Evaluation of intensive care unit acquired weakness in patients with sepsis
Elkholy, M., Osman, M., Abd El Basset, A., El Maraghi, S., Saber, H. (2023). Evaluation of intensive care unit acquired weakness in patients with sepsis. EKB Journal Management System, 3(1), 7-19. doi: 10.21608/jicem.2023.195510.1017
Mostafa M Elkholy; Mohammed A Osman; Ahmed S Abd El Basset; Sameh Kamal El Maraghi; Hamdy M Saber. "Evaluation of intensive care unit acquired weakness in patients with sepsis". EKB Journal Management System, 3, 1, 2023, 7-19. doi: 10.21608/jicem.2023.195510.1017
Elkholy, M., Osman, M., Abd El Basset, A., El Maraghi, S., Saber, H. (2023). 'Evaluation of intensive care unit acquired weakness in patients with sepsis', EKB Journal Management System, 3(1), pp. 7-19. doi: 10.21608/jicem.2023.195510.1017
Elkholy, M., Osman, M., Abd El Basset, A., El Maraghi, S., Saber, H. Evaluation of intensive care unit acquired weakness in patients with sepsis. EKB Journal Management System, 2023; 3(1): 7-19. doi: 10.21608/jicem.2023.195510.1017

Evaluation of intensive care unit acquired weakness in patients with sepsis

The Egyptian Journal of Intensive Care and Emergency Medicine
Volume 3, Issue 1, June 2023, Page 7-19  XML PDF (612.38 K)
Document Type: Original papers
DOI: 10.21608/jicem.2023.195510.1017
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Authors
Mostafa M Elkholy email orcid 1; Mohammed A Osman2; Ahmed S Abd El Basset3; Sameh Kamal El Maraghiorcid 4; Hamdy M Saber4
1Department of Clinical Neurophysiology (Neuro-Diagnostic and Research Center), Faculty of Medicine, Beni-Suef University, Egypt
2Department of Critical Care Medicine, Arish general hospital, Ministry of Health, Egypt
3Department of Radiology, Faculty of Medicine, Beni-Suef University, Egypt
4Department of Critical Care Medicine, Faculty of Medicine, Beni-Suef University, Egypt
Abstract
Purpose: Intensive care unit acquired weakness (ICUAW) has a negative impact on functional outcome and mortality. We aim to determine the incidence of ICUAW in septic ICU patients and to explore its significant correlations with clinical and laboratory findings. Patients and Methods: We included forty ICU patients diagnosed with sepsis on admission or within 48 hours later. Twenty-five ICU patients with no sepsis were included as a control group. All study populations were evaluated using clinical muscle assessment (medical research council, MRC) and muscle ultrasound at two-time points, the first was between days 2 and 5, and the second was between days 10 and 15. Laboratory workup included complete blood count, coagulation profile, arterial blood gases, liver, and kidney function tests. Results: There was a gradual declining neuromuscular function in all study populations and more significant in septic patients’ group. The incidence of ICUAW was 60% (by MRC score <48) and 100% (by abnormal muscle ultrasound) at second evaluation point of septic patients. SOFA score, blood haemoglobin level, total leucocytic count and creatinine had significant correlations with neuromuscular dysfunction. Conclusions: ICUAW is a prevalent complication in septic ICU patients and was correlated with SOFA score, blood haemoglobin, leucocytic count and creatinine level.
Keywords
ICU acquired weakness; muscle ultrasound, muscle weakness; neuromuscular dysfunction; sepsis
References
  1. Kramer CL. Intensive care unit–acquired weakness. Neurol Clin. 2017;35(4):723-36.
  2. Diaz Ballve LP, Dargains N, Urrutia Inchaustegui JG, Bratos A, Milagros Percaz Mdl, Bueno Ardariz C, et al. Weakness acquired in the intensive care unit. Incidence, risk factors and their association with inspiratory weakness. Observational cohort study. Rev Bras Ter Intensiva. 2017;29:466-75.
  3. Appleton RTD, Kinsella J, Quasim T. The incidence of intensive care unit-acquired weakness syndromes: a systematic review. J Intensive Care Soc. 2015;16(2):126-36.
  4. García-Martínez MÁ, González JCM, y Mateos AG-d-L, Teijeira S. Muscle weakness: Understanding the principles of myopathy and neuropathy in the critically ill patient and the management options. Clin Nutr. 2020;39(5):1331-44.
  5. Eggmann S, Luder G, Verra ML, Irincheeva I, Bastiaenen CH, Jakob SM. Functional ability and quality of life in critical illness survivors with intensive care unit acquired weakness: A secondary analysis of a randomised controlled trial. PLoS One. 2020;15(3):e0229725.
  6. Le Neindre A, Philippart F, Luperto M, Wormser J, Morel-Sapene J, Aho SL, et al. Diagnostic accuracy of diaphragm ultrasound to predict weaning outcome: a systematic review and meta-analysis. Int J Nurs Stud. 2021;117:103890.
  7. Toledo DO, de Freitas BJ, Dib R, do Amaral Pfeilsticker FJ, Dos Santos DM, Gomes BC, et al. Peripheral muscular ultrasound as outcome assessment tool in critically ill patients on mechanical ventilation: An observational cohort study. Clin Nutr ESPEN. 2021;43:408-14.
  8. Paolo F, Silvia C, Tommaso P, Elena C, Martin D, John JM, et al. The possible predictive value of muscle ultrasound in the diagnosis of ICUAW in long-term critically ill patients. J Crit Care. 2022;71:154104.
  9. McClafferty B, Umer I, Fye G, Kepko D, Kalayanamitra R, Shahid Z, et al. Approach to critical illness myopathy and polyneuropathy in the older SARS-CoV-2 patients. J Clin Neurosci. 2020;79:241-5.
  10. Rodriguez B, Larsson L, Z’Graggen WJ. Critical Illness Myopathy: Diagnostic Approach and Resulting Therapeutic Implications. Curr Treat Options Neurol. 2022:1-10.
  11. edu TSIchm. Early mobilization and recovery in mechanically ventilated patients in the ICU: a bi-national, multi-centre, prospective cohort study. Crit Care. 2015;19:1-10.
  12. de Jonghe B, Lacherade J-C, Sharshar T, Outin H. Intensive care unit-acquired weakness: risk factors and prevention. Crit Care Med. 2009;37(10):S309-S15.
  13. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). Jama. 2016;315(8):801-10.
  14. Vincent J-L, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Med: Springer-Verlag; 1996.
  15. Stevens RD, Marshall SA, Cornblath DR, Hoke A, Needham DM, De Jonghe B, et al. A framework for diagnosing and classifying intensive care unit-acquired weakness. Crit Care Med. 2009;37(10):S299-S308.
  16. Heckmatt JZ, Leeman S, Dubowitz V. Ultrasound imaging in the diagnosis of muscle disease. J Pediatr. 1982;101(5):656-60.
  17. Dos Santos C, Hussain SNA, Mathur S, Picard M, Herridge M, Correa J, et al. Mechanisms of chronic muscle wasting and dysfunction after an intensive care unit stay. A pilot study. Am J Respir Crit Care Med. 2016;194(7):821-30.
  18. Jolley SE, Bunnell AE, Hough CL. ICU-acquired weakness. Chest. 2016;150(5):1129-40.
  19. Tennilä A, Salmi T, Pettilä V, Roine RO, Varpula T, Takkunen O. Early signs of critical illness polyneuropathy in ICU patients with systemic inflammatory response syndrome or sepsis. Intensive Care Med. 2000;26(9):1360-3.
  20. Latronico N, Bolton CF. Critical illness polyneuropathy and myopathy: a major cause of muscle weakness and paralysis. Lancet Neurol. 2011;10(10):931-41.
  21. Schefold JC, Wollersheim T, Grunow JJ, Luedi MM, Z'Graggen WJ, Weber‐Carstens S. Muscular weakness and muscle wasting in the critically ill. J Cachexia Sarcopenia Muscle. 2020;11(6):1399-412.
  22. Mayer KP, Ortiz-Soriano VM, Kalantar A, Lambert J, Morris PE, Neyra JA. Acute kidney injury contributes to worse physical and quality of life outcomes in survivors of critical illness. BMC Nephrol. 2022;23(1):1-10.
  23. Teixeira JP, Mayer KP, Griffin BR, George N, Jenkins N, Pal CA, et al. Intensive Care Unit–Acquired Weakness in Patients With Acute Kidney Injury: A Contemporary Review. Am J Kidney Dis. 2022.
  24. Wang XH, Mitch WE. Mechanisms of muscle wasting in chronic kidney disease. Nat Rev Nephrol. 2014;10(9):504-16.
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