Evolución de la fuerza muscular en paciente críticos con ventilación mecánica invasiva / Evolution in muscle strength in critical patients with invasive mechanical ventilation

OBJETIVO: Evaluar la evolución de la fuerza muscular en pacientes críticos con ventilación mecánica (VM) tras la retirada de la sedación y hasta el alta hospitalaria. MATERIAL Y MÉTODO: Estudio de cohortes desarrollado en 2 unidades de cuidados intensivos (UCI) del Hospital Universitari de Bellvitge, de noviembre del 2011 a marzo del 2012. Se incluyó a pacientes consecutivos con VM > 72h. Variable dependiente: fuerza muscular mediante la escala Medical Research Council (MRC), el primer día que el paciente fue capaz de responder a 3 de 5 órdenes (día 1), cada semana, al alta de la UCI y al alta hospitalaria o 60 días. Variables independientes: factores asociados a la pérdida de fuerza, días libres de VM, días de estancia en la UCI y estancia hospitalaria. Los pacientes se distribuyeron en 2 grupos (MRC < 48, MRC ≥ 48) tras la primera medición. RESULTADOS: Se evaluó a 34 pacientes. Variables independientes asociadas a pérdida de fuerza: días con SOFA cardiovascular > 2 (p < 0,001) y días con corticoides (p < 0,001). MRC inicial para el grupo MRC < 48: 38 (27-43) y 52 (50-54) para el grupo MRC ≥ 48. La mayor ganancia de fuerza se obtuvo la primera semana (31% versus 52%). Un MRC < 48 se asoció a más días de VM (p < 0,007) y mayor estancia en la UCI (p < 0,003). CONCLUSIONES: La mayor ganancia de fuerza tras retirar la sedación se consigue la primera semana. La pérdida de fuerza se asocia a un valor de SOFA cardiovascular > 2 y al uso de corticoides. Los pacientes con MRC < 48 presentan mayor duración de la VM y mayor estancia en UCI

OBJECTIVE: To assess the evolution of muscle strength in critically ill patients with mechanical ventilation (MV) from withdrawal of sedatives to hospital discharge. MATERIAL AND METHOD: A cohort study was conducted in two intensive care units in the Hospital Universitari de Bellvitge from November 2011 to March 2012. Inclusion criteria: Consecutive patients with MV > 72h. Dependent outcome: Muscle strength measured with the Medical Research Council (MRC) scale beginning on the first day the patient was able to answer 3 out of 5 simple orders (day 1), every week, at ICU discharge and at hospital discharge or at day 60 Independent outcomes: factors associated with muscle strength loss, ventilator-free days, ICU length of stay and hospital length of stay. The patients were distributed into two groups (MRC< 48, MRC ≥ 48) after the first measurement. RESULTS: Thirty-four patients were assessed. Independent outcomes associated with muscle strength weakness were: days with cardiovascular SOFA >2 (P<.001) and days with costicosteroids (P<.001). Initial MRC in MRC < 48 group was 38 (27-43), and 52 (50-54) in MRC ≥ 48. The largest muscle strength gain was obtained the first week (31% versus 52%). A MRC < 48 value was associated with more MV days (P < .007) and a longer ICU stay. (P < .003). CONCLUSION: The greatest muscle strength gain after withdrawing of the sedatives was achieved in the first week. Muscle strength loss was associated with a cardiovascular SOFA > 2 and costicosteroids. Patients with a MRC < 48 required more days with MV and a longer ICU stay

[Evolution in muscle strength in critical patients with invasive mechanical ventilation]. / Evolución de la fuerza muscular en paciente críticos con ventilación mecánica invasiva.

OBJECTIVE: To assess the evolution of muscle strength in critically ill patients with mechanical ventilation (MV) from withdrawal of sedatives to hospital discharge. MATERIAL AND METHOD: A cohort study was conducted in two intensive care units in the Hospital Universitari de Bellvitge from November 2011 to March 2012. INCLUSION CRITERIA: Consecutive patients with MV > 72h. Dependent outcome: Muscle strength measured with the Medical Research Council (MRC) scale beginning on the first day the patient was able to answer 3 out of 5 simple orders (day 1), every week, at ICU discharge and at hospital discharge or at day 60 Independent outcomes: factors associated with muscle strength loss, ventilator-free days, ICU length of stay and hospital length of stay. The patients were distributed into two groups (MRC< 48, MRC ≥ 48) after the first measurement. RESULTS: Thirty-four patients were assessed. Independent outcomes associated with muscle strength weakness were: days with cardiovascular SOFA >2 (P<.001) and days with costicosteroids (P<.001). Initial MRC in MRC<48 group was 38 (27-43), and 52 (50-54) in MRC ≥ 48. The largest muscle strength gain was obtained the first week (31% versus 52%). A MRC < 48 value was associated with more MV days (P<.007) and a longer ICU stay. (P<.003). CONCLUSION: The greatest muscle strength gain after withdrawing of the sedatives was achieved in the first week. Muscle strength loss was associated with a cardiovascular SOFA > 2 and costicosteroids. Patients with a MRC < 48 required more days with MV and a longer ICU stay.