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Chest. 2018 Oct;154(4):781-787. doi: 10.1016/j.chest.2018.07.016. Epub 2018 Sep 11.

Impact of Vasoactive Medications on ICU-Acquired Weakness in Mechanically Ventilated Patients.

Author information

1
Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL. Electronic address: krysta.wolfe@uchospitals.edu.
2
Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL.
3
Department of Medicine, University of Chicago, Chicago, IL.
4
Section of Pulmonary and Critical Care, Department of Medicine, University of Washington, Seattle, WA.

Abstract

BACKGROUND:

Vasoactive medications are commonly used in the treatment of critically ill patients, but their impact on the development of ICU-acquired weakness is not well described. The objective of this study is to evaluate the relationship between vasoactive medication use and the outcome of ICU-acquired weakness.

METHODS:

This is a secondary analysis of mechanically ventilated patients (N = 172) enrolled in a randomized clinical trial of early occupational and physical therapy vs conventional therapy, which evaluated the end point of ICU-acquired weakness on hospital discharge. Patients underwent bedside muscle strength testing by a therapist blinded to study allocation to evaluate for ICU-acquired weakness. The effects of vasoactive medication use on the incidence of ICU-acquired weakness in this population were assessed.

RESULTS:

On logistic regression analysis, the use of vasoactive medications increased the odds of developing ICU-acquired weakness (odds ratio [OR], 3.2; P = .01) independent of all other established risk factors for weakness. Duration of vasoactive medication use (in days) (OR, 1.35; P = .004) and cumulative norepinephrine dose (μg/kg/d) (OR, 1.01; P = .02) (but not vasopressin or phenylephrine) were also independently associated with the outcome of ICU-acquired weakness.

CONCLUSIONS:

In mechanically ventilated patients enrolled in a randomized clinical trial of early mobilization, the use of vasoactive medications was independently associated with the development of ICU-acquired weakness. Prospective trials to further evaluate this relationship are merited.

TRIAL REGISTRY:

ClinicalTrials.gov; No.: NCT01777035; URL: www.clinicaltrials.gov.

KEYWORDS:

ICUs; critical care outcomes; critical illness; humans; muscle weakness; vasoconstrictor agents

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