Journal of critical care最新文献_第6页

Effectiveness of early high-flow nasal oxygen therapy after extubation of patients in the intensive care unit 重症监护室患者拔管后早期高流量鼻氧治疗的效果

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2024-10-28 DOI: 10.1016/j.jcrc.2024.154939

Dipasri Bhattacharya , Antonio M. Esquinas , Mohanchandra Mandal

引用次数: 0

Letter to the Editor: “Portal hypertension-like pattern in coronavirus disease 2019 acute respiratory distress syndrome” 致编辑的信："2019年冠状病毒病急性呼吸窘迫综合征的门静脉高压样模式"。

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2024-10-23 DOI: 10.1016/j.jcrc.2024.154941

Kashish Zehra Manjee, Aniqa Dejwani, Umaima Arif, Neeraj Kumar

引用次数: 0

Protective effect of intravenous amino acid on kidney function: A systematic review and meta-analysis of randomized controlled trials 静脉注射氨基酸对肾功能的保护作用：随机对照试验的系统回顾和荟萃分析。

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2024-10-23 DOI: 10.1016/j.jcrc.2024.154937

Wei Jiang , Keran Shi , Jun Shao , Lin Song , Ying Shi , Haoran Wang , Lulun Zhou , Luanluan Li , Yunfan Feng , Jiangquan Yu , Ruiqiang Zheng

Background

Acute kidney injury (AKI) is a common complication in critically ill and cardiac surgery patients. Intravenous amino acids can increase renal perfusion and replenish renal functional reserves. However, the exact therapeutic efficacy of intravenous amino acids in reducing the incidence of AKI remains uncertain. Therefore, this study aims to comprehensively review the existing evidence to assess the potential of intravenous amino acids in kidney protection.

Methods

EMBASE, PubMed, MEDLINE, and the Cochrane Library were searched for randomized controlled trials published on or before July 2, 2024, that examined the relationship between Intravenous amino acids and renal function. We extracted population characteristics and outcome variables related to renal function from randomized controlled trials comparing intravenous amino acid supplementation with no supplementation. We assessed this evidence using the Risk of Bias 2 (RoB2) tool for randomized controlled trials. Data were synthesized using a random-effects model.

Results

This review included 7 randomized controlled trials with a total of 505 patients. The results showed that compared with the control group, intravenous amino acid administration significantly reduced the incidence of AKI (RR: 0.81, 95 % CI: 0.68–0.97, P = 0.02) and increased urine output (MD: 308.87, 95 % CI: 168.68–449.06, P < 0.0001). However, intravenous amino acids did not reduce mortality or the incidence of kidney replacement therapy, with no statistical difference in 30-day mortality (RR: 0.93, 95 % CI: 0.65–1.34, P = 0.71), 90-day mortality (RR:1.00, 95 % CI: 0.77–1.29, P = 0.98), or need for kidney replacement therapy (RR: 0.92, 95 % CI: 0.41–2.06, P = 0.83). Subgroup analysis suggested that, regardless of sample size, intravenous amino acid administration reduced the incidence of AKI and was particularly significant in patients undergoing cardiac and major vascular surgery. Furthermore, intraoperative intravenous amino acid therapy demonstrated a significant reduction in the incidence of AKI compared to postoperative administration.

Conclusions

Intravenous amino acids protect renal function in patients at high risk of AKI, particularly after cardiac surgery. It reduces the incidence of AKI and increases urine output, but has no significant effect on KRT and mortality.

背景：急性肾损伤（AKI）是重症患者和心脏手术患者常见的并发症。静脉注射氨基酸可增加肾脏灌注并补充肾功能储备。然而，静脉注射氨基酸在降低 AKI 发生率方面的确切疗效仍不确定。因此，本研究旨在全面回顾现有证据，评估静脉注射氨基酸在保护肾脏方面的潜力：在 EMBASE、PubMed、MEDLINE 和 Cochrane 图书馆中检索了 2024 年 7 月 2 日或之前发表的研究静脉注射氨基酸与肾功能关系的随机对照试验。我们从比较静脉补充氨基酸与不补充氨基酸的随机对照试验中提取了与肾功能相关的人群特征和结果变量。我们使用随机对照试验的偏倚风险2（RoB2）工具对这些证据进行了评估。我们使用随机效应模型对数据进行了综合分析：本综述包括 7 项随机对照试验，共有 505 名患者参与。结果表明，与对照组相比，静脉注射氨基酸可显著降低 AKI 的发生率（RR：0.81，95 % CI：0.68-0.97，P = 0.02）并增加尿量（MD：308.87，95 % CI：168.68-449.06，P 结论：静脉注射氨基酸可保护肾脏：静脉注射氨基酸可保护高风险 AKI 患者的肾功能，尤其是心脏手术后的患者。它能降低 AKI 的发生率并增加尿量，但对 KRT 和死亡率没有显著影响。

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引用次数: 0

Impact of mild hypercapnia in critically ill patients with metabolic acidosis 代谢性酸中毒重症患者轻度高碳酸血症的影响。

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2024-10-20 DOI: 10.1016/j.jcrc.2024.154936

Ary Serpa Neto , Ahmad Nasser , Prashanti Marella , Tomoko Fujii , Kazunari Takahashi , Kevin Laupland , Alexis Tabah , Antony G. Attokaran , Aashish Kumar , James McCullough , Kiran Shekar , Peter Garrett , Sebastiaan Blank , Siva Senthuran , Stephen Luke , Mairead McNamara , Rinaldo Bellomo , Kyle White , on behalf of the Queensland Critical Care Research Network (QCCRN) and the SODa-BIC investigators

Purpose

Clinical trials focusing on critically ill patients with metabolic acidosis, a common exclusion criterion is the presence of a PaCO₂ > 45 mmHg. The aim of this study was to assess the impact of mild hypercapnia on patient characteristics, severity, and clinical outcomes in critically ill patients with metabolic acidosis.

Material and methods

Multicentre, retrospective, observational study conducted in 12 intensive care units (ICUs) in Queensland, Australia. Patients with metabolic acidosis and concurrent vasopressor requirement were included and the exposure of interest was the PaCO₂ level at the time of meeting the eligibility criteria divided in two groups: PaCO₂ ≤ 45 mmHg and PaCO₂ 46–50 mmHg. Primary clinical outcome was major adverse kidney events within 30 days (MAKE30).

Results

We studied 5601 patients, with 3605 (64.4 %) in the PaCO₂ ≤ 45 mmHg group and 1996 (35.6 %) in the PaCO₂ 46–50 mmHg group. The incidence of MAKE30 was lower in the PaCO₂ 46–50 mmHg group (29 % vs. 34 %; OR, 0.79 [95 %CI, 0.69 to 0.90]; p < 0.001) as was the use of renal replacement therapy, and the incidence of acute kidney injury. After adjustment for confounders, no outcome was different between the groups. The maximum fall of pH associated with an increase of 1 mmHg of PaCO₂ in the PaCO₂ 46–50 mmHg group was 0.006.

Conclusion

In patients with metabolic acidosis, after adjustment for potential confounders, mild hypercapnia does not increase the MAKE-30 rate and does not have a major impact on pH.

目的：针对代谢性酸中毒重症患者的临床试验，一个常见的排除标准是 PaCO2 > 45 mmHg。本研究旨在评估轻度高碳酸血症对代谢性酸中毒重症患者的特征、严重程度和临床结果的影响：在澳大利亚昆士兰州的 12 个重症监护病房（ICU）开展多中心、回顾性、观察性研究。研究纳入了代谢性酸中毒且同时需要血管加压素的患者，研究对象为符合资格标准时的 PaCO2 水平，分为两组：PaCO2 ≤ 45 mmHg 和 PaCO2 46-50 mmHg。主要临床结果为 30 天内的主要肾脏不良事件（MAKE30）：我们对 5601 名患者进行了研究，其中 PaCO2 ≤ 45 mmHg 组有 3605 人（64.4%），PaCO2 46-50 mmHg 组有 1996 人（35.6%）。PaCO2 46-50 mmHg 组的 MAKE30 发生率较低（29 % vs. 34 %；OR，0.79 [95 %CI，0.69 至 0.90]；PaCO2 46-50 mmHg 组的 P 2 为 0.006）：在代谢性酸中毒患者中，经调整潜在的混杂因素后，轻度高碳酸血症不会增加 MAKE-30 的速率，也不会对 pH 值产生重大影响。

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引用次数: 0

Clinical phenotyping of septic shock with latent profile analysis: A retrospective multicenter study 利用潜谱分析对脓毒性休克进行临床表型：一项多中心回顾性研究

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2024-10-20 DOI: 10.1016/j.jcrc.2024.154932

Guanghao Liu , Ruoqiong Wu , Jun He , Yichang Xu , Li Han , Yingying Yu , Haibo Zhu , Yehan Guo , Hao Fu , Ting Chen , Shixiang Zheng , Xiaopei Shen

Background

Septic shock (SS) is a highly fatal and heterogeneous syndrome. Identifying distinct clinical phenotypes provides valuable insights into the underlying pathophysiological mechanisms and may help to propose precise clinical management strategies.

Methods

Latent profile analysis (LPA), a model-based unsupervised method, was used for phenotyping in the MIMIC cohort, and the model was externally independently validated in the eICU and AUMC cohorts.

Results

Three phenotypes, labeled phenotype I, II, and III, were derived. These phenotypes varied in demographics, clinical features, comorbidities, patterns of organ dysfunction, organ support, and prognosis. Phenotype I, characterized by the most severe organ dysfunction (especially liver), the youngest age, and the highest BMI, had the highest mortality (p < 0.001). Phenotype II, with moderate mortality, was characterized by severe renal injury. In contrast, phenotype III, associated with the oldest age and the fewest comorbidities, exhibited significantly lower mortality. Phenotype I patients had the steepest survival curves and demonstrated an ultra-high risk of death, particularly within the first few days after SS onset.

Conclusions

The individualized identification of phenotypes is well suited to clinical practice. The three SS phenotypes differed significantly in pathophysiological and clinical outcomes, which are crucial for informing management decisions and prognosis.

背景：脓毒性休克（SS）是一种高度致命的异质性综合征。识别不同的临床表型有助于深入了解潜在的病理生理机制，并有助于提出精确的临床管理策略：方法：在 MIMIC 队列中使用基于模型的无监督方法 Latent profile analysis (LPA) 进行表型分析，并在 eICU 和 AUMC 队列中对该模型进行了外部独立验证：结果：得出了三种表型，分别称为表型 I、II 和 III。这些表型在人口统计学、临床特征、合并症、器官功能障碍模式、器官支持和预后方面各不相同。表型 I 以最严重的器官功能障碍（尤其是肝脏）、最年轻的年龄和最高的体重指数为特征，死亡率最高（P 结论）：表型的个体化鉴定非常适合临床实践。SS 的三种表型在病理生理学和临床结果方面存在显著差异，这对于制定管理决策和预后至关重要。

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引用次数: 0

Vasopressor utilization in septic shock patients receiving propofol versus midazolam 接受异丙酚与咪达唑仑治疗的脓毒性休克患者使用血管加压素的情况。

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2024-10-20 DOI: 10.1016/j.jcrc.2024.154935

Brittany R. Weger, Shannon Marie Carabetta, Lindsey Gignac, Sarah Hayes, J. Totty Johnson

Purpose

The purpose of this study was to evaluate the effect of propofol versus midazolam on vasopressor requirements in patients with septic shock to better guide sedative selection.

Methods

This was a multicenter, retrospective, observational, IRB-approved, non-inferiority cohort study. Included individuals were ≥ 18 years of age, had a diagnosis of septic shock, and exclusive administration of propofol or midazolam for at least 12 h. The primary outcome was maximum increase in vasopressor requirements within the first 12 h following sedative initiation.

Results

For the primary outcome of maximum increase in norepinephrine equivalents (NEE) within 12 h, propofol was non-inferior to midazolam (0.09 vs. 0.129 μg/kg/min, p = 0.002). No difference was seen between the propofol and midazolam groups for the secondary outcome of maximum increase in NEE within 3 h (0.02 vs 0.04 μg/kg/min, p = 0.208), however, the propofol group had a significantly lower increase within 6 h (0.06 vs 0.086 μg/kg/min, p = 0.043) and 24 h (0.11 vs 0.25 μg/kg/min, p = 0.013).

Conclusion

In patients with septic shock, vasopressor requirement increases with propofol were non-inferior to midazolam within the first 12 h.

目的：本研究旨在评估异丙酚与咪达唑仑对脓毒性休克患者血管加压剂需求的影响，以更好地指导镇静剂的选择：这是一项多中心、回顾性、观察性、经 IRB 批准的非劣效性队列研究。研究对象年龄≥18岁，诊断为脓毒性休克，至少12小时内未使用过丙泊酚或咪达唑仑：结果：就 12 小时内去甲肾上腺素当量（NEE）的最大增幅这一主要结果而言，异丙酚的效果不优于咪达唑仑（0.09 vs. 0.129 μg/kg/min，p = 0.002）。在3小时内NEE的最大增幅这一次要结果上，异丙酚组和咪达唑仑组之间没有差异（0.02 vs 0.04 μg/kg/min，p = 0.208），但异丙酚组在6小时内（0.06 vs 0.086 μg/kg/min，p = 0.043）和24小时内（0.11 vs 0.25 μg/kg/min，p = 0.013）的增幅明显较低：结论：对于脓毒性休克患者，在最初的12小时内，使用异丙酚增加的血管舒张剂需求量并不比咪达唑仑低。

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引用次数: 0

Intensivists' ethical perceptions about decisions to withhold or withdraw treatment: A clinical ethics empirical investigation 重症监护医师对暂停或撤销治疗决定的伦理认知：临床伦理实证调查。

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2024-10-19 DOI: 10.1016/j.jcrc.2024.154931

Marta Spranzi PhD , Sarah Morinet MD , Nicolas Foureur MD

Background

Intensive care professional societies have issued policy recommendations regarding decisions to withhold and/or withdraw treatment (Wh&Wd) that consistently classify them as ethically equivalent and ethically neutral. However, on the ground they are often perceived as “active” and morally problematic. Moreover, recent studies have highlighted personal “variability” in the way such decisions are made. Therefore, it seemed necessary to explore intensivists' different ethical perceptions about Wh&Wd decisions.

Methods

A qualitative retrospective and multicentered study was conducted in seven intensive care units belonging to the Paris Hospital Trust (AP-HP), which involved in-depth interviews with 44 intensivists of different ages and levels of professional experience. An inductive (“grounded theory”-inspired), multidisciplinary clinical ethics approach was used that aimed at eliciting and retrieving practitioners' ethical intuitions about different Wh&Wd decisions. Interview transcripts were analyzed using a “thematic analysis” approach.

Results

Practitioners' perceptions of Wh&Wd decisions vary along two continuous dimensions: active/passive and ethically problematic/unproblematic. Three groups have been identified: those who consider Wh&Wd decisions 1) as passive and unproblematic, 2) as active and problematic, and 3) as active and unproblematic. More interestingly, these groups can be differently characterized with respect to three other ethically relevant considerations: the role of consensus during the collegial decision-making procedure, the difference between withholding and withdrawing decisions, and the definition of one's own overarching professional goal.

Conclusion

The study results allow for recognition of intensivists' moral distress about Wh&Wd decisions and open new perspectives to deal with their deep-rooted variability, most notably by working on the rationale and format of the collegial decision-making procedure.

背景：重症监护专业协会已就暂停和/或撤消治疗（Wh&Wd）的决定发布了政策建议，并一致将其归类为伦理等同和伦理中性的决定。然而，在实际情况中，它们往往被认为是 "主动的"，在道德上是有问题的。此外，最近的研究还强调了在做出此类决定时个人的 "可变性"。因此，似乎有必要探讨一下重症监护医师对 Wh&Wd 决定的不同伦理看法：在隶属于巴黎医院信托基金会（AP-HP）的七个重症监护病房开展了一项定性回顾性多中心研究，对 44 名不同年龄和不同专业经验水平的重症监护医师进行了深入访谈。研究采用了归纳法（"基础理论 "启发）、多学科临床伦理方法，旨在激发和检索从业人员对不同Wh&Wd决策的伦理直觉。采用 "主题分析 "方法对访谈记录进行了分析：结果：从业人员对 WH&Wd 决策的看法有两个连续的维度：主动/被动和伦理问题/无问题。结果发现了三类人：1) 认为 Wh&Wd 决策是被动的、没有问题的；2) 认为是主动的、有问题的；3) 认为是主动的、没有问题的。更有趣的是，在其他三个与伦理相关的考虑因素方面，这些群体也有不同的特点：在共同决策程序中达成共识的作用、暂不做出决定与撤回决定之间的区别，以及对自身总体专业目标的定义：研究结果使我们认识到了重症监护医师在Wh&Wd决策方面的道德困扰，并为解决其根深蒂固的多变性开辟了新的视角，其中最主要的是通过研究共同决策程序的原理和形式。

{"title":"Intensivists' ethical perceptions about decisions to withhold or withdraw treatment: A clinical ethics empirical investigation","authors":"Marta Spranzi PhD , Sarah Morinet MD , Nicolas Foureur MD","doi":"10.1016/j.jcrc.2024.154931","DOIUrl":"10.1016/j.jcrc.2024.154931","url":null,"abstract":"<div><h3>Background</h3><div>Intensive care professional societies have issued policy recommendations regarding decisions to withhold and/or withdraw treatment (Wh&Wd) that consistently classify them as ethically equivalent and ethically neutral. However, on the ground they are often perceived as “active” and morally problematic. Moreover, recent studies have highlighted personal “variability” in the way such decisions are made. Therefore, it seemed necessary to explore intensivists' different ethical perceptions about Wh&Wd decisions.</div></div><div><h3>Methods</h3><div>A qualitative retrospective and multicentered study was conducted in seven intensive care units belonging to the Paris Hospital Trust (AP-HP), which involved in-depth interviews with 44 intensivists of different ages and levels of professional experience. An inductive (“grounded theory”-inspired), multidisciplinary clinical ethics approach was used that aimed at eliciting and retrieving practitioners' ethical intuitions about different Wh&Wd decisions. Interview transcripts were analyzed using a “thematic analysis” approach.</div></div><div><h3>Results</h3><div>Practitioners' perceptions of Wh&Wd decisions vary along two continuous dimensions: active/passive and ethically problematic/unproblematic. Three groups have been identified: those who consider Wh&Wd decisions 1) as passive and unproblematic, 2) as active and problematic, and 3) as active and unproblematic. More interestingly, these groups can be differently characterized with respect to three other ethically relevant considerations: the role of consensus during the collegial decision-making procedure, the difference between withholding and withdrawing decisions, and the definition of one's own overarching professional goal.</div></div><div><h3>Conclusion</h3><div>The study results allow for recognition of intensivists' moral distress about Wh&Wd decisions and open new perspectives to deal with their deep-rooted variability, most notably by working on the rationale and format of the collegial decision-making procedure.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154931"},"PeriodicalIF":3.2,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142466615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Ultrasound assessment of muscle mass in critically ill patients: A correlation with nutritional support and clinical outcomes 重症患者肌肉质量的超声评估：与营养支持和临床结果的相关性。

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2024-10-19 DOI: 10.1016/j.jcrc.2024.154938

Maria Leonor Guia Lopes , José Pedro Cidade , David Sousa , Marta Rebelo , Carolina Antunes , Eduarda Carmo , Pedro Póvoa , Pais Martins , Clotilde Limbert , João Sequeira Duarte

Background

Critically ill patients are at high risk of Intensive Care Unit (ICU) Acquired weakness, which negatively impacts clinical outcomes. Traditional muscle mass and nutritional status assessments are often impractical in the ICU. Ultrasound offers a promising, non-invasive alternative. This study evaluates the relationship between ultrasound-based muscle assessments, patients' nutritional support, and clinical outcomes in the ICU.

Methods

A prospective cohort study was conducted in three ICUs of a tertiary center. Daily nutritional intake, ultrasound measurements of the quadriceps muscle (rectus femoris cross-sectional area – RFCSA – and quadriceps muscle layer thickness - QMLT), and clinical data were collected on days 1, 3, and 7 of ICU.

Results

A total of 128 patients were included in the analysis, with a mean age of 65.4 (±18.1) years and a median ICU stay of 6 (4–10) days. QMLT decreased by 5 % and 13 %, and RFCSA decreased by 10 % and 27 % on days 3 and 7, respectively. A significant correlation was found between lower caloric and protein intake and greater muscle mass loss within the initial 3 days of ICU admission. Multivariate logistic regression indicated that QMLT reduction significantly contributed to 28-day mortality (adjusted OR 1.088, 95 % CI: 1.018–1.113, p = 0.015). Lower daily caloric and protein intake was depicted in non-surviving patients (p < 0.001).

Conclusions

Our study demonstrates that critically ill patients experience significant muscle mass loss within the first 72 h of ICU. QMLT reduction significantly impacts 28-day mortality, with an 8.8 % increase in the odds of death per 0.1 cm reduction.

背景：重症监护病房（ICU）的危重病人很容易出现后天性虚弱，这对临床疗效产生了负面影响。传统的肌肉质量和营养状况评估在重症监护病房往往不切实际。超声波是一种很有前景的无创替代方法。本研究评估了重症监护病房中基于超声的肌肉评估、患者营养支持和临床疗效之间的关系：一项前瞻性队列研究在一家三级医疗中心的三间重症监护室进行。在重症监护病房的第 1、3 和 7 天收集每日营养摄入量、股四头肌超声测量值（股直肌横截面积 - RFCSA 和股四头肌肌层厚度 - QMLT）和临床数据：共有 128 名患者参与分析，平均年龄为 65.4（±18.1）岁，入住重症监护室的中位时间为 6（4-10）天。在第 3 天和第 7 天，QMLT 分别下降了 5% 和 13%，RFCSA 分别下降了 10% 和 27%。在入住 ICU 的最初 3 天内，热量和蛋白质摄入量较低与肌肉质量损失较多之间存在明显的相关性。多变量逻辑回归结果表明，QMLT 的降低对 28 天死亡率有显著影响（调整 OR 1.088，95 % CI：1.018-1.113，p = 0.015）。非存活患者的每日热量和蛋白质摄入量较低（p 结论：我们的研究表明，危重病人的每日热量和蛋白质摄入量较低，而非存活患者的每日热量和蛋白质摄入量较高：我们的研究表明，重症患者在进入重症监护室的前 72 小时内会出现明显的肌肉质量下降。QMLT 的减少对 28 天的死亡率有重大影响，每减少 0.1 厘米，死亡几率增加 8.8%。

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引用次数: 0

Quadriceps Muscle Layer Thickness and its association with frailty in critically ill patients: A prospective observational study 重症患者股四头肌肌层厚度及其与虚弱的关系：前瞻性观察研究

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2024-10-19 DOI: 10.1016/j.jcrc.2024.154930

Vijay Sundarsingh , R. Manoj Kumar , Manjunath Kulkarni , Debasis Pradhan , Pramela Renisha Rodrigues , Nishanth Baliga , Mamata Prasad , Pooja Yadav , Monish Thomas , Tania Eltrida Pinto

Background

Frailty is a well-recognized clinical entity known to influence the outcomes of critically ill patients. Muscle ultrasound, particularly Quadriceps Muscle Layer Thickness (QMLT), assesses muscle mass, which is a key component determining frailty. However, no studies have assessed the association between frailty and QMLT. This study aimed to determine the association between the QMLT and frailty in critically ill elderly patients.

Method

In this prospective, observational, single-center study conducted in an ICU in India, patients aged >65 years were enrolled. Baseline frailty was assessed using the Clinical Frailty Scale (CFS). Quadriceps muscle thickness was measured via axial cross-section ultrasound at admission. Patients were categorized as non-frail (CFS 1–4) and frail (CFS ≥5), and their characteristics were compared. Multivariate regression analysis was used to identify factors associated with frailty.

Results

120 patients were included. The median APACHE II and SOFA scores were 19 [IQR 14.25–23] and 4.5 [IQR 3–6], respectively. The median age was 75 years [IQR 70–82]; 62.5 % were male. The most common comorbidities were diabetes mellitus (60 %) and hypertension (59 %). 65 % were mechanically ventilated. 65 % of patients were frail. Frail patients had higher mortality (37.17 % vs. 16.66 %, p = 0.022). QMLT was lesser in frail than non-frail (1.77 cm vs 2.21 cm, p < 0.001). QMLT decreased with an increase in CFS (p < 0.001). Frail and non-frail patients were further divided into four groups based on the median QMLT (1.96 cm). Frail patients with QMLT below the median had a higher 28-day mortality than non-frail and frail patients with QMLT above the median (48.97 % vs. 16.12 % vs. 18.18 % vs. 17.24 %, p = 0.003). Frailty was independently associated with increasing age (OR, 1.14; 95 % CI: 1.055–1.231, p = 0.001), higher APACHE II score (OR, 1.078; 95 % CI: 1.009–1.151, p = 0.025), and lower QMLT (OR, 0.205; 95 % CI: 0.083–0.509, p = 0.001).

Conclusions

We found an independent association between Quadriceps Muscle Layer Thickness (QMLT) and frailty. QMLT decreased progressively with CFS scores. Frail patients with lower QMLT had increased 28-day mortality. These findings highlight the role of incorporating QMLT measurements along with CFS in frailty evaluations to improve decision-making in critically ill elderly patients.

背景：众所周知，虚弱是影响危重病人预后的一个公认的临床实体。肌肉超声，尤其是股四头肌肌层厚度（QMLT），可评估肌肉质量，而肌肉质量是决定虚弱程度的关键因素。然而，还没有研究评估过虚弱与 QMLT 之间的关系。本研究旨在确定重症老年患者的 QMLT 与虚弱之间的关系：这项前瞻性、观察性、单中心研究在印度的一家重症监护室进行，研究对象为年龄大于 65 岁的患者。基线虚弱程度采用临床虚弱程度量表（CFS）进行评估。入院时通过轴向横截面超声波测量股四头肌厚度。患者被分为非虚弱（CFS 1-4）和虚弱（CFS ≥5）两类，并对他们的特征进行了比较。采用多变量回归分析确定与虚弱相关的因素：结果：共纳入 120 名患者。APACHE II 和 SOFA 评分的中位数分别为 19 [IQR 14.25-23] 和 4.5 [IQR 3-6]。中位年龄为 75 岁 [IQR 70-82]；62.5% 为男性。最常见的合并症是糖尿病（60%）和高血压（59%）。65%的患者使用机械通气。65%的患者身体虚弱。体弱患者的死亡率较高（37.17% 对 16.66%，P = 0.022）。体弱患者的 QMLT 小于非体弱患者（1.77 厘米 vs. 2.21 厘米，p 结论：我们发现股四头肌肌层厚度（QMLT）与体弱之间存在独立关联。QMLT随CFS评分的增加而逐渐减小。QMLT 较低的虚弱患者 28 天死亡率增加。这些发现强调了在评估虚弱程度时将 QMLT 测量与 CFS 结合起来以改善老年重症患者决策的作用。

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引用次数: 0

Association between the development of intensive care unit-acquired weakness and body composition at intensive care unit admission: A descriptive study 重症监护室获得性乏力的发生与重症监护室入院时身体成分之间的关系：描述性研究。

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2024-10-18 DOI: 10.1016/j.jcrc.2024.154933

Yoshito Yabe , Akira Komori , Hiroki Iriyama , Kazuto Ikezawa , Toshikazu Abe

Purpose

To evaluate differences in body composition at intensive care unit (ICU) admission between patients with and without ICU-acquired weakness (ICU-AW).

Materials and methods

This single-center, retrospective cohort study was conducted at Tsukuba Memorial Hospital's mixed ICU in Japan. We included patients who could walk unassisted before admission, received rehabilitation post-admission, and survived for at least 48 h. Body composition was assessed using bioelectrical impedance analysis (BIA) at ICU admission. Patients were classified into ICU-AW and non-ICU-AW groups, and their characteristics, outcomes, and body compositions were compared.

Results

Of the 282 patients analyzed, 28 (9.9 %) developed ICU-AW. ICU-AW patients were older (79 [72–86] vs. 70 [61–77], P < 0.01) and had higher SOFA scores (8 [5–13][ vs. 3 [2–6], P < 0.01). BIA showed a higher extracellular water to total body water ratio (0.408 [0.391–0.414] vs. 0.388 [0.380–0.400], P < 0.01) and a lower phase angle (3.7 [3.3–4.9] vs. 4.9 [4.2–5.7], P < 0.01) in the ICU-AW group. Skeletal muscle mass was similar between groups (23.2 [18.9–26.0] vs. 24.8 [20.5–28.3], P = 0.07).

Conclusions

ICU-AW patients had poorer cellular nutritional status but similar skeletal muscle mass at ICU admission compared to non-ICU-AW patients.

目的：评估重症监护病房（ICU）获得性虚弱（ICU-AW）患者和非获得性虚弱（ICU-AW）患者入院时身体成分的差异：这项单中心回顾性队列研究在日本筑波纪念医院的混合重症监护病房进行。我们纳入了入院前能独立行走、入院后接受康复治疗且存活至少 48 小时的患者。患者被分为重症监护病房辅助行走组和非重症监护病房辅助行走组，并对他们的特征、结果和身体成分进行了比较：在分析的 282 名患者中，有 28 人（9.9%）出现了 ICU-AW。ICU-AW 患者年龄较大（79 [72-86] vs. 70 [61-77]，P 结论：ICU-AW 患者的预后较差：与非 ICU-AW 患者相比，ICU-AW 患者入院时的细胞营养状况较差，但骨骼肌质量相似。

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引用次数: 0