Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2018 Oct;154(4):781-787.
doi: 10.1016/j.chest.2018.07.016. Epub 2018 Sep 11.

Impact of Vasoactive Medications on ICU-Acquired Weakness in Mechanically Ventilated Patients

Krysta S Wolfe  1 , Bhakti K Patel  2 , Erica L MacKenzie  3 , Shewit P Giovanni  4 , Anne S Pohlman  2 , Matthew M Churpek  2 , Jesse B Hall  2 , John P Kress  2
Affiliations
Randomized Controlled Trial

Impact of Vasoactive Medications on ICU-Acquired Weakness in Mechanically Ventilated Patients

Krysta S Wolfe et al. Chest. 2018 Oct.

Abstract

Background: Vasoactive medications are commonly used in the treatment of critically ill patients, but their impact on the development of ICU-acquired weakness is not well described. The objective of this study is to evaluate the relationship between vasoactive medication use and the outcome of ICU-acquired weakness.

Methods: This is a secondary analysis of mechanically ventilated patients (N = 172) enrolled in a randomized clinical trial of early occupational and physical therapy vs conventional therapy, which evaluated the end point of ICU-acquired weakness on hospital discharge. Patients underwent bedside muscle strength testing by a therapist blinded to study allocation to evaluate for ICU-acquired weakness. The effects of vasoactive medication use on the incidence of ICU-acquired weakness in this population were assessed.

Results: On logistic regression analysis, the use of vasoactive medications increased the odds of developing ICU-acquired weakness (odds ratio [OR], 3.2; P = .01) independent of all other established risk factors for weakness. Duration of vasoactive medication use (in days) (OR, 1.35; P = .004) and cumulative norepinephrine dose (μg/kg/d) (OR, 1.01; P = .02) (but not vasopressin or phenylephrine) were also independently associated with the outcome of ICU-acquired weakness.

Conclusions: In mechanically ventilated patients enrolled in a randomized clinical trial of early mobilization, the use of vasoactive medications was independently associated with the development of ICU-acquired weakness. Prospective trials to further evaluate this relationship are merited.

Trial registry: ClinicalTrials.gov; No.: NCT01777035; URL: www.clinicaltrials.gov.

Keywords: ICUs; critical care outcomes; critical illness; humans; muscle weakness; vasoconstrictor agents.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Incidence of ICU-acquired weakness (ICU-AW) with increasing cumulative dose of norepinephrine. *The proportion of patients with ICU-AW significantly increases with increasing cumulative dose of norepinephrine (χ2 for trend P < .0001).
See this image and copyright information in PMC

References

    1. De Jonghe B., Sharshar T., Lefaucheur J.P. Paresis acquired in the intensive care unit: a prospective multicenter study. JAMA. 2002;288(22):2859–2867. - PubMed
    1. Fan E., Cheek F., Chlan L. An official American Thoracic Society Clinical Practice guideline: the diagnosis of intensive care unit-acquired weakness in adults. Am J Respir Crit Care Med. 2014;190(12):1437–1446. - PubMed
    1. Jolley S.E., Bunnell A.E., Hough C.L. ICU-acquired weakness. Chest. 2016;150(5):1129–1140. - PMC - PubMed
    1. Hermans G., Van Mechelen H., Clerckx B. Acute outcomes and 1-year mortality of intensive care unit-acquired weakness: a cohort study and propensity-matched analysis. Am J Respir Crit Care Med. 2014;190(4):410–420. - PubMed
    1. Brunello A.G., Haenggi M., Wigger O., Porta F., Takala J., Jakob S.M. Usefulness of a clinical diagnosis of ICU-acquired paresis to predict outcome in patients with SIRS and acute respiratory failure. Intensive Care Med. 2010;36(1):66–74. - PubMed

Publication types

Substances

Associated data