Care and treatments related to intensive care unit-acquired muscle weakness: A cohort study.

BACKGROUND: Intensive care unit-acquired muscle weakness (ICUAW) has an incidence of 40-46%. Early mobilisation is known to be a protective factor. OBJECTIVE: The aim of the study was to identify the incidence of ICUAW in Spain and to evaluate variables likely to contribute to the development of ICUAW. METHODS: A 4-month, prospective observational multicentre cohort study was conducted on patients receiving invasive mechanical ventilation for at least 48 h. Data were collected from ICU day 3 until ICU discharge. The primary outcome was presence of ICUAW (diagnosed using the Medical Research Council [MRC] scale). The secondary outcome was nurse-patient ratio, physiotherapist availability, analgesia, sedation and delirium management, glycaemic control, and daily level of mobility during the ICU stay as per the ICU Mobility Scale. A logistic regression model was constructed based exclusively on days 3-5 of the ICU stay. RESULTS: The data of 642 patients were analysed from 80 ICUs, accounting for 35% of all ICUs in Spain. The incidence of ICUAW was 58% (275 of 474 patients; 95% confidence interval [CI] [53-62]). The predictors for ICUAW were older age (odds ratio [OR] = 1.01; 95% CI [1.00-1.03]) and more days with renal replacement therapy (OR = 1.01; 95% CI [1.00-1.02]). The protective factors for ICUAW were male gender (OR = 0.58; 95% CI [0.38-0.89]), higher Barthel Index (showing prehospital functional independence) (OR = 0.97; 95% CI [0.95-0.99]), more days of being awake and cooperative (defined by a feasible MRC assessment) (OR = 0.98; 95% CI [0.97-0.99]), presence of delirium (OR = 0.98; 95% CI [0.97-0.99]), and more days with active mobilisation (ICU Mobility Scale ≥ 4) (OR = 0.98; 95% CI [0.97-0.99]). CONCLUSIONS: The risk factors for ICUAW were functional dependence before admission, female gender, older age, and more days on renal replacement therapy. The protective factors for ICUAW were feasibility of MRC assessment, the presence of delirium, and being actively mobilised during the first 5 days in the ICU.

Intervenciones no farmacológicas para la promoción del sueño en la UCI / Non-pharmacological interventions for sleep promotion in the ICU

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Grado de implementación de las estrategias preventivas del síndrome post-UCI: estudio observacional multicéntrico en España / Degree of implementation of preventive strategies for post-ICU syndrome: Multi-centre, observational study in Spain

Objetivo: Evaluar el nivel de implementación de los protocolos asociados a la prevención de la debilidad muscular adquirida en la unidad de cuidados intensivos (UCI), así como la presencia del fisioterapeuta en distintas UCI de España. Método: Estudio descriptivo, transversal realizado en 86 UCI de adultos de España entre los meses de marzo a junio de 2017. Se excluyeron UCI neuroquirúrgicas y de grandes quemados. Se utilizó encuesta multirrespuesta que incluía preguntas sobre los protocolos de: control de glucemia, sedación, valoración del dolor, prevención del delirium, manejo del delirium y movilización precoz. La encuesta fue rellenada a través de un aplicativo protegido por usuario y contraseña. Análisis inferencial con t de Student o U de Mann-Whitney y de correlación con Pearson o Rho de Spearman. Resultados: El 89,5% de las UCI tenían protocolo de control de glucemia, con rango predominante de 110-140 mg/dl. El 74,4% evaluaban el nivel de sedación, si bien solo tenían protocolos de sedación el 36% de ellas. Con relación a la valoración del dolor se realizaba en el 73,7% de los pacientes comunicativos, mientras que en los no comunicativos solo era del 47,5%. Solo el 37,2% realizaban screening diario para detectar el delirium, y disponían de protocolos de prevención del delirium el 31,4% de las UCI, del manejo del delirium el 26,7% y de movilización precoz el 14% de las UCI. En el 34,9% de los casos se solicita interconsulta al servicio de rehabilitación. Conclusiones: La implementación de los diferentes protocolos asociados a la prevención de la debilidad muscular adquirida ha sido elevada en relación con los protocolos de control de glucemia, valoración del nivel de sedación y del dolor de pacientes comunicativos, mientras que baja en los de movilización precoz y screening y prevención del delirio. Asimismo, es poco frecuente la presencia del fisioterapeuta en la UCI

Aim: To evaluate the degree of implementation of protocols associated with the prevention of intensive-care-unit (ICU) acquired muscle weakness, and the presence of the physiotherapist in various ICU in Spain. Method: A descriptive, cross-sectional study performed in 86 adult ICU in Spain between March and June 2017. Neurosurgical and major burns ICU were excluded. A multiple-choice survey was used that included questions on protocols for glycaemia control, sedation, pain assessment, delirium prevention, delirium management and early mobilisation. The survey was completed using a user-protected application and password. The Student's t-test or Mann-Whitney U test and Pearson's correlation or Spearman's Rho test were used for the inferential analysis. Results: Eighty-nine point five percent of the ICU had a glycaemia control protocol, with a predominating range of 110-140 mg/dl. Seventy-four point four percent evaluated sedation levels, although only 36% had sedation protocols. Pain assessment was carried out on communicative patients in 73.7%, and on uncommunicative patients in only 47.5%. Only 37.2% performed daily screening to detect delirium and 31.4% of the ICU had delirium prevention protocols, 26.7% had delirium management protocols and 14% had protocols for early mobilisation. Thirty-four point nine percent requested cross consultation with the rehabilitation department. Conclusions: The implementation of the different protocols associated with the prevention of ICU-acquired muscle weakness was high in relation to glycaemia control protocols, sedation level and pain assessment in communicative patients, and was low for early mobilisation and delirium screening and prevention. Similarly, the physiotherapist was seldom present in the ICU

Degree of implementation of preventive strategies for post-ICU syndrome: Multi-centre, observational study in Spain. / Grado de implementación de las estrategias preventivas del síndrome post-UCI: estudio observacional multicéntrico en España.

AIM: To evaluate the degree of implementation of protocols associated with the prevention of intensive-care-unit (ICU) acquired muscle weakness, and the presence of the physiotherapist in various ICU in Spain. METHOD: A descriptive, cross-sectional study performed in 86 adult ICU in Spain between March and June 2017. Neurosurgical and major burns ICU were excluded. A multiple-choice survey was used that included questions on protocols for glycaemia control, sedation, pain assessment, delirium prevention, delirium management and early mobilisation. The survey was completed using a user-protected application and password. The Student's t-test or Mann-Whitney U test and Pearson's correlation or Spearman's Rho test were used for the inferential analysis. RESULTS: Eighty-nine point five percent of the ICU had a glycaemia control protocol, with a predominating range of 110-140mg/dl. Seventy-four point four percent evaluated sedation levels, although only 36% had sedation protocols. Pain assessment was carried out on communicative patients in 73.7%, and on uncommunicative patients in only 47.5%. Only 37.2% performed daily screening to detect delirium and 31.4% of the ICU had delirium prevention protocols, 26.7% had delirium management protocols and 14% had protocols for early mobilisation. Thirty-four point nine percent requested cross consultation with the rehabilitation department. CONCLUSIONS: The implementation of the different protocols associated with the prevention of ICU-acquired muscle weakness was high in relation to glycaemia control protocols, sedation level and pain assessment in communicative patients, and was low for early mobilisation and delirium screening and prevention. Similarly, the physiotherapist was seldom present in the ICU.