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Crit Care Med. 2009 Dec;37(12):3047-53. doi: 10.1097/CCM.0b013e3181b027e9.

Presence and severity of intensive care unit-acquired paresis at time of awakening are associated with increased intensive care unit and hospital mortality.

Author information

1
Department of Intensive Care Medicine, Raymond Poincaré Hospital, University Versailles Saint-Quentin en Yvelines, Garches, France. tarek.sharshar@rpc.aphp.fr

Abstract

OBJECTIVES:

To assess whether the presence and severity of intensive care unit-acquired paresis are associated with intensive care unit and in-hospital mortality.

DESIGN:

Prospective, observational study.

SETTING:

Two medical, one surgical, and one medico-surgical intensive care units in two university hospitals and one university-affiliated hospital.

PATIENTS:

A total of 115 consecutive patients were enrolled after > 7 days of mechanical ventilation.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

The Medical Research Council score (from 0-60) was used to evaluate upper and lower limb strength at time of awakening, identified as the ability to follow five commands. Intensive care unit-acquired paresis was defined as a Medical Research Council score <48. Patients were followed-up until hospital discharge. The primary end point was hospital mortality. At awakening, median Medical Research Council score was 41 (interquartile range, 21-52), and 75 (65%) patients had intensive care unit-acquired paresis. Hospital non-survivors had a significantly lower Medical Research Council score at awakening (21 [11-43]) vs. 41 [28-53]; p = .008) and a significantly higher rate of intensive care unit-acquired paresis (85.1% vs. 58.4%; p = .02) compared to survivors. After multivariate risk adjustment, intensive care unit-acquired paresis was independently associated with higher hospital and intensive care unit mortality (odds ratio for hospital mortality, 2.02; 95% confidence interval, 1.03-8.03; p = .048). Each Medical Research Council point decrease was associated with a significantly higher hospital mortality (odds ratio, 1.03; 95% confidence interval, 1.01-1.05; p = .033).

CONCLUSIONS:

Both the presence and severity of intensive care unit-acquired paresis at the time of awakening are associated with increased intensive care unit and hospital mortality; the mechanisms underlying this association need further study.

Comment in

PMID:
19770751
DOI:
10.1097/CCM.0b013e3181b027e9
[Indexed for MEDLINE]

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