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Paresis Acquired in the Intensive Care Unit
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.
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