Weakness acquired in the intensive care unit. Incidence, risk factors and their association with inspiratory weakness. Observational cohort study

ABSTRACT Objective: This paper sought to determine the accumulated incidence and analyze the risk factors associated with the development of weakness acquired in the intensive care unit and its relationship to inspiratory weakness. Methods: We conducted a prospective cohort study at a single center, multipurpose medical-surgical intensive care unit. We included adult patients who required mechanical ventilation ≥ 24 hours between July 2014 and January 2016. No interventions were performed. Demographic data, clinical diagnoses, the factors related to the development of intensive care unit -acquired weakness, and maximal inspiratory pressure were recorded. Results: Of the 111 patients included, 66 developed intensive care unit -acquired weakness, with a cumulative incidence of 40.5% over 18 months. The group with intensive care unit-acquired weakness were older (55.9 ± 17.6 versus 45.8 ± 16.7), required more mechanical ventilation (7 [4 - 10] days versus 4 [2 - 7.3] days), and spent more time in the intensive care unit (15.5 [9.2 - 22.8] days versus 9 [6 - 14] days). More patients presented with delirium (68% versus 39%), hyperglycemia > 3 days (84% versus 59%), and positive balance > 3 days (73.3% versus 37%). All comparisons were significant at p < 0.05. A multiple logistic regression identified age, hyperglycemia ≥ 3 days, delirium, and mechanical ventilation > 5 days as independent predictors of intensive care unit-acquired weakness. Low maximal inspiratory pressure was associated with intensive care unit-acquired weakness (p < 0.001), and the maximum inspiratory pressure cut-off value of < 36cmH2O had sensitivity and specificity values of 31.8% and 95.5%, respectively, when classifying patients with intensive care unit-acquired weakness. Conclusion: The intensive care unit acquired weakness is a condition with a high incidence in our environment. The development of intensive care unit-acquired weakness was associated with age, delirium, hyperglycemia, and mechanical ventilation > 5 days. The maximum inspiratory pressure value of ≥ 36cmH2O was associated with a high diagnostic value to exclude the presence of intensive care unit -acquired weakness.

摘要 研究目的：本研究旨在明确重症监护病房获得性肌无力（Intensive Care Unit-Acquired Weakness, ICU-AW）的累积发病率，分析其相关危险因素，并探讨其与吸气肌无力的关联。方法：本研究为单中心多用途内科-外科重症监护病房的前瞻性队列研究，纳入2014年7月至2016年1月期间需接受≥24小时机械通气（Mechanical Ventilation）的成年患者，未实施任何干预措施。研究记录了患者的人口学资料、临床诊断、与ICU-AW发生相关的危险因素以及最大吸气压（Maximal Inspiratory Pressure）。结果：纳入的111例患者中，66例发生ICU-AW，18个月内累积发病率为40.5%。发生ICU-AW的患者年龄更大（55.9±17.6 vs 45.8±16.7），机械通气时长更长[7（4~10）天 vs 4（2~7.3）天]，重症监护病房停留时间也更长[15.5（9.2~22.8）天 vs 9（6~14）天]。该组患者中谵妄发生率更高（68% vs 39%），高血糖持续＞3天的比例更高（84% vs 59%），液体正平衡持续＞3天的比例也更高（73.3% vs 37%），所有比较的P值均＜0.05，差异具有统计学意义。多因素logistic回归分析显示，年龄、高血糖持续≥3天、谵妄以及机械通气时长＞5天是ICU-AW的独立预测因素。低最大吸气压与ICU-AW显著相关（P＜0.001），当以＜36cmH₂O作为截断值时，其对ICU-AW的分类灵敏度为31.8%，特异度为95.5%。结论：ICU-AW在本研究人群中发病率较高。ICU-AW的发生与年龄、谵妄、高血糖以及机械通气时长＞5天相关。最大吸气压≥36cmH₂O具有较高的诊断价值，可用于排除ICU-AW的存在。