Early incidence and prognosis of ICU-acquired weakness in mechanical ventilation patients

Abstract

To observe the early morbidity of ICU-acquired weakness (ICU-AW) in mechanical ventilation patients, and to analyze the risk factors and prognosis of ICU-AW. A prospective cohort study was conducted. The patients undergoing mechanical ventilation admitted to intensive care unit (ICU) of Fu Xing Hospital of Capital Medical University from April 2016 to February 2017 were enrolled. The peroneal nerve test was performed on (3±1) days of mechanical ventilation, and complete neuro-electrophysiological examination was performed next on the patients with positive result of peroneal nerve test. The abnormal cases were enrolled in the observation group, others were enrolled in the control group, then the early incidence of ICU-AW was obtained. The control group reviewed the peroneal nerve test after 10 days, and the late ICU-AW incidence was obtained. Death, ICU discharge, or over 60 days of ICU stay were set to the endpoints of observation. Demographic data, basic indicators, drug usage, comorbidities and metabolic markers during the study period, outcome data were collected and analyzed, and risk factors and of early ICU-AW in mechanical ventilation patients were identified by multivariate Logistic regression analysis. A total of 60 patients were enrolled in the study, with 19 patients in the observation group, and 41 in the control group, with the early ICU-AW incidence of 31.7%. In the control group, 8 patients reviewed the peroneal nerve test after 10 days, of which 4 were positive, so the late incidence of ICU-AW was about 50% finally. It was shown by univariate analysis that the age of the observation group was significantly higher than that of the control group [years old: 84 (79, 89) vs. 81 (65, 85), P < 0.05], other basic indicators such as gender, body mass index (BMI), basic diseases, acute physiology and chronic health evaluation II (APACHE II) score, sequential organ failure assessment (SOFA) score, Glasgow coma scale (GCS) score, the reason of mechanical ventilation etc. were similar. Compared with the control group, the ratios of glucocorticoid and vasoactive drugs usage in the observation group were significantly increased [84.2% (16/19) vs. 43.9% (18/41), 100.0% (19/19) vs. 75.6% (31/41), both P < 0.05], the highest blood glucose was significantly increased (mmol/L: 18.73±4.98 vs. 15.66±5.11, P < 0.05), the incidence of sepsis and septic shock during the study period was significantly increased [84.2% (16/19) vs. 51.2% (21/41), P < 0.05]. The indices of P < 0.1 in univariate analysis were included in multivariate Logistic regression equation. The results showed that age was an independent risk factor for ICU-AW in early stage of mechanical ventilation [odds ratio (OR) = 1.086, 95% confidence interval (95%CI) = 1.008-1.171, P = 0.031]. Analysis of prognostic indicators showed that compared with the control group, the length of ICU stay and duration of mechanical ventilation in the observation group were prolonged [days: 16 (12, 28) vs. 13 (8, 31), hours: 306.0 (143.0, 376.0) vs. 224.0 (144.0, 365.5)], the total cost of hospitalization was increased (ten thousand Yuan: 17.04±7.20 vs. 15.23±5.64), 28-day mortality and 60-day mortality were increased [57.9% (11/19) vs. 41.5% (17/41), 68.4% (13/19) vs. 43.9% (18/41)], but the differences were not statistically significant (all P > 0.05). ICU-AW is more common in patients undergoing mechanical ventilation with high early incidence. Age, APACHE II score, sepsis and septic shock, the highest blood glucose can be considered as the risk factors of ICU-AW, and age can be considered as an independent risk factor. There was no significant correlation between early onset ICU-AW and short-term prognosis in patients undergoing mechanical ventilation.