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Muscle weakness a common side effect of long stays in intensive care units
October 28, 2009Doctors need better definitions to prevent and treat physical debility among critically ill
After decades of focusing on the management of respiratory failure, circulatory shock and severe infections that lead to extended stays in hospital intensive care units, critical care researchers are increasingly turning attention to what they believe is a treatable complication developed by many who spend days or weeks confined to an ICU bed: debilitating muscle weakness that can linger long after hospital discharge.
In a supplement to the current issue of the journal Critical Care Medicine, an interdisciplinary research group - from Johns Hopkins and across the world - propose a new classification scheme for helping physicians to uniformly and precisely identify a variety of muscle-wasting disorders acquired in the ICU, a framework that came out of a meeting of leaders in the field in Brussels, Belgium in March 2009.
Getting doctors on the same page with common definitions and awareness is a big first step in preventing and treating ICU-related debility, the researchers say.
"Patients who develop muscle weakness while they're critically ill do much worse," says Robert D. Stevens, M.D., associate professor of anesthesiology and critical care medicine, neurology, neurosurgery and radiology at the Johns Hopkins University School of Medicine. "They have higher mortality, their stay in the ICU is prolonged, their stay in the hospital is prolonged. They incur serious costs. Some of these patients in the long run remain weak and are unable to resume physical activities as before."
Some form of muscle weakness affects nearly half of patients with serious illness treated in intensive care units, or ICUs, the researchers say. But prevention or treatment of ICU-acquired weakness has been slowed, doctors say, by a lack of agreement on the definitions of what constitutes these disorders and an inadequate framework for properly classifying them. New treatments which might be effective in reducing weakness in the ICU include enduring better control of blood sugar levels and promoting early mobility.
Standard practice in ICUs, where patients are often hooked up to ventilators, dialysis machines and infusion pumps, has been to keep patients in bed until they recover from their critical illness. Stevens calls it the "classic paradox" in the treatment of many illnesses: Stay in bed and rest until you're better. It is now recognized, however, that muscle weakness is significantly worsened by being immobilized in ICU, Stevens says, and "that whole idea of bed rest as being something beneficial is being turned on its head." Other hospital units, including those that treat patients coming out of surgery, have adopted the practice of getting patients up and moving again as soon as possible. Only recently has critical care begun to move slowly in that direction. Recognizing the muscle wasting and weakness associated with extended ICU stays, Stevens says new research is promoting reduced levels of sedation and early mobilization and exercise among those patients. Some recent efforts - including work being done at Johns Hopkins - have been to get patients cycling in bed, standing, sitting in a chair and even walking while they are still on respirators.
Along with intensive care unit-acquired weakness (ICUAW), Stevens and his colleagues also define critical illness polyneuropathy (CIP), critical illness neuromyopathy (CINM) and critical illness myopathy (CIM). All of these are disorders that the patient may pick up in the ICU, not something he or she had upon admission.
Johns Hopkins Medical Institutions
Getting doctors on the same page with common definitions and awareness is a big first step in preventing and treating ICU-related debility, the researchers say.
"Patients who develop muscle weakness while they're critically ill do much worse," says Robert D. Stevens, M.D., associate professor of anesthesiology and critical care medicine, neurology, neurosurgery and radiology at the Johns Hopkins University School of Medicine. "They have higher mortality, their stay in the ICU is prolonged, their stay in the hospital is prolonged. They incur serious costs. Some of these patients in the long run remain weak and are unable to resume physical activities as before."
Some form of muscle weakness affects nearly half of patients with serious illness treated in intensive care units, or ICUs, the researchers say. But prevention or treatment of ICU-acquired weakness has been slowed, doctors say, by a lack of agreement on the definitions of what constitutes these disorders and an inadequate framework for properly classifying them. New treatments which might be effective in reducing weakness in the ICU include enduring better control of blood sugar levels and promoting early mobility.
Standard practice in ICUs, where patients are often hooked up to ventilators, dialysis machines and infusion pumps, has been to keep patients in bed until they recover from their critical illness. Stevens calls it the "classic paradox" in the treatment of many illnesses: Stay in bed and rest until you're better. It is now recognized, however, that muscle weakness is significantly worsened by being immobilized in ICU, Stevens says, and "that whole idea of bed rest as being something beneficial is being turned on its head." Other hospital units, including those that treat patients coming out of surgery, have adopted the practice of getting patients up and moving again as soon as possible. Only recently has critical care begun to move slowly in that direction. Recognizing the muscle wasting and weakness associated with extended ICU stays, Stevens says new research is promoting reduced levels of sedation and early mobilization and exercise among those patients. Some recent efforts - including work being done at Johns Hopkins - have been to get patients cycling in bed, standing, sitting in a chair and even walking while they are still on respirators.
Along with intensive care unit-acquired weakness (ICUAW), Stevens and his colleagues also define critical illness polyneuropathy (CIP), critical illness neuromyopathy (CINM) and critical illness myopathy (CIM). All of these are disorders that the patient may pick up in the ICU, not something he or she had upon admission.
Johns Hopkins Medical Institutions
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Multicenter study led by pitt finds early results of therapy for preemies not sustained
Inhaled nitric oxide (iNO), a therapy used in the treatment of premature newborns with respiratory failure that had shown promising results in short-term studies, does not significantly improve long-term outcomes, according to a national study led by critical care researchers at the University of Pittsburgh School of Medicine and Children's Hospital of Pittsburgh of UPMC.
H1N1 critical illness can occur rapidly; predominantly affects young patients
Critical illness among Canadian patients with 2009 influenza A(H1N1) occurred rapidly after hospital admission, often in young adults, and was associated with severely low levels of oxygen in the blood, multi-system organ failure, a need for prolonged mechanical ventilation, and frequent use of rescue therapies.
Most H1N1 patients with respiratory failure treated with oxygenating system survive illness
Despite the severity of disease and the intensity of treatment, most patients in Australia and New Zealand who experienced respiratory failure as a result of 2009 influenza A(H1N1) and were treated with a system that adds oxygen to the patient's blood survived the disease.
Intensive care procedure saves lives: Swine flu study
A research team has warned medical experts in the Northern Hemisphere not to underestimate the serious impact of the H1N1 (Swine flu) virus with a new report showing that many patients who were critically ill with the virus required prolonged life support treatment with heart-lung machines.
Should noninvasive ventilation be considered a high-risk procedure during an epidemic?
Contrary to current policies recommending that non-invasive ventilation be avoided during an infectious outbreak, the author of a commentary in CMAJ (Canadian Medical Association Journal) argues that it should be used expeditiously in this setting.
Implementation of acute care surgery service provides more timely patient care
A new study published in the October issue of the Journal of the American College of Surgeons shows that the establishment of an acute care surgery service can help surgeons at academic medical centers provide more timely care to the growing number of patients who are transferred from the emergency room or smaller hospitals and who require an immediate operation.
Mutation responsible for cystic fibrosis also involved in muscle atrophy
Patients with cystic fibrosis (CF) usually experience significant muscle loss, a symptom traditionally considered to be a secondary complication of the devastating genetic disease.
Nitrous gases and zinc in the crosshairs
The Senate Commission for the Investigation of Health Hazards of Chemical Compounds in the Work Area established by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) has issued the MAK and BAT Values List for 2009. This year's list contains 62 changes and new entries.
Low birth weight linked to long-term respiratory problems
Infants who weigh less than five and a half pounds at birth often enter the world with a host of medical complications, including respiratory problems.
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