or protein intake on the onset of ICUAW. Overfeeding was observed on a significant proportion of patient-days, while more overfeeding (as per US guidelines) was found among patients with obesity than those without (42.9% vs 12.5%; p<0.001). Protein intake was deficient (as per US/European guidelines) during ICU days 3-7.
The incidence of ICUAW was high in this patient cohort. Early mobility was associated with a lower incidence of ICUAW. Significant overfeeding and deficient protein intake were observed. However, energy and protein intake alone were insufficient to explain ICUAW onset.
Low mobility, high incidence of ICUAW and low protein intake suggest the need to train, update and involve ICU professionals in nutritional care and the need for early mobilization of ICU patients.
评估在 ICU 入住的前 7 天接受肠内营养（EN）和至少 48 小时机械通气的成年患者 ICU 获得性肌无力（ICUAW）的发生率和决定因素。
这是一项在全国 ICU 网络中的 80 个 ICU 进行的前瞻性、全国性、多中心队列研究。纳入标准为：接受至少 48 小时有创机械通气和 ICU 入住的前 7 天内接受 EN 的 ICU 患者。主要结局是 ICUAW 的发生率。次要结局是在 ICU 入住的第 3-7 天期间，分析人口统计学和临床数据与 ICUAW 发病的关系，确定能量和蛋白质摄入是否可以独立导致 ICUAW 的发病以及 EN 指南的依从性程度。
从我国的 69 个 ICU 中研究了 319 名患者。ICUAW 的发生率为 222 例中的 153 例（68.9%；95%CI[62.5%-74.7%]）。无 ICUAW 的患者表现出更高的主动活动能力（p=0.018）。 logistic 回归分析显示，能量或蛋白质摄入对 ICUAW 的发病没有影响。在相当一部分患者日中观察到过度喂养，而肥胖患者的过度喂养（按美国指南）比非肥胖患者更常见（42.9%比 12.5%；p<0.001）。在 ICU 入住的第 3-7 天期间，蛋白质摄入不足（按美国/欧洲指南）。
在该患者队列中，ICUAW 的发生率较高。早期活动与 ICUAW 发生率降低有关。观察到明显的过度喂养和蛋白质摄入不足。然而，能量和蛋白质摄入本身不足以解释 ICUAW 的发病机制。
低活动度、ICUAW 发生率高和蛋白质摄入不足表明需要培训、更新和让 ICU 专业人员参与营养护理，并需要早期活动 ICU 患者。
