Paresis acquired in the intensive care unit: a prospective multicenter study.
BACKGROUND
Although electrophysiologic and histologic neuromuscular abnormalities are common in intensive care unit (ICU) patients, the clinical incidence of ICU-acquired neuromuscular disorders in patients recovering from severe illness remains unknown.


OBJECTIVE
To assess the clinical incidence, risk factors, and outcomes of ICU-acquired paresis (ICUAP) during recovery from critical illness in the ICU and to determine the electrophysiologic and histologic patterns in patients with ICUAP.


METHODS
Prospective cohort study conducted from March 1999 to June 2000.


METHODS
Three medical and 2 surgical ICUs in 4 hospitals in France.


METHODS
All consecutive ICU patients without preexisting neuromuscular disease who underwent mechanical ventilation for 7 or more days were screened daily for awakening. The first day a patient was considered awake was day 1. Patients with severe muscle weakness on day 7 were considered to have ICUAP.


METHODS
Incidence and duration of ICUAP, risk factors for ICUAP, and comparative duration of mechanical ventilation between ICUAP and control patients.


RESULTS
Among the 95 patients who achieved satisfactory awakening, the incidence of ICUAP was 25.3% (95% confidence interval [CI], 16.9%-35.2%). All ICUAP patients had a sensorimotor axonopathy, and all patients who underwent a muscle biopsy had specific muscle involvement not related to nerve involvement. The median duration of ICUAP after day 1 was 21 days. Mean (SD) duration of mechanical ventilation after day 1 was significantly longer in patients with ICUAP compared with those without (18.2 [36.3] vs 7.6 [19.2] days; P =.03). Independent predictors of ICUAP were female sex (odds ratio [OR], 4.66; 95% CI, 1.19-18.30), the number of days with dysfunction of 2 or more organs (OR, 1.28; 95% CI, 1.11-1.49), duration of mechanical ventilation (OR, 1.10; 95% CI, 1.00-1.22), and administration of corticosteroids (OR, 14.90; 95% CI, 3.20-69.80) before day 1.


CONCLUSIONS
Identified using simple bedside clinical criteria, ICUAP was frequent during recovery from critical illness and was associated with a prolonged duration of mechanical ventilation. Our findings suggest an important role of corticosteroids in the development of ICUAP.
De Jonghe
Bernard
B
Service de Réanimation Médicale, Centre Hospitalier de Poissy-Saint-Germain en Laye, 10 rue du Champ-Gaillard, 78300 Poissy, France. bdejonghe@chi-poissy-st-germain.fr
Sharshar
Tarek
T
Lefaucheur
Jean-Pascal
JP
Authier
François-Jérome
FJ
Durand-Zaleski
Isabelle
I
Boussarsar
Mohamed
M
Cerf
Charles
C
Renaud
Estelle
E
Mesrati
Francine
F
Carlet
Jean
J
Raphaël
Jean-Claude
JC
Outin
Hervé
H
Bastuji-Garin
Sylvie
S
D000368:Aged; D016638:Critical Illness; D004594:Electrophysiology; D005260:Female; D005602:France / Q000453:epidemiology; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010291:Paresis / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D011446:Prospective Studies; D012121:Respiration, Artificial; D012307:Risk Factors
D005938:Glucocorticoids