title: Prediction and Outcome of Intensive Care Unit-Acquired Paresis.
abstract: BACKGROUND
  Intensive care unit-acquired paresis (ICUAP) is associated with poor outcomes. Our objective was to evaluate predictors for ICUAP and the short-term outcomes associated with this condition.
  
  
  METHODS
  A secondary analysis of a prospective study including 4157 mechanically ventilated adults in 494 intensive care units from 39 countries. After sedative interruption, patients were screened for ICUAP daily, which was defined as the presence of symmetric and flaccid quadriparesis associated with decreased or absent deep tendon reflexes. A multinomial logistic regression was used to create a predictive model for ICUAP. Propensity score matching was used to estimate the relationship between ICUAP and short-term outcomes (ie, weaning failure and intensive care unit [ICU] mortality).
  
  
  RESULTS
  Overall, 114 (3%) patients had ICUAP. Variables associated with ICUAP were duration of mechanical ventilation (relative risk ratio [RRR] per day, 1.10; 95% confidence interval [CI] 1.08-1.12), steroid therapy (RRR 1.8; 95% CI, 1.2-2.8), insulin therapy (RRR 1.8; 95% CI 1.2-2.7), sepsis (RRR 1.9; 95% CI: 1.2 to 2.9), acute renal failure (RRR 2.2; 95% CI 1.5-3.3), and hematological failure (RRR 1.9; 95% CI: 1.2-2.9). Coefficients were used to generate a weighted scoring system to predict ICUAP. ICUAP was significantly associated with both weaning failure (paired rate difference of 22.1%; 95% CI 9.8-31.6%) and ICU mortality (paired rate difference 10.5%; 95% CI 0.1-24.0%).
  
  
  CONCLUSIONS
  Intensive care unit-acquired paresis is relatively uncommon but is significantly associated with weaning failure and ICU mortality. We constructed a weighted scoring system, with good discrimination, to predict ICUAP in mechanically ventilated patients at the time of awakening.
authors.affiliation: 1 Hospital Universitario de Getafe & Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain.
authors.forename: Oscar
authors.initials: O
authors.lastname: Peñuelas
authors.affiliation: 2 Unidad de Bioestadística Clinica Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigaciones Sanitarias (IRYCIS) & Centro de Investigación en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Muriel
authors.affiliation: 1 Hospital Universitario de Getafe & Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Frutos-Vivar
authors.affiliation: 3 Interdepartmental Division of Critical Care Medicine, and Departments of Medicine & Physiology, University of Toronto, Canada.
authors.forename: Eddy
authors.initials: E
authors.lastname: Fan
authors.affiliation: 4 Medizinische Hochschule Hannover, Germany.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Raymondos
authors.affiliation: 5 Hospital Nacional Alejandro Posadas, Buenos Aires, Argentina.
authors.forename: Fernando
authors.initials: F
authors.lastname: Rios
authors.affiliation: 6 Hospital Universitario de Montevideo, Uruguay.
authors.forename: Nicolás
authors.initials: N
authors.lastname: Nin
authors.affiliation: 7 University Hospital of Poitiers, Poitiers, France.
authors.forename: Arnaud W
authors.initials: AW
authors.lastname: Thille
authors.affiliation: 8 Clínica Medellín & Universidad Pontificia Bolivariana, Medellín, Colombia.
authors.forename: Marco
authors.initials: M
authors.lastname: González
authors.affiliation: 9 Hospital Regional 1° de Octubre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), México DF, México.
authors.forename: Asisclo J
authors.initials: AJ
authors.lastname: Villagomez
authors.affiliation: 10 Alfred Hospital & Monash University, Melbourne, Australia.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Davies
authors.affiliation: 11 Peking Union Medical College Hospital, Beijing, Popular Republic of China.
authors.forename: Bin
authors.initials: B
authors.lastname: Du
authors.affiliation: 12 Policlinico "Agostino Gemelli", Università Cattolica Del Sacro Cuore, Roma, Italy.
authors.forename: Salvatore M
authors.initials: SM
authors.lastname: Maggiore
authors.affiliation: 13 Papageorgiou Hospital, Thessaloniki, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Matamis
authors.affiliation: 14 Hospital Fattouma Bourguina, Monastir, Tunisia.
authors.forename: Fekri
authors.initials: F
authors.lastname: Abroug
authors.affiliation: 15 Hospital de São José, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.
authors.forename: Rui P
authors.initials: RP
authors.lastname: Moreno
authors.affiliation: 16 Medical Center Leeuwarden (MCL), Leeuwarden, the Netherlands.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Kuiper
authors.affiliation: 17 South Texas Veterans Health Care System and University of Texas Health Science Center, San Antonio, Texas.
authors.forename: Antonio
authors.initials: A
authors.lastname: Anzueto
authors.affiliation: 3 Interdepartmental Division of Critical Care Medicine, and Departments of Medicine & Physiology, University of Toronto, Canada.
authors.forename: Niall D
authors.initials: ND
authors.lastname: Ferguson
authors.affiliation: 1 Hospital Universitario de Getafe & Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain.
authors.forename: Andrés
authors.initials: A
authors.lastname: Esteban
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009466:Neuromuscular Blocking Agents / Q000627:therapeutic use; D011379:Prognosis; D057216:Propensity Score; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D011782:Quadriplegia / Q000453:epidemiology* / Q000503:physiopathology; D012021:Reflex, Abnormal / Q000502:physiology*; D012026:Reflex, Stretch / Q000502:physiology*; D051437:Renal Insufficiency / Q000453:epidemiology; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000453:epidemiology / Q000628:therapy*; D018570:Risk Assessment; D018805:Sepsis / Q000453:epidemiology; D013577:Syndrome; D015300:Ventilator Weaning
chemical_list: D009466:Neuromuscular Blocking Agents
keywords: intensive care unit-acquired paresis; mechanical ventilation; mortality; weaning