Long-term functional deficiencies of ICUacquired weakness: a prospective study
I Patsaki, G Sidiras, V Gerovasili, A Kouvarakos, E Polimerou, G Mitsiou,
A Kardara, A Christakou, M Papadopoulos, V Markaki, S Nanas
N a t i o n a l a n d K a p o d i s t r i a n U n i v e r s i t y, M e d i c a l S c h o o l ,
First Critical Care Department,Evangelismos Hospital, Athens, Gree ce
Study Aims
Methods
Results
Conclusion
Please navigate using mouse/arrows or use buttons to jump to a specific slide
Background and Study Aims
 The incidence of ICU- acquired weakness (ICUAW) is estimated to
be 30%-90% depending on the method and time of diagnosis.
Nanas et al. Acta Neurol Scand. 2008
 One out of three patients that are dismissed from the ICU appear
to face serious functional disorders and one out of four face
decrease mobility.
Fletcher SN et al. Crit Care Med 2003
 The functional ability and muscle strength of patients in relation
to the presence of ICUAW after their discharge from the ICU has
not been extensively studied.
• The aim of this study was to assess the long term effect of ICUAW
on functional ability of ICU survivors.
Methods
Results
Conclusion
Methods 1.
Baseline characteristics (mean ± SD)
• 530 consecutive patients were evaluated
• 98 met the inclusion criteria.
• (M:63,F:35) (age:54±15years).
• Apache II admission score 15±5
• Sofa admission score 6±4
• ICU stay (days) 20±17
• Hospital stay (days) 20±18
• 29 patients were diagnosed clinically with
ICUAW and 69 without, by the Medical
Research Council (MRC) scale.
Methods 2.
• The patients were evaluated with MRC Go to
every week until their discharge from the
hospital.
• Functional ability was evaluated by the FIM
score (Functional Independence Measure, 18Go to
126)
and by the subscale of SF-36
(physical functioning) Go to at 3 and 6 months
from hospital discharge.
Results
Conclusion
MRC Scale
• 12 muscle groups
• The muscular strength
(0-5)
• Maximum score 60
• Cut off < 48/60
Back
FIM Scale
• The Functional Independence Measure (FIM) scale
assesses physical and cognitive disability.
• The FIM scale is used to measure the patient’s
progress and assess rehabilitation outcomes.
• FIM score ranges from 1 to 7, with 1 (Total
Assistance) being the lowest possible score and 7
(Complete Independence) being the best possible
score.
• Possible scores range from 18 to 126, with higher
scores indicating more independence.
Back
SF-36
• The Short Form (36) Health Survey is a survey of patient
health.
• The SF-36 consists of eight scaled scores, which are the
weighted sums of the questions in their section.
• Each scale is directly transformed into a 0-100 scale on
the assumption that each question carries equal weight.
• The eight sections are:
•
•
•
•
•
•
•
•
vitality
physical functioning
bodily pain
general health perceptions
physical role functioning
emotional role functioning
social role functioning
mental health
Back
Results 1.
• At hospital discharge patients with ICUAW had
significant lower MRC score (mean± SD: 50±9 vs
58±2, p<0.001). [Fig.1]. Go to
• At hospital discharge patients with ICUAW had
significant reduced FIM total score (mean± SD:
65±22 vs 99± 24, p<0.001).[Fig.2] Go to
compared
to those who did not.
(mean ± SD)
Results 2.
• The reduced functional ability of patients with ICUAW
persists even after 3 and 6 months after hospital
discharge according to FIM total score (mean± SD:
98± 30 vs 120±10, p< 0,001 ). Go to
[Fig.3] and 103±
24 vs 123± 6, p<0,001 respectively) [Fig.4] Go to
• According to the SF-36 subscale, functional ability in
patients with ICUAW tended to be lower at 3 months
although it did not reach statistical significance
(mean± SD: 45±40 vs 64±34). At 6 months patients
with ICUAW had significant reduced functional ability
(mean± SD: 43± 45 vs 74±31, p< 0,05 respectively ).
(mean ± SD)
Conclusion
Figure 1.
MRC score in patients with ICUAW and without assessed at Hospital
discharge.
P<0.001
(Boxplots represent median value, 25th-75th percentile and range)
Back
Figure 2.
FIM score in patients with ICUAW and without assessed at Hospital
discharge.
P<0.001
(Boxplots represent median value, 25th-75th percentile and range)
Back
Figure 3.
FIM score in patients with ICUAW and without assessed 3 months after
hospital discharge .
P<0.05
(Boxplots represent median value, 25th-75th percentile and range)
Back
Figure 4.
FIM score in patients with ICUAW and without assessed 6 months after
hospital discharge .
P<0.001
(Boxplots represent median value, 25th-75th percentile and range)
Back
Conclusion 1.
• The patients who developed ICUAW had
significant inferior muscle strength at their
ICU discharge and as a consequence they
have significant impaired functional ability at
hospital discharge
• Functional deficiencies for these patients
remain even at 6 months after hospital
discharge.
Conclusion 2.
• These initial findings suggests that the
appearance of ICUAW affects the patients
mobility after their discharge either from the
ICU or from the hospital and persists for
several months after ICU discharge.
• Further studies are needed to evaluate the
effect of this impairment on the quality of life
of these patients and also to evaluate
therapeutic tools for ICUAW.
Back
to top