Quadriceps strength in intensive care unit survivors: Variability and influence of preadmission physical activity
Quadriceps strength in intensive care unit survivors: Variability and influence of preadmission physical activity
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DOI：
10.1016/j.aucc.2020.10.007
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发表时间：
2021-06-15
影响因子：
3.3
通讯作者：
Rousseau, Anne-Francoise
中科院分区：
文献类型：
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作者：
Blanjean, Arielle;Kellens, Isabelle;Rousseau, Anne-Francoise
背景：肌肉无力在重症监护病房（ICU）存活的患者中很常见。股四头肌力量（QS）测量可以评估与活动结果相关的下肢表现。目的：本研究的目的是通过将ICU幸存者（ICUS）与无危重疾病的手术患者和健康参与者进行比较，描述其短期演变过程中QS的范围。第二个目的是探讨ICU入院前的身体活动是否会影响随访期间的QS。方法：纳入ICU住院时间为10 ~ 2天的患者、计划择期结肠直肠手术的成人患者和年轻健康志愿者。使用手持式测力仪和先前验证的标准化方案评估最大等距QS。主腿在仰卧位测试。ICU患者在ICU内及出院后1个月进行检测，手术患者在术前、术后1天及出院后1个月进行检测。健康患者只接受一次检测。患者在入院前根据自我报告分为身体不活跃和活跃两类。结果：ICU组38例，外科组32例，健康组34例。icu组和手术组的人口学数据相似。ICU组QS低于手术组和健康组（分别为3.01[1.88-3.48]、3.38[2.84-4.37]、5.5 [4.75 -6.05]N/kg）。在ICU出院1个月后，QS没有显著改善，除了先前运动的幸存者（22/ 38,56%）：两个时间点之间的差异分别为-6.6[-27.1至-1.7]%和20.4[-3.4至43.3%]%，在运动不活跃和运动的患者中（p = 0.002）。结论：ICU存活的患者比手术患者更虚弱。然而，他们之间的QS存在巨大的异质性。在ICU出院后的一个月内，他们的QS没有改善。不运动的患者应及早发现其恢复较差的风险。(c) 2020澳大利亚重症监护护士学院有限公司Elsevier Ltd.出版。版权所有。
Background: Muscle weakness is common in patients who survive a stay in the intensive care unit (ICU). Quadriceps strength (QS) measurement allows evaluation of lower limb performances that are associated with mobility outcomes.Objectives: The objective of the study was to characterise the range of QS in ICU survivors (ICUS) during their short-term evolution, by comparing them with surgical patients without critical illness and with healthy participants. The secondary aim was to explore whether physical activity before ICU admission influenced QS during that trajectory.Methods: Patients with length of ICU stay >2 days, adults scheduled for elective colorectal surgery, and young healthy volunteers were included. Maximal isometric QS was assessed using a handheld dynamometer and a previously validated standardised protocol. The dominant leg was tested in the supine position. ICUSs were tested in the ICU and 1 month after ICU discharge, while surgical patients were tested before and on the day after surgery, as well as 1 month after discharge. Healthy patients were tested once only. Patients were classified as physically inactive or active before admission from the selfreport. Results: Thirty-eight, 32, and 34 participants were included in the ICU, surgical, and healthy groups, respectively. Demographic data were similar in the ICUS and surgical groups. In the ICU, QS was lower in the ICU group than in the surgical and healthy groups (3.01 [1.88-3.48], 3.38 [2.84-4.37], and 5.5 [4.75 -6.05] N/kg, respectively). QS did not significantly improve 1 month after ICU discharge, excepted in survivors who were previously physically active (22/38, 56%): the difference between the two time points was -6.6 [-27.1 to -1.7]% vs 20.4 [-3.4 to 43.3]%, respectively, in physically inactive and active patients (p = 0.002).Conclusions: Patients who survived an ICU stay were weaker than surgical patients. However, a huge QS heterogeneity was observed among them. Their QS did not improve during the month after ICU discharge. Physically inactive patients should be early identified as at risk of poorer recovery.(c) 2020 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.