Intensive care unit-acquired weakness
Intensive care unit-acquired weakness
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DOI：
10.1097/ccm.0b013e3181cc4b53
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发表时间：
2010-03-01
影响因子：
8.8
通讯作者：
Hall, Jesse B.
中科院分区：
文献类型：
--
作者：
Griffiths, Richard D.;Hall, Jesse B.
目的：严重虚弱被认为是一种并发症，对器官衰竭患者恢复的速度和程度以及恢复到以前的功能状态有重大影响，这些患者需要使用机械通气等生命支持治疗。尽管这一问题显然很重要，但其发病率、原因、预防和治疗仍有待了解。设计：文献回顾和专家圆桌会议。背景：2009年的布鲁塞尔圆桌会议召集了20多位重症监护、神经病学和肌肉生理学领域的专家，回顾了目前对重症监护病房获得性虚弱的理解，并改善了临床结果。主要结果：重症监护病房获得性虚弱患者的正式电生理评估可以识别周围神经病变、肌病和这些疾病的组合，尽管这些发现与床边可测量的虚弱的相关性并不总是精确的。对于常规的临床目的，可以进行神经肌肉功能的床边评估，但通常因镇静和镇痛等复杂因素而混淆。重症监护病房获得性虚弱的危险因素包括卧床休息本身、败血症和皮质类固醇暴露。虚弱和长期依赖呼吸机之间存在很强的关联；虚弱是急性呼吸衰竭存活后患者预后的主要决定因素，在危重疾病的恢复期，虚弱可能持续数月，甚至无限期。结论：尽管我们对衰老、运动、废弃和败血症条件下骨骼和膈肌功能障碍的生理学和细胞分子生物学已经有了很多了解，但将这些认识应用到床边还需要在实验模型和患者中进行更多的研究。尽管在过去几十年的重症监护病房护理中，患者越来越倾向于固定和镇静，但最近的研究表明，早期物理和职业治疗，包括在插管和呼吸机支持期间，可以安全地进行，并可能改善患者的功能状态。（重症护理医学2010；38:779-787）
Objective: Severe weakness is being recognized as a complication that impacts significantly on the pace and degree of recovery and return to former functional status of patients who survive the organ failures that mandate life-support therapies such as mechanical ventilation. Despite the apparent importance of this problem, much remains to be understood about its incidence, causes, prevention, and treatment.Design: Review from literature and an expert round-table.Setting: The Brussels Round Table Conference in 2009 convened more than 20 experts in the fields of intensive care, neurology, and muscle physiology to review current understandings of intensive care unit-acquired weakness and to improve clinical outcome.Main Results: Formal electrophysiological evaluation of patients with intensive care unit-acquired weakness can identify peripheral neuropathies, myopathies, and combinations of these disorders, although the correlation of these findings to weakness measurable at the bedside is not always precise. For routine clinical purposes, bedside assessment of neuromuscular function can be performed but is often confounded by complicating factors such as sedative and analgesic administration. Risk factors for development of intensive care unit-acquired weakness include bed rest itself, sepsis, and corticosteroid exposure. A strong association exists between weakness and long-term ventilator dependence; weakness is a major determinant of patient outcomes after surviving acute respiratory failure and may be present for months, or indefinitely, in the convalescence phase of critical illness.Conclusion: Although much has been learned about the physiology and cell and molecular biology of skeletal and diaphragm dysfunction under conditions of aging, exercise, disuse, and sepsis, the application of these understandings to the bedside requires more study in both bench models and patients. Although a trend toward greater immobilization and sedation of patients has characterized the past several decades of intensive care unit care, recent studies have demonstrated that early physical and occupational therapy, including during the period of intubation and ventilator support, can be safely performed and will likely improve patient outcomes with regard to functional status. (Crit Care Med 2010; 38: 779-787)