title: Global muscle strength but not grip strength predicts mortality and length of stay in a general population in a surgical intensive care unit.
abstract: BACKGROUND
  Paresis acquired in the intensive care unit (ICU) is common in patients who are critically ill and independently predicts mortality and morbidity. Manual muscle testing (MMT) and handgrip dynamometry assessments have been used to evaluate muscle weakness in patients in a medical ICU, but similar data for patients in a surgical ICU (SICU) are limited.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate the predictive value of strength measured by MMT and handgrip dynamometry at ICU admission for in-hospital mortality, SICU length of stay (LOS), hospital LOS, and duration of mechanical ventilation.
  
  
  METHODS
  This investigation was a prospective, observational study.
  
  
  METHODS
  One hundred ten patients were screened for eligibility for testing in the SICU of a large, academic medical center. The Acute Physiology and Chronic Health Evaluation (APACHE) II score, diagnoses, and laboratory data were collected. Measurements were obtained by MMT quantified with the sum (total) score on the Medical Research Council Scale and by handgrip dynamometry. Outcome data, including in-hospital mortality, SICU LOS, hospital LOS, and duration of mechanical ventilation, were collected for all participants.
  
  
  RESULTS
  One hundred seven participants were eligible for testing; 89% were tested successfully at a median of 3 days (25th-75th percentiles=3-6 days) after admission. Sedation was the most frequent barrier to testing (70.6%). Manual muscle testing was identified as an independent predictor of mortality, SICU LOS, hospital LOS, and duration of mechanical ventilation. Grip strength was not independently associated with these outcomes.
  
  
  CONCLUSIONS
  This study did not address whether muscle weakness translates to functional outcome impairment.
  
  
  CONCLUSIONS
  In contrast to handgrip strength, MMT reliably predicted in-hospital mortality, duration of mechanical ventilation, SICU LOS, and hospital LOS.
authors.affiliation: Department of Anesthesia, Critical Care & Pain Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA.
authors.forename: Jeanette J
authors.initials: JJ
authors.lastname: Lee
authors.forename: Karen
authors.initials: K
authors.lastname: Waak
authors.forename: Martina
authors.initials: M
authors.lastname: Grosse-Sundrup
authors.forename: Feifei
authors.initials: F
authors.lastname: Xue
authors.forename: Jarone
authors.initials: J
authors.lastname: Lee
authors.forename: Daniel
authors.initials: D
authors.lastname: Chipman
authors.forename: Cheryl
authors.initials: C
authors.lastname: Ryan
authors.forename: Edward A
authors.initials: EA
authors.lastname: Bittner
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schmidt
authors.forename: Matthias
authors.initials: M
authors.lastname: Eikermann
mesh_terms: D005260:Female; D018737:Hand Strength; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D053580:Muscle Strength; D053581:Muscle Strength Dynamometer; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000706:statistics & numerical data