American Thoracic Society Documents an Official American Thoracic Society Clinical Practice Guideline: the Diagnosis of Intensive Care Unit–acquired Weakness in Adults on Behalf of the Ats Committee on Icu-acquired Weakness in Adults Overview Introduction Methods Guideline Panel Formulation of Quest
American Thoracic Society Documents an Official American Thoracic Society Clinical Practice Guideline: the Diagnosis of Intensive Care Unit–acquired Weakness in Adults on Behalf of the Ats Committee on Icu-acquired Weakness in Adults Overview Introduction Methods Guideline Panel Formulation of Quest
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E. Fan;Fern M. Cheek;L. Chlan;R. Gosselink;N. Hart;M. Herridge;R. Hopkins;C. Hough;J. Kress;N. Latronico;M. Moss;D. Needham;M. Rich;R. Stevens;K. Wilson;C. Winkelman;D. Zochodne;N. Ali
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E. Fan;Fern M. Cheek;L. Chlan;R. Gosselink;N. Hart;M. Herridge;R. Hopkins;C. Hough;J. Kress;N. Latronico;M. Moss;D. Needham;M. Rich;R. Stevens;K. Wilson;C. Winkelman;D. Zochodne;N. Ali
基本原理：危重病期间和之后的严重肌无力被称为重症监护室获得性肌无力（ICUAW）。目的：为ICUAW制定诊断建议。测量和主要结果：严重脓毒症、呼吸机释放困难和机械通气时间延长与ICUAW相关。物理康复改善ICU患者异质人群的结局。由于提供普遍的身体康复可能不可行，另一种方法是确定最有可能受益的患者。ICUAW患者可能就是这样一个群体。我们的综述仅确定了一个接受物理治疗的ICUAW患者的病例系列。与未接受结构化物理治疗的ICUAW患者的病例系列相比，有证据表明接受物理康复的患者更频繁地出院回家，而不是到康复机构，尽管置信区间没有差异。其他干预措施显示出希望，但证明患者受益的数据较少，因此排除了具体的评论。此外，既往合并症的定义不足以确定其对结局、治疗反应或患者诊断偏好的影响。我们建议在ICUAW患者中进行对照临床试验，比较物理康复与常规护理，并进一步研究了解风险和患者偏好。结论：有必要进行研究，确定有利于ICUAW患者的治疗方法，以确定ICUAW诊断测试的益处是否超过其负担。严重肌无力在重症患者中很常见，但对于是否或如何系统地识别重症监护室获得性肌无力（ICUAW）患者尚未达成共识。指南制定委员会从一项系统性综述开始，确定ICUAW可能在重症脓毒症ICU患者以及难以从机械通气中解脱或需要长时间机械通气的患者中更常见。文献综述未能识别出比较诊断性检测与无诊断性检测对临床结局影响的证据。确定了一个接受物理治疗的ICUAW患者的小型病例系列，与未接受物理治疗的ICUAW患者的类似系列相比，似乎治疗患者可能更频繁地出院回家而不是到康复机构。然而，置信区间并不排除无影响。因此，证据对物理治疗对ICUAW患者临床结局的估计影响提供的置信度非常低。指导方针制定委员会确信有必要进行更多的研究来确定...
Rationale: Profound muscle weakness during and after critical illness is termed intensive care unit–acquired weakness (ICUAW). Objectives: To develop diagnostic recommendations for ICUAW. Measurement and Main Results: Severe sepsis, difficult ventilator liberation, and prolonged mechanical ventilation are associated with ICUAW. Physical rehabilitation improves outcomes in heterogeneous populations of ICU patients. Because it may not be feasible to provide universal physical rehabilitation, an alternative approach is to identify patients most likely to benefit. Patients with ICUAW may be such a group. Our review identified only one case series of patients with ICUAW who received physical therapy. When compared with a case series of patients with ICUAW who did not receive structured physical therapy, evidence suggested those who receive physical rehabilitation were more frequently discharged home rather than to a rehabilitative facility, although confidence intervals included no difference. Other interventions show promise, but fewer data proving patient benefit existed, thus precluding specific comment. Additionally, prior comorbidity was insufficiently defined to determine its influence on outcome, treatment response, or patient preferences for diagnostic efforts. We recommend controlled clinical trials in patients with ICUAW that compare physical rehabilitation with usual care and further research in understanding risk and patient preferences. Conclusions: Research that identifies treatments that benefit patients with ICUAW is necessary to determine whether the benefits of diagnostic testing for ICUAW outweigh its burdens. Overview Severe muscle weakness is common among critically ill patients, yet there is no consensus on whether or how to systematically identify patients with intensive care unit–acquired weakness (ICUAW). The guideline development committee began with a systematic review that identified that ICUAW may be more common among ICU patients with severe sepsis as well as those having difficulty being liberated from mechanical ventilation or requiring prolonged mechanical ventilation. Literature review failed to identify evidence comparing the effects of diagnostic testing versus no diagnostic testing on clinical outcomes. A small case series of patients with ICUAW who received physical therapy was identified, and when compared with a similar series of patients with ICUAW who did not receive physical therapy, it appeared that therapy patients might be discharged home rather than to a rehabilitative facility more frequently. However, the confidence intervals did not exclude no effect. As such, the evidence provides very little confidence in the estimated effects of physical therapy on clinical outcomes in patients with ICUAW. The guideline development committee is certain that additional research is necessary to determine …