CQ18. ICU-acquired weakness (ICU-AW) Post ... - …

1 Doi doi: CQ18. ICU-acquired weakness (ICU-AW) Post-Intensive Care Syndrome PICS .. ICU 2010 Society of Critical Care Medicine ICU-acquired weakness (ICU-AW) Post-Intensive Care Syndrome PICS 1) ICU-AW. ICU PICS ICU . ICU ICU . PICS ICU-AW . ICU . 2016 ICU-AW . PICS Clinical Question .. ICU-acquired weakness ICU . 2) Critical Illness Polyneuropathy (CIP) Critical Illness Myopathy (CIM) . ICU-acquired weakness (ICU-AW) . 46 ICU-AW 3) . ICU-AW CIP CIM CIM CIP 4) . ICU-AW CIM CIP . 5) . 6,7) Stevens 3) . ICU-AW . 7) . 2014 American Thoracic Society ICU-AW 8) . 31 ICU-AW 84 . 26/31 EMG 90% 28/31 NCS 84 26/31 . MMT MRC Medical Research Council . 9) MMT MRC EMG NCS MRC 60 . 48 .. ICU-AW 10) . 262 . 504 64% vs. 30%, P< . ICU-AW . Post-Intensive Care Syndrome 2010 Post-Intensive Care Syndrome PICS . 1) PICS ICU ICU ICU .. 2012 2 PICS.

2 11) . PICS 4 ICU .. PICS 2000 Nelson 12) . PTSD . PICS PICS .. ICU . PICS ICU 2010 Jones 13) . ICU PTSD PICS . 1 . 14) . 1. ICU-AW PICS RCT . 2 CQ .. ICU-AW PICS .. 1) Needham DM, Davidson J, Cohen H, et al. Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders' conference. Crit Care Med 2012;40:502-9. 2) Kress JP, Hall JB. ICU-acquired weakness and recovery from critical illness. N Engl J Med 2014;370:1626-35. 3) Stevens RD, Dowdy DW, Michaels RK, et al. Neuromuscular dysfunction acquired in critical illness: a systematic review. Intensive Care Med 2007;33:1876-91. 4) Koch S, Spuler S, Deja M, et al. Critical illness myopathy is frequent: accompanying neuropathy protracts ICU. discharge. Journal of Neurology, Neurosurgery & Psychiatry 2011;82:287-93. 5) Koch S, Wollersheim T, Bierbrauer J, et al.

3 Long-term recovery In critical illness myopathy is complete, contrary to polyneuropathy. Muscle & Nerve 2014;50:431-6. 6) Deconinck N, Van Parijs V, Beckers-Bleukx G, et al. Critical illness myopathy unrelated to corticosteroids or neuromuscular blocking agents. Neuromuscul Disord 1998;8:186-92. 7) Callahan LA, Supinski GS. Sepsis-induced myopathy. Crit Care Med 2009;37:S354-67. 8) Fan E, Cheek F, Chlan L, et al. An Official American Thoracic Society Clinical Practice Guideline: The Diagnosis of Intensive Care Unit acquired weakness in Adults. Am J Respir Crit Care Med 2014;190:1437 46. 9) Kleyweg RP, van der Meche FG, Meulstee J. Treatment of Guillain-Barre syndrome with high-dose gammaglobulin. Neurology 1988;38:1639-41. 10) Schefold JC, Bierbrauer J, Weber-Carstens S. Intensive care unit-acquired weakness (ICU-AW) and muscle wasting in critically ill patients with severe sepsis and septic shock.

4 J Cachexia Sarcopenia Muscle 2010;1:147-57. 11) Elliott D, Davidson JE, Harvey MA, et al. Exploring the scope of post-intensive care syndrome therapy and care: engagement of non-critical care providers and survivors in a second stakeholders meeting. Crit Care Med 2014;42:2518-26. 12) Nelson BJ, Weinert CR, Bury CL, et al. Intensive care unit drug use and subsequent quality of life in acute lung injury patients. Crit Care Med 2000;28:3626-30. 13) Jones C, Backman C, Capuzzo M, et al. Intensive care diaries reduce new onset post traumatic stress disorder following critical illness: a randomised, controlled trial. Crit Care 2010;14:R168. 14) Prescott HC, Langa KM, Liu V, et al. Increased 1-year healthcare use in survivors of severe sepsis. Am J Respir Crit Care Med. 2014;190:62-9. 2. CQ 18-1: ICU-AW .. ICU-AW (2C) .. 1. CQ . ICU-AW ICU ICU-AW.

5 1)2) . 3) CQ . ICU-AW . 2. PICO. P . I . C . O ICU-AW ICU . 3.. CQ Routsi C 20104), Kho ME 20155), Hermans G 20146), Abu-Khaber HA 20137), Karatzanos E 20128), Zanotti E 20039), Burke D 201410) 7 .. ICU-AW RCT 2 4),5) Routsi 4) . Intention-to-treat 6) Kho 5) ICU-AW .. / . RCT3 7)-9) 10) . 72 .. ICU .. 4.. C . 3.. ICU-AW CQ 2 . C . 5.. ICU-AW .. 6.. 7.. 8.. or . 9.. ICU . 10.. 1 .. 11.. 12.. CQ ICU-AW . 19 19 . 13.. 2015.. B .. 1) Vivodtzev I, P pin JL, Vottero G, et al. Improvement in quadriceps strength and dyspnea in daily tasks after 1 month of electrical stimulation in severely deconditioned and malnourished COPD. Chest 2006;129:1540-8. 2) Nuhr MJ, Pette D, Berger R, et al. Beneficial effects of chronic low-frequency stimulation of thigh muscles in patients with advanced chronic heart failure. Eur Heart J 2004;25:136-43.

6 3) Sillen MJ, Speksnijder CM, Eterman RM, et al. Effects of neuromuscular electrical stimulation of muscles of ambulation in patients with chronic heart failure or COPD: a systematic review of the English-language literature. Chest 2009;136:44-61. 4) Routsi C Gerovasili V Vasileieiadis I et al. Electrical muscle stimulation prevents critical illness polyneuromyopathy: a randomized parallel intervention trial. Crit Care 2010;14:R74. 5) Kho ME Truong AD Zanni JM et al. Neuromuscular electrical stimulation in mechanically ventilated patients: a randomized, sham-controlled pilot trial with blinded outcome assessment. J Crit Care 2015;30:32-9. 6) Hermans G De Jonghe B Bruyninckx F et al. Interventions for preventing critical illness polyneuropathy and critical illness myopathy. Cochrane Database Syst Rev 2014;1 4. 7) Abu-Khaber HA, Abouelela AMZ, Abdelkarim EM.

7 Effect of electrical muscle weakness and facilitating weaning from mechanical ventilation. Alexandria Journal of Medicine 2013;49:309-15. 8) Karatzanos E, Gerovasili V, Zervakis D, et al. Electrical muscle stimulation: an effective form of exercise and early mobilization to preserve muscle strength in critically ill patients. Crit Care Res Pract 2012;2012:432752. 9) Zanotti E, Felicetti G, Maini M, et al. Peripheral muscle strength training in bed-bound patients with COPD receiving mechanical ventilation: effect of electrical stimulation. Chest 2003;124:292-6. 10) Burke D, Gorman E, Stokes D, et al. An evaluation of neuromuscular electrical stimulation in critical care using the ICF framework: a systematic review and meta-analysis. Clin Respir J 2014;10:407-20.. ICU-AW . ICU ICU-AW. RCT .. 5. CQ 18-2: PICS ICU-AW .. PICS 2C.

8 1. CQ . ICU ICU PICS .. RCT . RCT . RCT ICU 1 .. RCT 8 1)-8) PICS ICUAW ICUAW . 6 6-Minute Working Distance 6 MWD Medical Research Council MRC . Short Form-36 Physical Functioning SF-36 PF EuroQol-5 Dimensions EQ5D Hospital Anxiety and Depression Scale HADS . 6 MWD . RCT 1 2 .. ICU .. 8,9) Adler .. 9). 1 RASS -3 . RASS 2 . 2 .. 3 70% . 20% . 40 / 130 / .. 4 180mmHg 20% . 65mmHg 100mmHg . 5 5 / 40 / . 6 SpO2 4% . 88-90%. 7 FiO2 PEEP 10cmH2O.. 6. 2. PICO. P . I . C . O ICU-AW ICU-AW 6 6-Minute Working Distance . 6 MWD Medical Research Council MRC Short Form-36 Physical Functioning SF-36 PF . EuroQol-5 Dimensions EQ5D Hospital Anxiety and Depression Scale HADS . 3.. Brummel 20141), Burtin 20092), Dantas 20123), Denehy 20134), Jones 20155), Kayambu 20156), Pattanshetty 20107), Schweickert 20098), Adler 20129) 9 .. RCT PICS . 6 MWD /4 /.

9 4.. C .. ICU-AW PICS RCT . RCT .. C( ) . 5.. PICS ICU-AW MRC 6 MWD .. ICU median/IQR . mean/SD . 6.. 7.. 7.. 8.. 9.. ICU .. 10.. 11.. PICS ICU .. 12.. CQ PICS . 19 19 . PICS . 13.. PICS .. 1) Brummel NE, Girard TD, Ely EW, et al. Feasibility and safety of early combined cognitive and physical therapy for critically ill medical and surgical patients: the Activity and Cognitive Therapy in ICU (ACT-ICU) trial. Intensive Care Med 2014;40:370-9. 2)Burtin C, Clerckx B, Robbeets C, et al. Early exercise in critically ill patients enhances short-term functional recovery. Crit Care Med 2009;37:2499-505. 3)Dantas CM, Silva PF, Siqueira FH, et al. Influence of early mobilization on respiratory and peripheral muscle strength in critically ill patients. Rev Bras Ter Intensiva 2012;24:173-8. 4) Denehy L, Skinner EH, Edbrooke L, et al. Exercise rehabilitation for patients with critical illness: a randomized controlled trial with 12 months of follow-up.

10 Crit Care 2013;17:R156. 5) Jones C, Eddleston J, McCairn A, et al. Improving rehabilitation after critical illness through outpatient physiotherapy classes and essential amino acid supplement: A randomized controlled trial. J Crit Care 2015;30:901-7. 6) Kayambu G, Boots R, Paratz J. Early physical rehabilitation in intensive care patients with sepsis syndromes: a pilot randomised controlled trial. Intensive Care Med 2015;41:865-74. 7) Pattanshetty RB, Gaude GS. Effect of multimodality chest physiotherapy in prevention of ventilator-associated pneumonia: A randomized clinical trial. Indian J Crit Care Med 2010;14:70-6. 8) Schweickert WD, Pohlman MC, Pohlman AS, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet 2009;373:1874-82. 9) Adler J, Malone D.