Paresis Acquired in the Intensive Care Unit A Prospective Multicenter Study

作者：Bernard De Jonghe · 发表于：JAMA · 年份：2002 · DOI：10.1001/jama.288.22.2859 · 被引用次数：1534 · 研究领域：Intensive Care Unit Cognitive Disorders、Myasthenia Gravis and Thymoma、Peripheral Neuropathies and Disorders

CONTEXT: Although electrophysiologic and histologic neuromuscular abnormalities are common in intensive care unit (ICU) patients, the clinical incidence of ICU-acquired neuromuscular disorders in patients recovering from severe illness remains unknown. OBJECTIVES: To assess the clinical incidence, risk factors, and outcomes of ICU-acquired paresis (ICUAP) during recovery from critical illness in the ICU and to determine the electrophysiologic and histologic patterns in patients with ICUAP. DESIGN: Prospective cohort study conducted from March 1999 to June 2000. SETTING: Three medical and 2 surgical ICUs in 4 hospitals in France. PARTICIPANTS: All consecutive ICU patients without preexisting neuromuscular disease who underwent mechanical ventilation for 7 or more days were screened daily for awakening. The first day a patient was considered awake was day 1. Patients with severe muscle weakness on day 7 were considered to have ICUAP. MAIN OUTCOME MEASURES: Incidence and duration of ICUAP, risk factors for ICUAP, and comparative duration of mechanical ventilation between ICUAP and control patients. RESULTS: Among the 95 patients who achieved satisfactory awakening, the incidence of ICUAP was 25.3% (95% confidence interval [CI], 16.9%-35.2%). All ICUAP patients had a sensorimotor axonopathy, and all patients who underwent a muscle biopsy had specific muscle involvement not related to nerve involvement. The median duration of ICUAP after day 1 was 21 days. Mean (SD) duration of me...