Impact of ICU-acquired weakness on post-ICU physical functioning: a follow-up study

• Published in: Critical care (London, England) Vol. 19; no. 1; p. 196
• Main Authors: Wieske, Luuk, Dettling-Ihnenfeldt, Daniela S, Verhamme, Camiel, Nollet, Frans, van Schaik, Ivo N, Schultz, Marcus J, Horn, Janneke, van der Schaaf, Marike
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 27.04.2015; BioMed Central
• Subjects: Aged; Aged, 80 and over; Analysis; Care and treatment; Cohort Studies; Critical care; Critical Illness - mortality; Critical Illness - therapy; Female; Follow-Up Studies; Health aspects; Hospital patients; Hospitals; Humans; Illnesses; Intensive care; Intensive Care Units - trends; Male; Medical research; Medicine, Experimental; Middle Aged; Mortality; Muscle Weakness - complications; Muscle Weakness - diagnosis; Muscle Weakness - mortality; Patient Discharge - trends; Prospective Studies; Quality of life; R&D; Recovery of Function; Research & development; Respiration, Artificial - adverse effects; Respiration, Artificial - mortality; Respiration, Artificial - trends; Respiratory distress syndrome; Sepsis; Survival Rate - trends
• ISSN: 1364-8535; 1466-609X; 1364-8535; 1366-609X
• DOI: 10.1186/s13054-015-0937-2

ICU-acquired weakness is thought to mediate physical impairments in survivors of critical illness, but few studies have investigated this thoroughly. The purpose was to investigate differences in post-ICU mortality and physical functioning between patients with and without ICU-acquired weakness at 6 months after ICU discharge. ICU patients, mechanically ventilated ≥ 2 days, were included in a single-center prospective observational cohort study. ICU-acquired weakness was diagnosed when the average Medical Research Council score was <4 in awake and attentive patients. Post-ICU mortality was recorded until 6 months after ICU discharge; in surviving patients, physical functioning was assessed using the Short-Form Health Survey physical functioning domain. The independent effect of ICU-acquired weakness on post-ICU mortality was analyzed using a multivariable Cox proportional hazards model. The independent effect of ICU-acquired weakness on the physical functioning domain score was analyzed using a multivariable linear regression model. Of the 156 patients included, 80 had ICU-acquired weakness. Twenty-three patients died in the ICU (20 with ICU-acquired weakness); during 6 months follow-up after ICU discharge another 25 patients died (17 with ICU-acquired weakness). Physical functioning domain scores were available for 96 survivors (39 patients with ICU-acquired weakness). ICU-acquired weakness was independently associated with an increase in post-ICU mortality (hazard ratio 3.6, 95% confidence interval, 1.3 to 9.8; P = 0.01) and with a decrease in physical functioning (β: -16.7 points; 95% confidence interval, -30.2 to -3.1; P = 0.02). ICU-acquired weakness is independently associated with higher post-ICU mortality and with clinically relevant lower physical functioning in survivors at 6 months after ICU discharge.