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Observational studies of patients receiving prolonged mechanical ventilation and other forms of critical care support have determined acquired neuromuscular disorders to be extremely common. Early studies used electrophysiologic investigations to diagnose critical illness polyneuropathy (CIP) and muscle biopsy to confirm critical illness myopathy (CIM). More recent approaches seek to obviate these invasive techniques and build on a standardized bedside neuromuscular examination to identify patients with acquired weakness syndromes. Serial examination in the alert patient may serve as a reasonable prognosticator for most patients. The importance of ICU-acquired weakness syndromes is supported by the observation that muscle wasting and weakness are among the most prominent long-term complications of survivors of ARDS. In addition, a strong association appears to exist between acquired weakness and protracted ventilator dependence, an important determinant of ICU length of stay. Multivariate analysis has identified several risk factors associated with increased incidence for ICU-acquired weakness, including severe systemic inflammation, medications (specifically, corticosteroids and neuromuscular blocking agents), glycemic control, and immobility. We advocate an approach to this common syndrome that identifies risk factors early in the hope of minimizing their impact. 相似文献
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Juultje Sommers Emily Klooster Siebrand B. Zoethout Huub L.A. van den Oever Frans Nollet Robert Tepaske Janneke Horn Raoul H.H. Engelbert Marike van der Schaaf 《Archives of physical medicine and rehabilitation》2019,100(2):239-246
Objective
To evaluate the feasibility and safety of exercise testing and to describe the physiological response to exercise of patients in the Intensive Care Unit (ICU).Design
A prospective observational multicenter study.Setting
Two mixed medical-surgical ICUs.Participants
Patients (N=37; with no primary neurological disorders, 59% men; median age 50y; ICU length of stay 14.5d; Acute Physiology and Chronic Health Evaluation IV 73.0) who had been mechanically ventilated for more than 48 hours and were hemodynamically stable enough to perform physical exercise.Interventions
A passive or active incremental exercise test, depending on muscle strength, on a bed-based cycle ergometer.Main Outcome Measures
Feasibility and safety were evaluated based on protocol adherence and adverse events. Physiological responses to exercise quantified as changes in respiratory frequency (RF), oxygen uptake (Vo2), carbon dioxide output (Vco2), respiratory exchange ratio (RER), and blood lactate.Results
Thirty-seven patients of whom 18 were mechanically ventilated underwent the exercise test. The active incremental test was performed by 28, and the passive test by 9 participants. Thirty-three (89%) accomplished the test according to the protocol and 1 moderate severe adverse event (bradycardia; heart rate 44) occurred shortly after the test. RF, Vo2, Vco2, and lactate increased significantly, whereas RER did not change during the active incremental exercise test. No changes were observed during the passive exercise test.Conclusions
It is safe and feasible to perform exercise testing on a bed-based cycle ergometer in patients who are critically ill and a physiological response could be measured. Future research should investigate the clinical value of exercise testing in daily ICU practice and whether exercise capacity and its limiting factors could be determined by incremental exercise testing. 相似文献3.
目的：探讨多学科协作早期运动对预防ICU机械通气患者获得性衰弱的影响。方法：将100例机械通气患者按照随机数字表分成观察组和对照组各50例,所有患者遵循国际认可的机械通气患者早期四步运动锻炼方案。对照组采取传统医护合作模式;观察组患者由多学科协作早期运动治疗小组成员对患者进行康复运动指导及监督。对两组干预后的相关指标进行比较。结果：观察组患者开始下床时间、机械通气时间、住ICU时间均少于对照组,差异有统计学意义（P<0.05）;观察组患者ICU获得性衰弱、VAP和谵妄发生率均低于对照组,差异有统计学意义（P<0.05）。结论：多学科协作可以保证机械通气患者早期运动的有效实施,促进患者的康复,降低各种并发症的发生。 相似文献
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目的观察温和灸联合补中益气汤干预脾胃虚弱型ICU获得性肌无力(ICU-AW)的临床疗效。方法将70例ICU-AW患者随机分为对照组和观察组,每组35例。对照组予ICU常规治疗,观察组在此基础上予温和灸联合补中益气汤治疗,疗程为1个月。治疗前后评定医学研究委员会(MRC)评分、改良Barthel指数(MBI)评分、功能性步行量表(FAC)及Berg平衡量表(BBS)评分,并于治疗前后测定患者静脉血白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)及胰岛素样生长因子-1(IGF-1)水平。结果观察组治疗后MRC、MBI、FAC及BBS评分均明显升高(P<0.05),且与对照组比较差异有统计学意义(P<0.05);观察组治疗后外周血IL-6、TNF-α水平明显降低,IGF-1水平明显升高(P<0.05),且与对照组比较差异有统计学意义(P<0.05)。结论基于常规治疗,温和灸联合补中益气汤可明显增强脾胃虚弱型ICU-AW患者的四肢肌力,提升患者生活自理能力、步行能力及平衡能力,并有助于纠正外周血IL-6、TNF-α、IGF-1的水平。 相似文献
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目的:系统评价神经肌肉电刺激对ICU患者肌力及临床结局的干预效果。方法:计算机检索Cochrane Library、Web of Science、PubMed、中国知网、维普以及万方数据库中从建库至2018年12月公开发表的关于神经肌肉电刺激在ICU患者中应用效果的随机对照试验,由两名研究人员独立对文献筛选、数据提取和文献质量进行评价。采用Revman5.3软件对符合质量标准的文献中的结局指标进行Meta分析。结果:共纳入14篇文献。6篇文献报告了患者的MRC总评分,Meta分析结果显示：观察组MRC总评分高于对照组［MD=4.14,95%CI（2.69,5.58）,P＜0.01］;6篇文献报道了患者住ICU期间的机械通气时间,Meta分析结果显示：观察组机械通气时间较对照组明显缩短［MD=-2.19,95%(-4.09,-0.30),P=0.02］;5篇文献报道了患者的住ICU时间,Meta分析结果显示: 观察组住ICU时间较对照组明显缩短［MD=-1.80,95%CI（-3.33,-0.27）,P=0.02］。结论:神经肌肉电刺激在ICU患者中应用是安全有效的,可提高MRC评分,缩短机械通气时间和住ICU时间,但仍需要多中心、大样本随机对照试验进一步证明。 相似文献
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