Fuentes-Aspe Rocío, Gutierrez-Arias Ruvistay, González-Seguel Felipe, Marzuca-Nassr Gabriel Nasri, Torres-Castro Rodrigo, Najum-Flores Jasim, Seron Pamela
Departamento Ciencias de la Rehabilitación, Facultad de Medicina, Universidad de La Frontera, Claro Solar 115, Temuco, Chile.
Facultad de Medicina, Centro de Excelencia CIGES, Universidad de La Frontera, Temuco, Chile.
J Intensive Care. 2024 Sep 5;12(1):33. doi: 10.1186/s40560-024-00744-0.
Intensive care unit-acquired weakness (ICUAW) is common in critically ill patients, characterized by muscle weakness and physical function loss. Determining risk factors for ICUAW poses challenges due to variations in assessment methods and limited generalizability of results from specific populations, the existing literature on these risk factors lacks a clear and comprehensive synthesis.
This overview aimed to synthesize risk factors for ICUAW, categorizing its modifiable and nonmodifiable factors.
An overview of systematic reviews was conducted. Six relevant databases were searched for systematic reviews. Two pairs of reviewers selected reviews following predefined criteria, where bias was evaluated. Results were qualitatively summarized and an overlap analysis was performed for meta-analyses.
Eighteen systematic reviews were included, comprising 24 risk factors for ICUAW. Meta-analyses were performed for 15 factors, while remaining reviews provided qualitative syntheses. Twelve reviews had low risk of bias, 4 reviews were unclear, and 2 reviews exhibited high risk of bias. The extent of overlap ranged from 0 to 23% for the corrected covered area index. Nonmodifiable factors, including advanced age, female gender, and multiple organ failure, were consistently associated with ICUAW. Modifiable factors, including neuromuscular blocking agents, hyperglycemia, and corticosteroids, yielded conflicting results. Aminoglycosides, renal replacement therapy, and norepinephrine were associated with ICUAW but with high heterogeneity.
Multiple risk factors associated with ICUAW were identified, warranting consideration in prevention and treatment strategies. Some risk factors have produced conflicting results, and several remain underexplored, emphasizing the ongoing need for personalized studies encompassing all potential contributors to ICUAW development.
重症监护病房获得性肌无力（ICUAW）在危重症患者中很常见，其特征为肌肉无力和身体功能丧失。由于评估方法的差异以及特定人群结果的普遍性有限，确定ICUAW的风险因素具有挑战性，关于这些风险因素的现有文献缺乏清晰全面的综合分析。
本综述旨在综合ICUAW的风险因素，对其可改变和不可改变的因素进行分类。
进行系统评价的综述。检索六个相关数据库以获取系统评价。两对评审员根据预定义标准选择综述，并评估偏倚情况。对结果进行定性总结，并对荟萃分析进行重叠分析。
纳入18项系统评价，包含24个ICUAW的风险因素。对15个因素进行了荟萃分析，其余综述提供了定性综合分析。12项综述的偏倚风险较低，4项综述不明确，2项综述显示出较高的偏倚风险。校正后的覆盖面积指数重叠程度在0%至23%之间。不可改变的因素，包括高龄、女性性别和多器官功能衰竭，一直与ICUAW相关。可改变的因素，包括神经肌肉阻滞剂、高血糖和皮质类固醇，结果相互矛盾。氨基糖苷类、肾脏替代治疗和去甲肾上腺素与ICUAW相关，但异质性较高。
确定了与ICUAW相关的多个风险因素，在预防和治疗策略中值得考虑。一些风险因素产生了相互矛盾的结果，还有几个因素仍未得到充分研究，强调持续需要进行个性化研究，涵盖所有可能导致ICUAW发生的因素。
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