RESUMO
Palliative care for patients with chronic non-malignant diseases is a less addressed area. In-hospital care, particularly, critical care of elderly population with advanced organ failure, can lead to poor resource management. ICU beds come under the strained resource category, more so in the backdrop of the recent COVID-19 pandemic. Home-based palliative care ensures better comfort to the patient and their kin, at the same time facilitating better resource utilisation. This approach may also reduce the mental trauma caused by the loss of a dear one. Major hurdles in providing palliative care for the chronically ill are lack of awareness and financial constraints. The need of the hour is enhanced awareness and promotion of the practice of palliative care. A favourable change in government policy and budget allocation will go a long way in achieving this goal. Home-based palliative care paves the way to care for the subset of patients with end-stage organ failure in a more humane manner.
RESUMO
BACKGROUND: Neuromuscular weakness may manifest subsequent to critical illness in intensive care unit (ICU) patients. This weakness termed as "ICU-acquired weakness" (ICUAW) has a significant bearing on the length of mechanical ventilation, duration of ICU stays, long-term disability, and survival rate. Early identification of ICUAW helps in planning appropriate strategies, as well as in predicting the prognosis and long-term outcomes of these patients. AIMS AND OBJECTIVES: To identify the incidence of new-onset neuromuscular weakness developing among patients admitted in the ICU (ICUAW) and study its clinical course and impact on the duration of ICU stay. METHODS: This prospective observational study evaluated patients admitted to the ICU over a period of 1 year and 3 months (November 1, 2015, to January 31, 2017). All patients fulfilling the inclusion and exclusion criteria were evaluated with the Medical Research Council (MRC) score for muscle strength. Patients with an average score <4 were diagnosed with ICUAW. Included patients were examined on alternate days to study the clinical progression of the weakness till ICU discharge or death of the patient. The duration of ICU stay was noted. RESULTS AND CONCLUSION: The study revealed a significant association of ICUAW with age, Acute Physiology And Chronic Health Evaluation (APACHE II) Score, duration of mechanical ventilation, and ICU mortality. The incidence of the weakness was found to be 7.83% among the patients who survived and 50% among those patients who did not survive critical illness. HOW TO CITE THIS ARTICLE: Baby S, George C, Osahan NM. Intensive Care Unit-acquired Neuromuscular Weakness: A Prospective Study on Incidence, Clinical Course, and Outcomes. Indian J Crit Care Med 2021;25(9):1006-1012.