ICU Acquired Weakness in patients with respiratory failure

Background:Most patients with severe respiratory failure in intensive care unit (ICU) require bed rest. The limitation of physical activity leads to some adverse consequences such as ICU Acquired Weakness (ICUAW). Progression of respiratory failure, including that caused by the new coronavirus infection (COVID-19), can lead to the development of acute respiratory distress syndrome, the treatment of which contributes to a combination of risk factors for the development of ICUAW. Traditional diagnostic methods have certain limitations. Muscle ultrasonography is a modern tool for early detection of muscle mass loss.Aims:To compare different methods of early ICUAW screening and to estimate the incidence and peculiarities of ICUAW in patients with respiratory failure of infectious genesis.Methods:31 patients with severe coronavirus pneumonia (COVID-19+) and 13 patients with viral and/or bacterial lung infection (COVID-19 -) were included in the study. The muscle mass loss percent from day 1 to day 7 was higher in the COVID-19 - group (p=0.022). These patients also had longer durations of the ICU and hospital stay but a significantly lower mortality (2.5 times).Results:The analysis of the parameters of deceased and living patients regardless of the lung damage etiology showed a correlation between the indices of hand grip strength dynamometry (handgrip test) and ultrasonography of the thigh muscles: F1 and D1 (rho=0.6, p=0.003), F1 and S1 (rho=0.6, p=0.005), D1 and F7 (rho=0.9, p=0.001). In addition, the examined levels of the ICUAW markers were associated with age - F1 (rho=-0.6, p=0.001), D1 (rho=-0.4, p=0.003), S1 (rho=-0.4, p=0.004).Conclusions:During the critical illness, ICUAW develops by the 3d day of bed rest in two thirds of patients with respiratory failure of different infectious genesis. The correlation between the investigated markers of ICUAW and age indicates that elderly patients are the most vulnerable category in respect to the formation and progression of muscle weakness in the ICU. The handgrip test can serve as a reliable and simple method of ICUAW screening. Early identification of patients with ICUAW should provide the improvement of nutritional support and individualization of rehabilitation.

Screening power of STIR muscle MRI in Critical illness myo-neuropathy and GBS in the ICU

Introduction; Critical illness myo-neuropathy [CIMN] or ICU acquired weakness [CIMN] is a common cause of weakness in ICU patients. It is diagnosed by clinical features, nerve conduction studies and muscle/nerve biopsies. Methods; The MRI muscle STIR images of 7 patients with suspected CIMN and 7 GBS patients were reviewed. Results; All 7 patients with CIMN showed diffuse muscle edema, predominating in the lower limbs. Only one patient with GBS showed abnormal MRI changes (14%) and MRI was normal in 86%. The sensitivity of MRI to detect CIMN was 100%, whereas the specificity was 85.7%. Thus, the positive predictive value of MRI in this situation was 87.5% and the negative predictive value was 100%. Conclusions; Muscle STIR imaging may help to differentiate between CIMN and GBS and can modify the diagnostic algorithm of CIMN.

Risk Factors of ICU-Acquired Weakness in Critical Ill Patients with ECMO Support: A Retrospective Study

Background Muscle weakness is exceedingly common in critical illness patients and is well described. However, information on the risk factors of muscle weakness in critically ill patients who received extracorporeal membrane oxygenation (ECMO) support are lacking. Our study aims to clarify the risk factors of ICU-acquired weakness (ICU-AW) in ECMO patients to help early recognize potential weakness. Methods We conducted a retrospective study of critical ill patients who used ECMO during their ICU stay. ICU-AW was diagnosed at the time when patients discharged and had a muscle strength sum score < 48 out of a maximal score of 60. Baseline characters and therapy details were collected from the case report form and inspection report. Results 63 patients receiving ECMO support were divided to ICU-AW group and no ICU-AW group according to the Medical Research Council (MRC) score when discharged. A total of 50 of the 63 patients were diagnosed with ICU-AW. On logistic regression analysis, the use of adrenaline apparently increased the odds of developing ICU-AW (OR=6.8,95%CI 1.19-38.92, p=0.032), and it was independent of all other established risk factors for ICU-AW. Meanwhile, the occurrence of infection during ECMO support significantly increased the risks of ICU-AW (OR=7.3,95% CI 1.28-41.24, p=0.025) and was independently associated with the outcome of ICU-AW. Other factors such as mechanical ventilation duration, steroid use and neuromuscular blockade did not differ significantly between the groups in our analysis. Conclusion Infection during ECMO support and use of adrenaline were found independently associated with the development of ICU-AW.

Effect of vibration therapy on physical function in critically ill adults (VTICIA trial): protocol for a single-blinded randomised controlled trial

IntroductionVibration therapy has been used as an additional approach in passive rehabilitation. Recently, it has been demonstrated to be feasible and safe for critically ill patients, whose muscle weakness and intensive care unit (ICU)-acquired weakness are serious problems. However, the effectiveness of vibration therapy in this population is unclear.Methods and analysisThis study will enrol 188 adult critically ill patients who require further ICU stay after they can achieve sitting at the edge of the bed or wheelchair. The sample size calculation is based on a 15% improvement of Functional Status Score for the ICU. They will be randomised to vibration therapy coupled with protocolised mobilisation or to protocolised mobilisation alone; outcomes will be compared between the two groups. Therapy will be administered using a low-frequency vibration device (5.6–13 Hz) for 15 min/day from when the patient first achieves a sitting position and onward until discharge from the ICU. Outcome assessments will be blinded to the intervention. Primary outcome will be measured using the Functional Status Score for the ICU during discharge. Secondary outcomes will be identified as follows: delirium, Medical Research Council Score, ICU-acquired weakness, the change of biceps brachii and rectus femoris muscle mass measured by ultrasound, ICU mobility scale and ventilator-free and ICU-free days (number of free days during 28 days after admission). For safety assessment, vital signs will be monitored during the intervention.Ethics and disseminationThis study has been approved by the Clinical Research Ethics Committee of Tokushima University Hospital. Results will be disseminated through publication in a peer-reviewed journal and presented at conferences.Trial registration numberUMIN000039616.