TY - JOUR
T1 - The ICM research agenda on intensive care unit-acquired weakness
AU - Latronico, Nicola
AU - Herridge, Margaret
AU - Hopkins, Ramona O.
AU - Angus, Derek
AU - Hart, Nicholas
AU - Hermans, Greet
AU - Iwashyna, Theodore
AU - Arabi, Yaseen
AU - Citerio, Giuseppe
AU - Wesley Ely, E.
AU - Hall, Jesse
AU - Mehta, Sangeeta
AU - Puntillo, Kathleen
AU - Van den Hoeven, Johannes
AU - Wunsch, Hannah
AU - Cook, Deborah
AU - Dos Santos, Claudia
AU - Rubenfeld, Gordon
AU - Vincent, Jean Louis
AU - Van den Berghe, Greet
AU - Azoulay, Elie
AU - Needham, Dale M.
N1 - Publisher Copyright:
© 2017, Springer-Verlag Berlin Heidelberg and ESICM.
PY - 2017/9/1
Y1 - 2017/9/1
N2 - We present areas of uncertainty concerning intensive care unit-acquired weakness (ICUAW) and identify areas for future research. Age, pre-ICU functional and cognitive state, concurrent illness, frailty, and health trajectories impact outcomes and should be assessed to stratify patients. In the ICU, early assessment of limb and diaphragm muscle strength and function using nonvolitional tests may be useful, but comparison with established methods of global and specific muscle strength and physical function and determination of their reliability and normal values would be important to advance these techniques. Serial measurements of limb and respiratory muscle strength, and systematic screening for dysphagia, would be helpful to clarify if and how weakness of these muscle groups is independently associated with outcome. ICUAW, delirium, and sedatives and analgesics may interact with each other, amplifying the effects of each individual factor. Reduced mobility in patients with hypoactive delirium needs investigations into dysfunction of central and peripheral nervous system motor pathways. Interventional nutritional studies should include muscle mass, strength, and physical function as outcomes, and prioritize elucidation of mechanisms. At follow-up, ICU survivors may suffer from prolonged muscle weakness and wasting and other physical impairments, as well as fatigue without demonstrable weakness on examination. Further studies should evaluate the prevalence and severity of fatigue in ICU survivors and define its association with psychiatric disorders, pain, cognitive impairment, and axonal loss. Finally, methodological issues, including accounting for baseline status, handling of missing data, and inclusion of patient-centered outcome measures should be addressed in future studies.
AB - We present areas of uncertainty concerning intensive care unit-acquired weakness (ICUAW) and identify areas for future research. Age, pre-ICU functional and cognitive state, concurrent illness, frailty, and health trajectories impact outcomes and should be assessed to stratify patients. In the ICU, early assessment of limb and diaphragm muscle strength and function using nonvolitional tests may be useful, but comparison with established methods of global and specific muscle strength and physical function and determination of their reliability and normal values would be important to advance these techniques. Serial measurements of limb and respiratory muscle strength, and systematic screening for dysphagia, would be helpful to clarify if and how weakness of these muscle groups is independently associated with outcome. ICUAW, delirium, and sedatives and analgesics may interact with each other, amplifying the effects of each individual factor. Reduced mobility in patients with hypoactive delirium needs investigations into dysfunction of central and peripheral nervous system motor pathways. Interventional nutritional studies should include muscle mass, strength, and physical function as outcomes, and prioritize elucidation of mechanisms. At follow-up, ICU survivors may suffer from prolonged muscle weakness and wasting and other physical impairments, as well as fatigue without demonstrable weakness on examination. Further studies should evaluate the prevalence and severity of fatigue in ICU survivors and define its association with psychiatric disorders, pain, cognitive impairment, and axonal loss. Finally, methodological issues, including accounting for baseline status, handling of missing data, and inclusion of patient-centered outcome measures should be addressed in future studies.
KW - Disability
KW - Fatigue
KW - Muscle weakness
KW - Myopathy
KW - Pain
KW - Physical impairment
KW - Polyneuropathy
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U2 - 10.1007/s00134-017-4757-5
DO - 10.1007/s00134-017-4757-5
M3 - Article
C2 - 28289812
AN - SCOPUS:85015092953
SN - 0342-4642
VL - 43
SP - 1270
EP - 1281
JO - Intensive Care Medicine
JF - Intensive Care Medicine
IS - 9
ER -