Chen Xue-Xian, Xiong Jing, Chen Jin-Xia, Luo Chen-Juan, Zhuang Yao-Ning, Xu Mei-Lian, Li Hong, Wu Ting-Ting
Critical Care Medicine, Ningde Municipal Hospital of Ningde Normal University, Ningde, China.
Department of Nursing, Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.
Nurs Crit Care. 2025 Jul;30(4):e13209. doi: 10.1111/nicc.13209. Epub 2024 Dec 4.
Intensive care unit-acquired weakness (ICU-AW) is prevalent and adversely affects patient outcomes. Muscle strength progression and response to rehabilitation differ across ICU populations. However, the trajectories, determinants and prognoses of muscle strength changes remain unclear.
This study aimed to investigate the trajectory and determinants of ICU-AW in critical illness and its impact on 60-day postadmission mortality.
A multicentre prospective cohort study was conducted, involving critically ill patients from 10 ICUs across five tertiary hospitals in Fujian Province, China. Patients were evaluated using the Medical Research Council (MRC) scale at three time points: within 48 h of ICU admission or within 24 h of regaining consciousness (T1), within 24 h of ICU discharge (T2) and at the time of hospital discharge (T3). The latent class growth mixed model was utilized for data analysis, and multivariable logistic regression was employed to examine the determinants of muscle strength trajectories.
This study encompassed 343 patients from five tertiary hospitals. Three latent trajectory groups were identified: a low-level decline group (5.83%), a medium-level stability group (25.36%) and a high-level recovery group (68.81%). Multivariable logistic regression revealed that Charlson comorbidity index (CCI) and alcohol consumption significantly influenced the trajectory of muscle strength development in ICU patients (p < .05). The mortality rate at 60 days was significantly higher in both the low-level decline and medium-level stability groups compared with the high-level recovery groups (p < .05).
This study identified three muscle strength trajectories in ICU patients: low-level decline, medium-level stability and high-level recovery. CCI and alcohol consumption significantly influenced these trajectories. The lower 60-day mortality rate in the high-level recovery group underscores the need for early intervention and tailored care.
Developing targeted rehabilitation strategies for those at risk of low-level decline or medium-level stability group is challenging and may potentially improve recovery and outcomes.
重症监护病房获得性肌无力（ICU-AW）很常见，会对患者预后产生不利影响。不同ICU人群的肌肉力量进展和对康复的反应有所不同。然而，肌肉力量变化的轨迹、决定因素和预后仍不明确。
本研究旨在调查危重症患者ICU-AW的轨迹和决定因素及其对入院后60天死亡率的影响。
开展了一项多中心前瞻性队列研究，纳入了中国福建省五家三级医院10个ICU的危重症患者。在三个时间点使用医学研究委员会（MRC）量表对患者进行评估：ICU入院后48小时内或意识恢复后24小时内（T1）、ICU出院后24小时内（T2）和出院时（T3）。采用潜在类别增长混合模型进行数据分析，并使用多变量逻辑回归分析肌肉力量轨迹的决定因素。
本研究纳入了五家三级医院的343例患者。确定了三个潜在轨迹组：低水平下降组（5.83%）、中等水平稳定组（25.36%）和高水平恢复组（68.81%）。多变量逻辑回归显示，Charlson合并症指数（CCI）和饮酒对ICU患者肌肉力量发展轨迹有显著影响（p < 0.05）。与高水平恢复组相比，低水平下降组和中等水平稳定组60天时的死亡率显著更高（p < 0.05）。
本研究确定了ICU患者的三种肌肉力量轨迹：低水平下降、中等水平稳定和高水平恢复。CCI和饮酒对这些轨迹有显著影响。高水平恢复组较低的60天死亡率强调了早期干预和个性化护理的必要性。
为低水平下降或中等水平稳定组风险患者制定有针对性的康复策略具有挑战性，但可能会改善恢复情况和预后。
