Muscle glycogen metabolism is rapidly dysregulated in critical illness, which may have implications for muscle ATP resynthesis and ICU-acquired weakness.

ObjectiveThe primary objective of this study was to identify the occurrence and factors associated with intensive care unit (ICU)–acquired weakness (ICUAW) in patients with COVID-19. Secondarily, we monitored the evolution of muscle strength and mobility among patients with ICUAW and patients without ICUAW and the association of these variables with length of stay, mechanical ventilation (MV), and other clinical variables.MethodsIn this prospective observational study, patients admitted to the ICU for >72 h with COVID-19 were evaluated for muscle strength and mobility at 3 times: when being weaned from ventilatory support, discharged from the ICU, and discharged from the hospital. Risk factors for ICUAW were monitored.ResultsThe occurrences of ICUAW at the 3 times evaluated among the 75 patients included were 52%, 38%, and 13%. The length of the ICU stay (29.5 [16.3–42.5] versus 11 [6.5–16] days; P ≤ .001), the length of the hospital stay (43.5 [22.8–55.3] versus 16 [12.5–24] days; P ≤ .001) and time on MV (25.5 [13.8–41.3] versus 10 [5–22.5] days; P ≤ .001) were greater in patients with ICUAW. Muscle strength and mobility were lower at all times assessed in patients with ICUAW (P < .05). Bed rest time for all patients (relative risk = 1.14; 95% CI = 1.02–1.28; P = .03 per week) and use of corticosteroids (relative risk = 1.01; 95% CI = 1.00–1.03; P = .01 per day) for those who required MV were factors independently associated with ICUAW. Muscle strength was found to have a positive correlation with mobility and a negative correlation with lengths of stay in the ICU and hospital and time on MV.ConclusionsThe occurrence of ICUAW was high upon patients’ awakening in the ICU but decreases throughout hospitalization; however, strength and mobility remained compromised at hospital discharge. Bed rest time and use of corticosteroids (for those who needed MV) were factors independently associated with ICUAW in patients with COVID-19.

To date, studies assessing the relationship between intensive care unit acquired weakness (ICU-AW) and postoperative delirium (POD), two of the most common complications in the intensive care unit (ICU), are lacking. To explore the association of the occurrence of POD, POD subtypes and POD duration with ICU-AW in a surgical intensive care unit (SICU). This study was a prospective observational study. Four hundred and two postoperative patients in a SICU at a tertiary hospital in Shanghai, China, participated in the study. Data were collected through the electronic medical record system of the hospital between October 2022 and July 2023. POD was assessed using the Richmond agitation-sedation scale (RASS) and the Confusion Assessment Method for the intensive care unit (CAM-ICU). The Medical Research Council score (MRC score) was used to measure ICU-AW. The bivariate logistic regression analysis was used to analyse the relationship between ICU-AW and POD, and further, the influencing factors of ICU-AW. Of the 402 analysed patients (mean age: 69.2 ± 14.84, 59.7% male), 121 (30.10%) patients developed ICU-AW, and 92 (22.89%) patients developed POD. Of the ICU-AW group, 53 (43.80%) patients screened positive for POD. The occurrence of POD (odds ratio (OR), 0.227 95% CI: 0.052-0.981), hypoactive POD (OR, 4.241 95% CI: 1.490-12.072) and POD duration (OR, 2.649; 95% CI: 1.422-4.935) were independently associated with ICU-AW. Moreover, diabetes (OR, 1.710; 95% CI: 1.036-2.823) and Interleukin-6 (IL-6) (OR, 1.001; 95% CI: 1.000-1.001) were also significantly correlated with ICU-AW. ICU-AW was associated with POD, POD subtypes and POD duration in the SICU patients. Screening for hypoactive POD should be used as part of routine risk assessment in the SICU focused on identifying ICU-AW and specifying a timely and targeted plan during the early stages of the postoperative period. While closely monitoring ICU patients with high IL-6 levels and diabetes, nurses should assess the type and duration of POD in patients and implement care interventions to prevent the development of ICU-AW.

To investigate the current status of intensive care unit-acquired weakness (ICU-AW) assessment, analyze the assessment barriers, and to provide reference to improve ICU-AW assessment. A convenient sampling cross-sectional survey was conducted. First, an interview outline which based on related domestic and international literatures and combining with the research purpose of this study were designed. Thirteen medical personnel (8 ICU nurses, 3 ICU doctors, 1 respiratory therapist and 1 physiotherapist) who worked in the intensive care unit (ICU) of the First Hospital of Lanzhou University were enrolled with convenience sampling method to interview. Second, the topics were comprehensively analyzed and extracted, and then a questionnaire was constructed, and the reliability and validity was assessed. Finally, the questionnaire survey including the general situation of ICU medical staffs, the current practices of ICU-AW and influencing factors was implemented in China. The retest reliability was 0.92 and expert validity was 0.96 of the questionnaire. There were 3 563 respondents in 31 provinces, municipalities and autonomous regions which eliminated 357 unqualified questionnaires, including 173 respondents from neonatal or pediatric ICU, 89 respondents whose working time was less than 6 months, and 95 invalid respondents, and then there were finally 3 206 valid questionnaires and the response rate were 90.0%. Those 3 206 respondents included 616 doctors (19.2%), 2 371 nurses (74.0%), 129 respiratory therapists (4.0%), 51 physiotherapist (1.6%) and 39 dietitians (1.2%). The mean age was (30.7±6.3) years old. Most of them had bachelor's degree (65.9%), master and above was 14.1%. Associate senior physician and above was 8.0%; ICU working time was (5.94±4.50) years. In clinical practice, only 26.5% of the ICU medical staffs confirmed that they had treated or taken care for ICU-AW patients; 52.9% of medical staffs evaluated ICU-AW only based on clinical experience, and only 12.3% used ICU-AW assessment tools. The majority of respondents believed that ICU-AW knowledge training should be performed (81.8%), ICU-AW assessment should be as important as other complications (pressure sore, infected ventilator associated pneumonia, etc., 75.1%), and ICU-AW assessment should be part of daily treatment and care activities (61.2%). However, only 10.2% of respondents had received ICU-AW related knowledge training, and 42.7% respondents believed that their ICU-AW related knowledge could not meet clinical needs. Only 18.7% respondents would actively assess whether patients suffered from ICU-AW or not, and 42.3% respondents thought that ICU-AW should be assessed every day, and the assessment tools were also inconsistent. There were 44.0% respondents considered the Medical Research Council Muscle score (MRC-score) scale was the optimal tool for diagnosing ICU-AW, the following were neuro-electrophysiological examination (17.2%) and manual muscle strength (MMT, 11.1%). The main cause of the ICU-AW assessment barriers was the lack of ICU-AW related knowledge (88.1%), and the following were lack of ICU-AW assessment guidelines (76.5%), patients' cognitive impairment or limited understanding ability (84.6%), unable to cooperate with the assessment due to critical illness (83.0%), and inadequate attention to ICU-AW assessment by the department (77.5%). The current status of ICU-AW assessment were unsatisfying in China, and the main barriers were lack of skills and knowledge.

The objective of this prospective cohort study was to investigate the incidence of intensive care unit (ICU)-acquired weakness (ICUAW) and compare handgrip strength (HGS) and inspiratory muscle strength, measured by maximum inspiratory pressure (MIP), between critical illness survivors with and without ICUAW. Additionally, we examined whether HGS and MIP could serve as surrogate measures for ICUAW and establish reference cut-off values for both HGS and MIP in Taiwanese ICU survivors. A total of 274 ICU survivors aged ≥20 yrs without prior systemic weakness from six medical ICUs at a tertiary care hospital in Taiwan were consecutively enrolled. ICUAW was identified at the time of ICU discharge using standardised manual muscle testing based on the Medical Research Council scale. Simultaneously, HGS and MIP were assessed. A receiver operating characteristic curve analysis was performed to evaluate whether HGS and MIP could serve as surrogate markers for ICUAW and to establish their cut-off values. Among the 406 enrolled participants, 310 survived their ICU stay, and 274 completed the Medical Research Council test upon ICU discharge. The survivors were predominantly male (65.7%), with a median age of 70 years (interquartile range: 59-80). Acute respiratory failure was the leading cause of ICU admission (52.9%), and 60.2% of patients required mechanical ventilation during their ICU stay, with a median duration of 8 days (interquartile range: 3-8). ICUAW was identified in 23.0% of survivors. Fewer participants in the ICUAW group were able to complete HGS (87.1%) and MIP (45.2%) assessments, likely due to physical limitations. Compared with those without ICUAW, the ICUAW group was significantly older, had higher Acute Physiology and Chronic Health Evaluation scores at admission, required longer mechanical ventilation, had longer ICU stays, and displayed weaker HGS and lower MIP at ICU discharge. The receiver operating characteristic curve analysis demonstrated that both HGS and MIP served as promising surrogate markers with areas under the curve of 0.842 and 0.822, respectively, and optimal cut-offs of 10.9 kg-force for HGS and 22.5 cmH2O for MIP. Additionally, sex-specific cut-offs were also identified. HGS and MIP show promise as surrogate markers for ICUAW, with our ICU survivor cohort revealing comparable HGS and lower MIP cut-off values compared to previous recommendations. These results emphasise the importance of tailored cut-offs and screening approaches for different ethnic and geographic regions. Additionally, they provide preliminary reference values for ICU survivors in Taiwan and highlight the need for further studies in the region.

To explore the risk factors of intensive care unit acquired weakness (ICUAW) in patients with sepsis, and to evaluate the predictive value of each risk factor for ICUAW. A case control study was conducted, 60 septic patients admitted to the intensive care unit (ICU) of Henan Provincial People's Hospital from October 20, 2020 to February 20, 2021 were enrolled. The patients were divided into two groups: sepsis ICUAW group and sepsis non-ICUAW group. The data of gender, age, body mass index (BMI), acute physiology and chronic health evaluation II (APACHE II) score, complications, mechanical ventilation, duration of ICUAW, length of stay in ICU, fasting blood glucose, blood lactic acid (Lac), procalcitonin (PCT), C-reactive protein (CRP), sequential organ failure assessment (SOFA) score, outcome, antimicrobial agent, glucocorticoid, sedatives and analgesics drugs and vasoactive drugs were collected. Risk factors were screened by univariate Logistic regression analysis, and odds ratio (OR) was adjusted by multivariate binary logistic regression, P < 0.05 was considered as independent risk factors. Finally, the receiver operating characteristic curve (ROC curve) was drawn to analyze the predictive value of independent risk factors. The APACHE II score of the sepsis ICUAW group was significantly higher than that of the sepsis non-ICUAW group (23.05±8.17 vs. 15.33±4.89, P < 0.05), the total length of stay in the ICU was significantly longer than that of the sepsis non-ICUAW group (days: 15.1±9.2 vs. 8.5±3.4, P < 0.05), the improvement rate of patients was significantly lower than that of the sepsis non-ICUAW group [45.0% (9/20) vs. 95.0% (38/40), P < 0.05]. After univariate Logistic regression and multicollinearity test analysis, 7 factors including APACHE II score, average SOFA score, blood lactic acid, proportion of mechanical ventilation, sedatives and analgesics drugs, type of antibiotics and type of vasoactive drugs were included in the binary Logistic regression model [OR: 1.21, 2.05, 2.26, 0.21, 1.54, 2.07, 1.38, 95% confidence interval (95%CI): 1.09-1.35, 1.42-2.94, 1.12-4.57, 0.05-0.66, 1.03-2.29, 1.27-3.37, 0.96-2.00, all P < 0.05]. Hosmer-Lemchaw test P = 0.901, and the correct percentage of prediction was 85%, indicating good model fit. Multivariate binary Logistic regression analysis showed that APACHE II score and average SOFA score were independent risk factors for the occurrence of ICUAW in septic patients (APACHE II score: OR = 1.17, 95%CI was 1.004-1.376, P = 0.044; average SOFA score: OR = 1.86, 95%CI was 1.157-2.981, P = 0.01). ROC curve analysis showed that the mean value of APACHE II score, average SOFA score and their combined detection had a certain predictive value for the occurrence of ICUAW in sepsis patients, areas under ROC curve (AUC) were 0.787, 0.881, 0.905, 95%CI was 0.646-0.928, 0.791-0.972, 0.828-0.982, all P < 0.05. When the cut-off value was 19.500, 6.225, 0.375, the sensitivity was 75%, 90%, 90%, and the specificity were 80%, 80%, 85%, respectively. APACHE II score and average SOFA score can be used as independent risk factors for the occurrence of ICUAW in sepsis, and their combined predictive value is better than that of individual index.

The objective of this study was to evaluate the impact of intensive care unit (ICU)-acquired weakness (ICUAW) on the functional independence of patients hospitalized for coronavirus disease 2019 (COVID-19) over 6months after ICU discharge. This was a prospective cohort study that included patients who were admitted to the ICU because of COVID-19 and who were monitored for 6months after discharge from the ICU via telephone. Patients were evaluated at 3 times (30days, 3months, and 6months after discharge from the ICU) for functional independence for personal care and mobility activities (Barthel Scale), independence for self-care (Katz Index), impact of COVID-19 on functional status (post-COVID-19 Functional Status Scale [PCFS]), and mobility level (ICU Mobility Scale). The existence of some degree of dependence was considered when the Barthel Scale score was <100 points, the Katz Index was ≥1, and the PCFS score was ≥1. A PCFS score of ≥3 indicated moderate or severe dependence. Patients with a Medical Research Council score of <48 at discharge from the ICU were diagnosed with ICUAW. Sixty-eight patients were included, with a mean age of 51 (SD = 13) years. The ICUAW rate at ICU discharge was 35%. In the evaluation with the PCFS, the values for the presence of any functional limitation at 30days, 3months, and 6months after ICU discharge were 89.7%, 57.4%, and 38.2%, respectively. The rate of persistence of functional limitations after 6months was higher in patients with ICUAW than in those without ICUAW (66.7% vs 22.8%; P = .000); the same was true for moderate or severe limitations (20.8% vs 4.5%; P = .035). Likewise, functional independence for personal care, mobility, and self-care activities was poorer in patients with ICUAW. In patients surviving an ICU stay due to COVID-19, decreased functional independence persists even 6months after discharge, and patients with ICUAW have worse outcomes. Patients who survive ICU stays due to COVID-19 continue to have greater functional dependence even 6months after ICU discharge.

Background: Intensive Care Unit-acquired weakness (ICU-AW) is one of the most common neuromuscular disorders affecting intensive care unit (ICU) patients' outcomes and clinical course. ICU-AW is found in 30-50% of patients and increases to 67% in sepsis-critically ill patients. Prolonged ICU stay, the difficulty of weaning from the ventilator, higher hospitalization costs, and an increase in mortality, as well as long-term morbidity, are associated with ICU-AW. ICU-AW causes skeletal muscle weakness, including respiratory muscles, which results in complications that continue even years after being discharged from the hospital. Aim: To describe the rehabilitation management of ICU-AW and provide the information needed clinically to manage these patients. Methods: The authors reviewed all types of articles without time filtering using PubMed and Google Scholar databases with “ICU-AW”, “ICU-related weakness”, “rehabilitation”, and “early mobilization” used as keywords. Results: Rehabilitation management can be done as early as possible, beginning while the patient is still in the ICU. Early mobilization programs require teamwork consisting of doctors, therapists, and nurses. Physical activity and early mobilization in the ICU must be carried out with consideration for safety. Monitoring patient safety before and during mobilization is an essential factor to be considered. Any mobilization program should be the decision of the ICU care team. Implementation of rehabilitation programs and early mobilization improves outcomes for patients with ICU-AW and should be continued until the follow-up period. Conclusion: The rehabilitation management aiming at preventing and treating ICU-AW should be done since the patient was still in the ICU and under careful consideration of safety aspects.

Substrate depletion in different types of muscle and in liver during prolonged running.

Intensive care unit-acquired weakness is a frequent complication that affects the prognosis of critical illness during hospital stay and after hospital discharge. To determine if a multicomponent protocol of early active mobility involving adequate pain control, non-sedation, non-pharmacologic delirium prevention, cognitive stimulation, and family support, reduces intensive care unit-acquired weakness at the moment of discharge. We carried out a non-randomized clinical trial in two mixed intensive care units in a high-complexity hospital, including patients over 14 years old with invasive mechanical ventilation for more than 48 hours. We compared the intervention –the multicomponent protocol– during intensive care hospitalization versus the standard care. We analyzed 82 patients in the intervention group and 106 in the control group. Muscle weakness acquired in the intensive care unit at the moment of discharge was less frequent in the intervention group (41.3% versus 78.9%, p<0.00001). The mobility score at intensive unit care discharge was better in the intervention group (median = 3.5 versus 2, p < 0.0138). There were no statistically significant differences in the invasive mechanical ventilation-free days at day 28 (18 versus 15 days, p<0.49), and neither in the mortality (18.2 versus 27.3%, p<0.167). A multi-component protocol of early active mobility significantly reduces intensive care unit-acquired muscle weakness at the moment of discharge.

Background and objective: Intensive care unit (ICU) acquired weakness (ICU-AW) is muscle weakness caused by neuromuscular dysfunction, which can cause muscle mass and muscle strength decline, and is one of the common complications of ICU. ICU-AW can affect patients' daily activities and long-term quality of life. We sought to understand the current knowledge, attitude and behavior of ICU nurses relative to ICU-AW, and analyze the factors influencing the knowledge, attitude and behavior.Methods: Design: A cross-sectional survey. A survey was conducted of 236 ICU nurses using a self-designed questionnaire.Results: The knowledge, attitude and behavior scores of ICU nurses were 17.05 ± 6.003, 17.47 ± 5.538 and 19.84 ± 5.100, respectively. Multivariate analysis showed that education level, previous exposure to ICU-AW and ICU-AW-related knowledge were the three factors affecting ICU nurses' knowledge of ICU-AW. Education level and previous exposure to ICU-AW were the two factors affecting attitude. Education level and ICU-AW-related knowledge were the factors influencing nurses’ behavior (p &lt; .05).Conclusions: ICU nurses have a lower knowledge and attitude score on ICU-AW and a higher score on ICU-AW intervention practice. Relevance to clinical practice: ICU nurses need to acquire more theoretical knowledge and deepen their understanding of ICU-AW, so as to prevent the incidence of ICU-AW.

IntroductionIt has been proposed that intensive care unit (ICU)-acquired weakness (ICUAW) should be assessed using the sum of manual muscle strength test scores in 12 muscle groups (the sum score). This approach has been tested in patients with Guillain-Barré syndrome, yet little is known about the feasibility or test characteristics in other critically ill patients. We studied the feasibility and interobserver agreement of this sum score in a mixed cohort of critically ill and injured patients.MethodsWe enrolled patients requiring more than 3 days of mechanical ventilation. Two observers performed systematic strength assessments of each patient. The primary outcome measure was interobserver agreement of weakness as a binary outcome (ICUAW is sum score less than 48; "no ICUAW" is a sum score greater than or equal to 48) using the Cohen's kappa statistic.ResultsWe identified 135 patients who met the inclusion criteria. Most were precluded from study participation by altered mental status or polytrauma. Thirty-four participants were enrolled, and 30 of these individuals completed assessments conducted by both observers. Six met the criteria for ICUAW recorded by at least one observer. The observers agreed on the diagnosis of ICUAW for 93% of participants (Cohen's kappa = 0.76; 95% confidence interval (CI), 0.44 to 1.0). Observer agreement was fair in the ICU (Cohen's kappa = 0.38), and agreement was perfect after ICU discharge (Cohen's kappa = 1.0). Absolute values of sum scores were similar between observers (intraclass correlation coefficient 0.83; 95% CI, 0.67 to 0.91), but they differed between observers by six points or more for 23% of the participants.ConclusionsManual muscle testing (MMT) during critical illness was not possible for most patients because of coma, delirium and/or injury. Among patients who were able to participate in testing, we found that interobserver agreement regarding ICUAW was good, particularly when evaluated after ICU discharge. MMT is insufficient for early detection of ICU-acquired neuromuscular dysfunction in most patients and may be unreliable during critical illness.

Background &amp; objective: Intensive Care Unit-Acquired Weakness (ICU-AW) is a weakness found in critically ill patients, and this weakness can persist even after discharge from the Intensive Care Unit (ICU). Various rehabilitation medicine procedures have been shown to be effective in prevention as well as managing the established weakness in this cohort of the patients. We analyzed the effect of Neuromuscular Electrical Stimulation (NMES) therapy on the global muscle strength, quadriceps femoris muscle, and creatine kinase examination in patients known to have ICU-AW. Methodology: The type of study used a pre-experimental one-group pre-posttest, and the study population consisted of 23 patients who experienced ICU-AW. Patients were given NMES therapy at the beginning of treatment in the ICU and then evaluated using the Medical Research Council Scale for Muscle Strength (MRC-SS), Manual Muscle Test (MMT), and creatine kinase levels. Results: NMES therapy provides significant results on increasing muscle strength on the fifth day with MRC-SS 42.78 (24-60) and MMT 3.57 (2-5) (P &lt; 0.001), as well as a significant decrease in creatine kinase levels given therapy at the beginning of ICU admission. Conclusion: NMES therapy increases global muscle strength and quadriceps femoris muscle and decreases creatine kinase levels. Abbreviations: ICU-AW - Intensive Care Unit-Acquired Weakness, NMES - Neuromuscular Electrical Stimulation, ICU - Intensive care unit, MRC-SS - Medical Research Council Scale for Muscle Strength, MMT - Manual Muscle Testing, CK-MM - Creatine kinase muscle specific Key Words: Neuromuscular electrical stimulation; Intensive Care Unit-Acquired Weakness, Creatine kinase Citation: Yustiawan A, Semedi BP, Arfianti L, Maulydia, Edwar PPM, Airlangga PS, Santoso KH, Andriana M. The effect of early neuromuscular electrical stimulation in intensive care unit-acquired weakness. Anaesth. pain intensive care 2024;28(4):706−711; DOI: 10.35975/apic.v28i4.2405 Received: March 04, 2024; Reviewed: April 29, 2024; Accepted: May 10, 2024

Background:Intensive care unit acquired weakness (ICUAW) is a known complication in ICU patients, especially in those with severe underlying diseases. The cause and pathogenesis of ICUAW are still unknown. This study examined the incidence rate of ICUAW in intensive care units (ICUs) of the Masih-Daneshvari Hospital.Materials and Methods:This descriptive-comparative study was conducted on 160 patients admitted in the ICUs, including an acute respiratory infectious ICU (TB-ICU) and medical ICU. The total number of patients was 80 in each of the ICUs. Demographic information was obtained from the patients after the initial examination and Medical Research Council (MRC) score was done on daily basis. EMG was performed on the 2nd and 8th days of the admission. ICUAW diagnosis was used in cases with MRC scores under 48.Results:Among the patients, 68.6% were male and the mean age was 59.13±18. 68 years. The final outcomes were 48.4% mortality and 51.6% discharge, which were 41% and 59% in the TB-ICU and 56.7% and 43.3% in the medical ICU, respectively. By defining electromyography as the gold standard, the sensitivity and specificity of ICUAW diagnosis based on the MRC score definition were about 70% and 83%, respectively. The comparison ICUAW patients in the two ICUs in terms of mortality showed no significant difference between them.Conclusion:It is concluded that nearly half of ICU-admitted patients develop ICUAW that causes a higher mortality rate. Therefore, new plans should be developed to reduce the rate of ICUAW and subsequent death, as well as other possible morbidities.

BackgroundCritical illness survivors frequently suffer from long-term impairments, often described as post-intensive care syndrome (PICS). PICS encompasses physical, cognitive, and mental impairments. Additionally, the term intensive care unit (ICU)-acquired weakness (ICUAW) was coined for muscle weakness after critical illness. Research on the progression and outcome of individuals affected by PICS and ICUAW is scant. Thus we aimed to assess the health status and its progression during neurorehabilitation in critically ill patients using comprehensive outcome measures, describe the prevalence of PICS, and evaluate factors associated with rehabilitation outcomes.MethodsPatients with mixed reasons for critical illness who received ≥ 5 days of mechanical ventilation on the ICU and who were admitted to neurorehabilitation, were eligible to be included in this prospective cohort study. A number of outcomes (patient-reported, clinician-reported, and performance) were assessed after discharge from the ICU (V1) and shortly before discharge from inpatient neurorehabilitation (V2). The prevalence of PICS, defined as having at least one impairment in any PICS dimension), was calculated at V1 and V2. Multiple logistic regressions were conducted to identify factors associated with rehabilitation outcome (poor outcome = modified Rankin Scale > 2) and ICUAW at V2 (MRC sum score < 48).ResultsIn total, 250 critical illness survivors (62 ± 14 years, 34% female, median stay on ICU 55 days, median inpatient rehabilitation 65 days) were included. 11 participants (4.4%) died before V2. All outcomes improved significantly during rehabilitation except sensory impairment and pain. PICS was present in 96% at V1 and in 85% at V2, whereby mainly the physical domain (V1: 87%, V2: 66%; ICUAW with MRC sum score < 48) and the cognitive domain (V1:65%, V2:55%; Montreal Cognitive Assessment < 26) were affected. Mental impairment was lower (V1:48%, V2:29%; Hospital Anxiety and Depression Scale > 7), but still affected a considerable number of participants. Accordingly, health-related quality of life was rather low at discharge (0.64 ± 0.28, index value of EQ-5D-5L). MRC sum score at V1, duration of mechanical ventilation, and female gender were significantly associated with a poor rehabilitation outcome. Grip strength in % of reference at V1, age, female gender, and comorbidities were significantly associated with persistent ICUAW at discharge.ConclusionsDespite significant improvements during rehabilitation, survivors after critical illness experience a substantial burden of PICS and ICUAW at discharge from rehabilitation care. Survivors of critical illness require long-term follow-up, supportive structures, and tailored long-term multi-disciplinary therapies even after intensive rehabilitation.Trial registration: German Clinical Trials Register, DRKS00021753. Registered 03 September, 2020. https://drks.de/search/en/trial/DRKS00021753.

BackgroundAt present, intensive care unit acquired weakness (ICU-AW) has become an important health care issue. The aim of this study was to develop and validate an ICU-AW prediction model for adult patients in intensive care unit (ICU) to provide a practical tool for early clinical diagnosis.MethodsAn observational cohort study was conducted including 400 adult patients admitted from September 2021 to June 2022 at an ICU with four ward at a medical university affiliated hospital in China. The Medical Research Council (MRC) scale was used to assess bedside muscle strength in ICU patients as a diagnostic basis for ICUAW. Patients were divided into the ICU-AW group and the no ICU-AW group and the clinical data of the two groups were statistically analyzed. A risk prediction model was then developed using binary logistic regression. Sensitivity, specificity, and the area under the curve (AUC) were used to evaluate the predictive ability of the model. The Hosmer-Lemeshow test was used to assess the model fit. The bootstrap method was used for internal verification of the model. In addition, the data of 120 patients in the validation group were selected for external validation of the model.ResultsThe prediction model contained five risk factors: gender (OR: 4.31, 95% CI: 1.682–11.042), shock (OR: 3.473, 95% CI: 1.191–10.122), mechanical ventilation time (OR: 1.592, 95% CI: 1.317–1.925), length of ICU stay (OR: 1.085, 95% CI: 1.018–1.156) and age (OR: 1.075, 95% CI: 1.036–1.115). The AUC of this model was 0.904 (95% CI: 0.847–0.961), with sensitivity of 87.5%, specificity of 85.8%, and Youden index of 0.733. The AUC of the model after resampling is 0.889. The model verification results showed that the sensitivity, specificity and accuracy were 71.4, 92.9, and 92.9%, respectively.ConclusionAn accurate, and readily implementable, risk prediction model for ICU-AW has been developed. This model uses readily obtained variables to predict patient ICU-AW risk. This model provides a tool for early clinical screening for ICU-AW.