Chuang Ya-Chi, Shiu Sz-Iuan, Lee Yu-Chun, Tsai Yu-Lin, Cheng Yuan-Yang
Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.
J Intensive Care Med. 2024 Aug 14:8850666241268437. doi: 10.1177/08850666241268437.
Intensive care unit acquired weakness (ICUAW) is a common neuromuscular complication of critical illness, impacting patients' recovery and long-term outcomes. However, limited evidence is available on pooled prevalence and risk factors of ICUAW specifically in the COVID-19-infected population.
We searched on PubMed, Embase, Cochrane Library, Web of Science, PEDro, and EBSCOhost/CINAHL up to January 31, 2024. Data synthesis was conducted using the Freeman-Tukey double-arcsine transformation model for the pooled prevalence rate and odds ratios with corresponding 95% confidence intervals was used to identify risk factors.
The pooled prevalence of ICUAW in COVID-19 patients was 55% in eight studies on 868 patients. Risk factors for developing ICUAW in these patients were: old age (WMD 4.78, 95% CI, 1.06-8.49), pre-existing hypertension (OR = 1.63, 95% CI, 1.02-2.61), medical intervention of prone position (OR = 5.21, 95% CI, 2.72-9.98), use of neuromuscular blocking agents (NMBA) (OR = 12.04, 95% CI, 6.20-23.39), needed tracheostomy (OR = 18.07, 95% CI, 5.64-57.92) and renal replacement therapy (RRT) (OR = 5.24, 95% CI = 2.36-11.63).
The prevalence of ICUAW in patients with COVID-19 was considered relatively high. Older age, pre-existing hypertension, medical intervention of prone position, NMBA use, needed tracheostomy and RRT were likely risk factors. In the future, interdisciplinary medical team should pay attention to high-risk groups for ICUAW prevention and early treatments.
重症监护病房获得性肌无力（ICUAW）是危重症常见的神经肌肉并发症，影响患者的康复及长期预后。然而，关于ICUAW在新冠病毒感染人群中的合并患病率及危险因素的证据有限。
我们检索了截至2024年1月31日的PubMed、Embase、Cochrane图书馆、Web of Science、PEDro以及EBSCOhost/CINAHL。采用Freeman-Tukey双反正弦变换模型进行数据合成以计算合并患病率，并使用比值比及相应的95%置信区间来确定危险因素。
八项针对868例患者的研究显示，新冠患者中ICUAW的合并患病率为55%。这些患者发生ICUAW的危险因素包括：高龄（加权均数差4.78，95%置信区间1.06 - 8.49）、既往高血压（比值比=1.63，95%置信区间1.02 - 2.61）、俯卧位医学干预（比值比=5.21，95%置信区间2.72 - 9.98）、使用神经肌肉阻滞剂（NMBA）（比值比=12.04，95%置信区间6.20 - 23.39）、需要气管切开术（比值比=18.07，95%置信区间5.64 - 57.92）及肾脏替代治疗（RRT）（比值比=5.24，95%置信区间=2.36 - 11.63）。
新冠患者中ICUAW的患病率较高。高龄、既往高血压、俯卧位医学干预、使用NMBA、需要气管切开术及RRT可能是危险因素。未来，跨学科医疗团队应关注ICUAW的高危人群，进行预防及早期治疗。
