Long-term functional deficiencies of ICU-acquired 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 ,F i r s t C r i t i c a l C a r e D e p a r t m e n t , E v a n g e l i s m o s H o s p i t a l , A t h e n s , G r e e c e

Study Aims Results Conclusion

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Methods

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.

Results ConclusionMethods

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.

• The patients were evaluated with MRC

every week until their discharge from the hospital.

• Functional ability was evaluated by the FIM score (Functional Independence Measure, 18-126) and by the subscale of SF-36 (physical functioning) at 3 and 6 months from hospital discharge.

Methods 2.

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Results Conclusion

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• 12 muscle groups

• The muscular strength (0-5)

• Maximum score 60

• Cut off < 48/60

MRC Scale

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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.

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• 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

SF-36

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• At hospital discharge patients with ICUAW had significant lower MRC score (mean± SD: 50±9 vs 58±2, p<0.001). [Fig.1].

• At hospital discharge patients with ICUAW had significant reduced FIM total score (mean± SD: 65±22 vs 99± 24, p<0.001).[Fig.2] compared to those who did not.

Results 1.

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(mean ± SD)

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• 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 ). [Fig.3] and 103± 24 vs 123± 6, p<0,001 respectively) [Fig.4]

• 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 ).

Results 2.

Conclusion

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(mean ± SD)

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Figure 1.MRC score in patients with ICUAW and without assessed at Hospital discharge.

(Boxplots represent median value, 25th-75th percentile and range)Back

P<0.001

Figure 2.FIM score in patients with ICUAW and without assessed at Hospital discharge.

(Boxplots represent median value, 25th-75th percentile and range)Back

P<0.001

Figure 3.FIM score in patients with ICUAW and without assessed 3 months after hospital discharge .

(Boxplots represent median value, 25th-75th percentile and range)Back

P<0.05

Figure 4.FIM score in patients with ICUAW and without assessed 6 months after hospital discharge .

(Boxplots represent median value, 25th-75th percentile and range)

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P<0.001

• 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 1.

• 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.

Conclusion 2.

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