Dataset Information

Intensive Care Unit-Acquired Weakness in Children: A Prospective Observational Study Using Simplified Serial Electrophysiological Testing (PEDCIMP Study).

ABSTRACT:

Background

To study the incidence and time of onset of intensive care unit-acquired weakness in a prospective cohort of children (2-12 years) by serial simplified electrophysiological assessment (Pediatric Critical Illness Myopathy Polyneuropathy study, PEDCIMP).

Methods

A single-center, prospective cohort study (Trial Registry Number: NCT02763709; PEDCIMP2016) was conducted at the pediatric intensive care unit of a tertiary care hospital in North India. A complete electrophysiological evaluation (4 motor nerves and 2 sensory nerves) was performed at baseline in children (2-12 years) admitted to the ICU with a pediatric risk of mortality (PRISM) of > 20 with more than 24-h stay. Following the entry evaluation, a minimal alternate day simplified electrophysiological testing of the unilateral common peroneal nerve and the sural nerve was assessed. A 25% reduction in compound muscle action potential (CMAP) and sensory nerve action potential from baseline was considered significant for ICUAW and was confirmed by complete electrophysiological re-evaluation.

Results

Of the total 481 children assessed for eligibility, 97 were enrolled. The median age of the cohort was 7 years. Sepsis (81%); need for vasoactive support (43%); multiorgan dysfunction (26%) were the common reasons for admission. Of the 433 eligible patient ICU days, 380 electrophysiological observations were done. A significant decrease of > 25% in CMAP of common peroneal nerve was not detected in any of the 380 observations. However, two children unfit for inclusion were diagnosed with ICUAW during the study period.

Conclusions

Children admitted with PRISM > 20 have a very low incidence of intensive care unit-acquired weakness by serial clinical and abbreviated electrophysiological evaluation.

SUBMITTER: Kasinathan A

PROVIDER: S-EPMC7538369 | biostudies-literature | 2021 Jun

REPOSITORIES: biostudies-literature

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Publications

Intensive Care Unit-Acquired Weakness in Children: A Prospective Observational Study Using Simplified Serial Electrophysiological Testing (PEDCIMP Study).

Kasinathan Ananthanarayanan A Sharawat Indar Kumar IK Singhi Pratibha P Jayashree Muralidharan M Sahu Jitendra Kumar JK Sankhyan Naveen N

Neurocritical care 20201007 3

<h4>Background</h4>To study the incidence and time of onset of intensive care unit-acquired weakness in a prospective cohort of children (2-12 years) by serial simplified electrophysiological assessment (Pediatric Critical Illness Myopathy Polyneuropathy study, PEDCIMP).<h4>Methods</h4>A single-center, prospective cohort study (Trial Registry Number: NCT02763709; PEDCIMP2016) was conducted at the pediatric intensive care unit of a tertiary care hospital in North India. A complete electrophysiolo ...[more]

PMID: 33025545

Similar Datasets

Project description:Intensive care unit-acquired weakness (ICU-AW) is the most common neuromuscular impairment in critically ill patients. We discuss critical aspects of ICU-AW that have not been completely defined or that are still under discussion. Critical illness polyneuropathy, myopathy, and muscle atrophy contribute in various proportions to ICU-AW. Diagnosis of ICU-AW is clinical and is based on Medical Research Council sum score and handgrip dynamometry for limb weakness and recognition of a patient's ventilator dependency or difficult weaning from artificial ventilation for diaphragmatic weakness (DW). ICU-AW can be caused by a critical illness polyneuropathy, a critical illness myopathy, or muscle disuse atrophy, alone or in combination. Its diagnosis requires both clinical assessment of muscle strength and complete electrophysiological evaluation of peripheral nerves and muscles. The peroneal nerve test (PENT) is a quick simplified electrophysiological test with high sensitivity and good specificity that can be used instead of complete electrophysiological evaluation as a screening test in non-cooperative patients. DW, assessed by bilateral phrenic nerve magnetic stimulation or diaphragm ultrasound, can be an isolated event without concurrent limb muscle involvement. Therefore, it remains uncertain whether DW and limb weakness are different manifestations of the same syndrome or are two distinct entities. Delirium is often associated with ICU-AW but a clear correlation between these two entities requires further studies. Artificial nutrition may have an impact on ICU-AW, but no study has assessed the impact of nutrition on ICU-AW as the primary outcome. Early mobilization improves activity limitation at hospital discharge if it is started early in the ICU, but beneficial long-term effects are not established. Determinants of ICU-AW can be many and can interact with each other. Therefore, future studies assessing early mobilization should consider a holistic patient approach with consideration of all components that may lead to muscle weakness.

Project description:BackgroundIntensive care unit-acquired weakness is a prevalent complication among critically ill patients, associated with heightened mortality rates, extended durations of mechanical ventilation and hospital stays, as well as diminished mobility and unfavorable prognoses. Early diagnosis of intensive care unit-acquired weakness and identification of its subcategories are essential for early implementation of targeted interventions and care strategies. Nevertheless, there remains a significant gap in the availability of widely accepted, accurate, and user-friendly diagnostic tools for intensive care unit-acquired weakness.ObjectiveThe aim of this research was to conduct a comprehensive review of pertinent studies on diagnostic tools for intensive care unit-acquired weakness in critically ill patients, summarizing their diagnostic efficacy and constraints to aid healthcare professionals in choosing suitable diagnostic tools for intensive care unit-acquired weakness.MethodsThe Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement were utilized to direct the literature search, bias risk assessment and data extraction. The search databases included PubMed, Web of Science, EMBASE, Cochrane Library, and CINAHL. The search period was from the inception of the database to 1 July 2024. Different types of risk bias assessment tools were used for different types of studies. Due to the heterogeneity of the data, solely a narrative synthesis of the intensive care unit-acquired weakness diagnostic tool was performed in this study.ResultsA total of 38 observational studies were included in the study. In the included studies, the gold standard for intensive care unit-acquired weakness diagnosis include the Medical Research Council score, muscle biopsy and electrophysiologic testing, potential diagnostic tools include the manual muscle test, electrophysiologic testing, imaging, serum inflammatory markers, neuromuscular ultrasound, and other parameters. In various studies, the diagnostic accuracy of intensive care unit-acquired weakness diagnostic tools has been inconsistent, with each tool possessing its own set of advantages and disadvantages. At present, no single tool is available for the definitive diagnosis of intensive care unit-acquired weakness, necessitating the combined use of multiple methods, each with inherent limitations. Manual muscle test is inexpensive and straightforward to perform, but it requires the patient to be conscious and cooperative. Muscle biopsy is invasive and rarely utilized. Electrophysiological testing can help differentiate whether intensive care unit-acquired weakness is caused by neural or muscular alterations, thereby aiding in the classification of its subtypes. However, it is moderately invasive, costly, and operator-dependent. Other diagnostic modalities, such as imaging and respiratory parameters, are under ongoing investigation.ConclusionsThe diagnostic tools available in intensive care unit-acquired weakness are varied, each with its own strengths and limitations. This study summarizes the current evidence on potential diagnostic tools for intensive care unit-acquired weakness and identifies possible future directions for these diagnostic tools.RegistrationPROSPERO Registration Number CRD42024573139.

Dataset Information

Intensive Care Unit-Acquired Weakness in Children: A Prospective Observational Study Using Simplified Serial Electrophysiological Testing (PEDCIMP Study).

Background

Methods

Results

Conclusions

Publications

Intensive Care Unit-Acquired Weakness in Children: A Prospective Observational Study Using Simplified Serial Electrophysiological Testing (PEDCIMP Study).

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