Presence and severity of intensive care unit-acquired paresis at time of awakening are associated with increased intensive care unit and hospital mortality *.
Sharshar, Tarek MD, PhD; Bastuji-Garin, Sylvie MD, PhD; Stevens, Robert D. MD; Durand, Marie-Christine MD; Malissin, Isabelle MD; Rodriguez, Pablo MD; Cerf, Charles MD; Outin, Herve MD; De Jonghe, Bernard MD; for the Groupe de Reflexion et d'Etude des Neuromyopathies En Reanimation (GRENER)
Critical Care Medicine.
37(12):3047-3053, December 2009.
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Objectives: To assess whether the presence and severity of intensive care unit-acquired paresis are associated with intensive care unit and in-hospital mortality.
Design: Prospective, observational study.
Setting: Two medical, one surgical, and one medico-surgical intensive care units in two university hospitals and one university-affiliated hospital.
Patients: A total of 115 consecutive patients were enrolled after > 7 days of mechanical ventilation.
Measurements and Main Results: The Medical Research Council score (from 0-60) was used to evaluate upper and lower limb strength at time of awakening, identified as the ability to follow five commands. Intensive care unit-acquired paresis was defined as a Medical Research Council score <48. Patients were followed-up until hospital discharge. The primary end point was hospital mortality. At awakening, median Medical Research Council score was 41 (interquartile range, 21-52), and 75 (65%) patients had intensive care unit-acquired paresis. Hospital non-survivors had a significantly lower Medical Research Council score at awakening (21 [11-43]) vs. 41 [28-53]; p = .008) and a significantly higher rate of intensive care unit-acquired paresis (85.1% vs. 58.4%; p = .02) compared to survivors. After multivariate risk adjustment, intensive care unit-acquired paresis was independently associated with higher hospital and intensive care unit mortality (odds ratio for hospital mortality, 2.02; 95% confidence interval, 1.03-8.03; p = .048). Each Medical Research Council point decrease was associated with a significantly higher hospital mortality (odds ratio, 1.03; 95% confidence interval, 1.01-1.05; p = .033).
Conclusions: Both the presence and severity of intensive care unit-acquired paresis at the time of awakening are associated with increased intensive care unit and hospital mortality; the mechanisms underlying this association need further study.
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