title: Paresis acquired in the intensive care unit: a prospective multicenter study.
abstract: 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.
authors.affiliation: 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
authors.forename: Bernard
authors.initials: B
authors.lastname: De Jonghe
authors.forename: Tarek
authors.initials: T
authors.lastname: Sharshar
authors.forename: Jean-Pascal
authors.initials: JP
authors.lastname: Lefaucheur
authors.forename: François-Jérome
authors.initials: FJ
authors.lastname: Authier
authors.forename: Isabelle
authors.initials: I
authors.lastname: Durand-Zaleski
authors.forename: Mohamed
authors.initials: M
authors.lastname: Boussarsar
authors.forename: Charles
authors.initials: C
authors.lastname: Cerf
authors.forename: Estelle
authors.initials: E
authors.lastname: Renaud
authors.forename: Francine
authors.initials: F
authors.lastname: Mesrati
authors.forename: Jean
authors.initials: J
authors.lastname: Carlet
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Raphaël
authors.forename: Hervé
authors.initials: H
authors.lastname: Outin
authors.forename: Sylvie
authors.initials: S
authors.lastname: Bastuji-Garin
mesh_terms: 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
chemical_list: D005938:Glucocorticoids