Article

Paresis acquired in the intensive care unit (ICU) is common in
patients who are critically ill and independently predicts mortality and
morbidity. Manual muscle testing (MMT) and handgrip dynamometry assessments have
been used to evaluate muscle weakness in patients in a medical ICU, but similar
data for patients in a surgical ICU (SICU) are limited. OBJECTIVE: The purpose of
this study was to evaluate the predictive value of strength measured by MMT and
handgrip dynamometry at ICU admission for in-hospital mortality, SICU length of
stay (LOS), hospital LOS, and duration of mechanical ventilation. DESIGN: This
investigation was a prospective, observational study. METHODS: One hundred ten
patients were screened for eligibility for testing in the SICU of a large,
academic medical center. The Acute Physiology and Chronic Health Evaluation
(APACHE) II score, diagnoses, and laboratory data were collected. Measurements
were obtained by MMT quantified with the sum (total) score on the Medical
Research Council Scale and by handgrip dynamometry. Outcome data, including
in-hospital mortality, SICU LOS, hospital LOS, and duration of mechanical
ventilation, were collected for all participants. RESULTS: One hundred seven
participants were eligible for testing; 89% were tested successfully at a median
of 3 days (25th-75th percentiles=3-6 days) after admission. Sedation was the most
frequent barrier to testing (70.6%). Manual muscle testing was identified as an
independent predictor of mortality, SICU LOS, hospital LOS, and duration of
mechanical ventilation. Grip strength was not independently associated with these
outcomes. LIMITATIONS: This study did not address whether muscle weakness
translates to functional outcome impairment. CONCLUSIONS: In contrast to handgrip
strength, MMT reliably predicted in-hospital mortality, duration of mechanical
ventilation, SICU LOS, and hospital LOS.

Langue : ANGLAIS