This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (144)  • Contact me when this article is cited  Related Content  • Related letters  • Similar articles in JAMA  Topic Collections  • Critical Care/ Intensive Care Medicine  • Adult Critical Care  • Alert me on articles by topic  Social Bookmarking   What's this?

A Prospective Multicenter Study

Bernard De Jonghe, MD; Tarek Sharshar, MD; Jean-Pascal Lefaucheur, MD, PhD; François-Jérome Authier, MD; Isabelle Durand-Zaleski, MD, PhD; Mohamed Boussarsar, MD; Charles Cerf, MD; Estelle Renaud, MD; Francine Mesrati, MD; Jean Carlet, MD; Jean-Claude Raphaël, MD; Hervé Outin, MD; Sylvie Bastuji-Garin, MD, PhD; for the Groupe de Réflexion et d'Etude des Neuromyopathies en Réanimation

JAMA. 2002;288:2859-2867.

Context  Although electrophysiologic and histologic neuromuscular abnormalities are common in intensive care unit (ICU) patients, the clinical incidence of ICU-acquired neuromuscular disorders in patients recovering from severe illness remains unknown.

Objectives  To assess the clinical incidence, risk factors, and outcomes of ICU-acquired paresis (ICUAP) during recovery from critical illness in the ICU and to determine the electrophysiologic and histologic patterns in patients with ICUAP.

Design  Prospective cohort study conducted from March 1999 to June 2000.

Setting  Three medical and 2 surgical ICUs in 4 hospitals in France.

Participants  All consecutive ICU patients without preexisting neuromuscular disease who underwent mechanical ventilation for 7 or more days were screened daily for awakening. The first day a patient was considered awake was day 1. Patients with severe muscle weakness on day 7 were considered to have ICUAP.

Main Outcome Measures  Incidence and duration of ICUAP, risk factors for ICUAP, and comparative duration of mechanical ventilation between ICUAP and control patients.

Results  Among the 95 patients who achieved satisfactory awakening, the incidence of ICUAP was 25.3% (95% confidence interval [CI], 16.9%-35.2%). All ICUAP patients had a sensorimotor axonopathy, and all patients who underwent a muscle biopsy had specific muscle involvement not related to nerve involvement. The median duration of ICUAP after day 1 was 21 days. Mean (SD) duration of mechanical ventilation after day 1 was significantly longer in patients with ICUAP compared with those without (18.2 [36.3] vs 7.6 [19.2] days; P = .03). Independent predictors of ICUAP were female sex (odds ratio [OR], 4.66; 95% CI, 1.19-18.30), the number of days with dysfunction of 2 or more organs (OR, 1.28; 95% CI, 1.11-1.49), duration of mechanical ventilation (OR, 1.10; 95% CI, 1.00-1.22), and administration of corticosteroids (OR, 14.90; 95% CI, 3.20-69.80) before day 1.

Conclusions  Identified using simple bedside clinical criteria, ICUAP was frequent during recovery from critical illness and was associated with a prolonged duration of mechanical ventilation. Our findings suggest an important role of corticosteroids in the development of ICUAP.

Author Affiliations: Réanimation Médicale, Centre Hospitalier de Poissy-Saint-Germain en Laye, Poissy, France (Drs De Jonghe and Outin); Réanimation Médicale, Hôpital Raymond Poincaré, Garches, France (Drs Sharshar and Raphaël); Service de Physiologie–Explorations Fonctionnelles (Drs Lefaucheur and Mesrati), Département de Pathologie (Dr Authier), Santé Publique (Drs Durand-Zaleski and Bastuji-Garin), Réanimation Médicale (Dr Boussarsar), and Réanimation Chirurgicale (Dr Cerf), Hôpital Henri Mondor, Créteil, France; and Réanimation Polyvalente, Hôpital Lariboisière (Dr Renaud), and Réanimation Polyvalente, Fondation-Hôpital Saint-Joseph (Dr Carlet), Paris, France.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED LETTERS

Paresis Following Mechanical Ventilation
Nicola Latronico
JAMA. 2003;289(13):1633-1634.
EXTRACT | FULL TEXT  

Paresis Following Mechanical Ventilation
Syed Ahmed, Yizhak Kupfer, and Sidney Tessler
JAMA. 2003;289(13):1634.
EXTRACT | FULL TEXT  

Paresis Following Mechanical Ventilation
Steffen Weber-Carstens, Sven Bercker, Thilo Busch, and Udo Kaisers
JAMA. 2003;289(13):1634.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Short-term Systemic Effect of Electrical Muscle Stimulation in Critically Ill Patients
Gerovasili et al.
Chest 2009;136:1249-1256.
ABSTRACT | FULL TEXT  

Critical Illness Polyneuromyopathy in a Child with Severe Demyelinating Myelitis
Adamovic et al.
J Child Neurol 2009;24:758-762.
ABSTRACT  

Early short-term versus prolonged low-dose methylprednisolone therapy in acute lung injury
Silva et al.
Eur Respir J 2009;33:634-645.
ABSTRACT | FULL TEXT  

Can Hand Dynamometry Serve as a Simple Test to Identify ICU-acquired Paresis?
Lee
Am. J. Respir. Crit. Care Med. 2009;179:329-329.
FULL TEXT  

Mobilizing Patients in the Intensive Care Unit: Improving Neuromuscular Weakness and Physical Function
Needham
JAMA 2008;300:1685-1690.
ABSTRACT | FULL TEXT  

Effects of glucocorticoids in ventilated piglets with severe pneumonia
Sibila et al.
Eur Respir J 2008;32:1037-1046.
ABSTRACT | FULL TEXT  

Corticosteroids in severe pneumonia
Sibila et al.
Eur Respir J 2008;32:259-264.
ABSTRACT | FULL TEXT  

Acquired Weakness, Handgrip Strength, and Mortality in Critically Ill Patients
Ali et al.
Am. J. Respir. Crit. Care Med. 2008;178:261-268.
ABSTRACT | FULL TEXT  

Mobility Interventions to Improve Outcomes in Patients Undergoing Prolonged Mechanical Ventilation: A Review of the Literature
Choi et al.
Biol Res Nurs 2008;10:21-33.
ABSTRACT  

Approach to critical illness polyneuropathy and myopathy
Pati et al.
Postgrad. Med. J. 2008;84:354-360.
ABSTRACT | FULL TEXT  

Hydrocortisone Therapy for Patients with Septic Shock
Sprung et al.
NEJM 2008;358:111-124.
ABSTRACT | FULL TEXT  

Weaning from mechanical ventilation
Boles et al.
Eur Respir J 2007;29:1033-1056.
ABSTRACT | FULL TEXT  

ICU-Acquired Weakness
Schweickert and Hall
Chest 2007;131:1541-1549.
ABSTRACT | FULL TEXT  

Nonventilatory Treatments for Acute Lung Injury and ARDS
Calfee and Matthay
Chest 2007;131:913-920.
ABSTRACT | FULL TEXT  

Critical Illness Neuromyopathy: From Risk Factors to Prevention
De Jonghe and Finfer
Am. J. Respir. Crit. Care Med. 2007;175:424-425.
FULL TEXT  

Impact of Intensive Insulin Therapy on Neuromuscular Complications and Ventilator Dependency in the Medical Intensive Care Unit
Hermans et al.
Am. J. Respir. Crit. Care Med. 2007;175:480-489.
ABSTRACT | FULL TEXT  

Effects of Physical Training on Functional Status in Patients With Prolonged Mechanical Ventilation
Chiang et al.
ptjournal 2006;86:1271-1281.
ABSTRACT | FULL TEXT  

Efficacy and safety of corticosteroids for persistent acute respiratory distress syndrome.
The National Heart, Lung, and Blood Institute Acut
NEJM 2006;354:1671-1684.
ABSTRACT | FULL TEXT  

Origin of ICU acquired paresis determined by direct muscle stimulation
Lefaucheur et al.
J. Neurol. Neurosurg. Psychiatry 2006;77:500-506.
ABSTRACT | FULL TEXT  

Impact of Ventilator-Associated Pneumonia on Outcome in Patients With COPD
Nseir et al.
Chest 2005;128:1650-1656.
ABSTRACT | FULL TEXT  

Myopathic Changes Associated With Severe Acute Respiratory Syndrome: A Postmortem Case Series
Leung et al.
Arch Neurol 2005;62:1113-1117.
ABSTRACT | FULL TEXT  

Insulin therapy protects the central and peripheral nervous system of intensive care patients
Van den Berghe et al.
Neurology 2005;64:1348-1353.
ABSTRACT | FULL TEXT  

Clinical Issues and Research in Respiratory Failure from Severe Acute Respiratory Syndrome
Levy et al.
Am. J. Respir. Crit. Care Med. 2005;171:518-526.
ABSTRACT | FULL TEXT  

Train-of-Four To Monitor Neuromuscular Blockade?
Sessler
Chest 2004;126:1018-1022.
FULL TEXT  

Editorial III: Corticosteroids for septic shock--a standard of care?
Bloomfield and Noble
Br J Anaesth 2004;93:178-180.
FULL TEXT  

Acute effect of oral steroids on muscle function in chronic obstructive pulmonary disease
Hopkinson et al.
Eur Respir J 2004;24:137-142.
ABSTRACT | FULL TEXT  

Ventilator-induced Diaphragmatic Dysfunction
Vassilakopoulos and Petrof
Am. J. Respir. Crit. Care Med. 2004;169:336-341.
FULL TEXT  

Acquired Neuromuscular Disorders in the Intensive Care Unit
Deem et al.
Am. J. Respir. Crit. Care Med. 2003;168:735-739.
FULL TEXT  

Disorders of the Respiratory Muscles
Laghi and Tobin
Am. J. Respir. Crit. Care Med. 2003;168:10-48.
ABSTRACT | FULL TEXT  

Paresis Following Mechanical Ventilation
Ahmed et al.
JAMA 2003;289:1634-1634.
FULL TEXT  

Paresis Following Mechanical Ventilation
Latronico
JAMA 2003;289:1633-1634.
FULL TEXT  

Paresis Following Mechanical Ventilation
Weber-Carstens et al.
JAMA 2003;289:1634-1634.
FULL TEXT  

Neuromuscular Sequelae of Critical Illness
Hudson and Lee
NEJM 2003;348:745-747.
FULL TEXT  

Neuropathic and Myopathic Weakness in ICU Patients
JWatch General 2003;2003:3-3.
FULL TEXT