Usefulness of a clinical diagnosis of ICU-acquired paresis to predict outcome in patients with SIRS and acute respiratory failure.
OBJECTIVE
Neuromuscular abnormalities are common in ICU patients. We aimed to assess the incidence of clinically diagnosed ICU-acquired paresis (ICUAP) and its impact on outcome.


METHODS
Forty-two patients with systemic inflammatory response syndrome on mechanical ventilation for >or=48 h were prospectively studied. Diagnosis of ICUAP was defined as symmetric limb muscle weakness in at least two muscle groups at ICU discharge without other explanation. The threshold Medical Research Council (MRC) Score was set at 35 (of 50) points. Activities in daily living were scored using the Barthel Index 28 and 180 days after ICU discharge.


RESULTS
Three patients died before sedation was stopped. ICUAP was diagnosed in 13 of the 39 patients (33%). Multivariate regression analysis yielded five ICUAP-predicting variables (P < 0.05): SAPS II at ICU admission, treatment with steroids, muscle relaxants or norepinephrine, and days with sepsis. Patients with ICUAP had lower admission SAPS II scores [37 +/- 13 vs. 49 +/- 15 (P = 0.018)], lower Barthel Index at 28 days and lower survival at 180 days after ICU discharge (38 vs. 77%, P = 0.033) than patients without ICUAP. Daily TISS-28 scores were similar but cumulative TISS-28 scores were higher in patients with ICUAP (664 +/- 275) than in patients without ICUAP (417 +/- 236; P = 0.008). The only independent risk factor for death before day 180 was the presence of ICUAP.


CONCLUSIONS
A clinical diagnosis of ICUAP was frequently established in this patient group. Despite lower SAPS II scores, these patients needed more resources and had high mortality and prolonged recovery periods after ICU discharge.
Brunello
Anna-Giulia
AG
Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland.
Haenggi
Matthias
M
Wigger
Oliver
O
Porta
Francesca
F
Takala
Jukka
J
Jakob
Stephan M
SM
D000208:Acute Disease; D000368:Aged; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007049:Iatrogenic Disease; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D010291:Paresis / Q000175:diagnosis* / Q000453:epidemiology*; D011446:Prospective Studies; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000534:rehabilitation / Q000628:therapy*; D012131:Respiratory Insufficiency / Q000453:epidemiology*; D012720:Severity of Illness Index; D018746:Systemic Inflammatory Response Syndrome / Q000453:epidemiology* / Q000534:rehabilitation; D016896:Treatment Outcome; D015300:Ventilator Weaning