Changes in Limb Circumferences among Intensive Care Unit Patients and Related Factors

중환자실 환자의 입원기간에 따른 사지 둘레 변화 및 관련요인

  • Shin, Hye Eun (Neurosurgical Intensive Care Unit, Kosin University Gospel Hospital) ;
  • Kang, Jiyeon (Department of Nursing, Dong-A University)
  • 신혜은 (고신대학교 복음병원 중환자실) ;
  • 강지연 (동아대학교 간호학과)
  • Received : 2016.10.14
  • Accepted : 2016.12.08
  • Published : 2016.12.31

Abstract

Purpose: This study was conducted to identify changes in limb circumferences among patients admitted to the intensive care unit (ICU) and related factors. Methods: We conducted a prospective observational study with 27 patients from 3 ICUs at a university hospital located in B city of Korea, from September 1 to October 30, 2015. The circumferences of the left and right upper arms, thighs, and lower legs were measured on the first, third, fifth, and seventh days of ICU admission. Information on the related factors was collected from the medical records. The data were analyzed using a linear mixed model method. Results: The limbs circumferences significantly reduced from day 3, and the changes continued till day 7. These changes were related to the gender of the subjects, restraints application, use of steroids, and continuous renal replacement therapy. Conclusions: Based on the above results, it can be concluded that ICU-acquired weakness begins before the third day of admission. Thus, early mobilization protocols for ICU patients need to be developed and implemented in order to improve long-term outcomes.

Keywords

References

  1. Appleton, R., & Kinsella, J. (2012). Intensive care unit-acquired weakness, Continuing Education in Anaesthesia, Critical Care & Pain Advance Access. 12(2), 1-5. http://dx.doi.org/10.1093/bjaceaccp/mkr057
  2. Bassett, R. D., & Vollman, K. M., Brandwene, L., Murray, T. (2012). Integrating a multidisciplinary mobility programme into intensive care practice (IMMPTP): A multicenter collaborative. Intensive & Critical Care Nursing, 28(2), 88-97. http://dx.doi.org/10.1016/j.iccn.2011.12.001
  3. Brownback, C. A., Fletcher, P., Pierce, L.N., & Klaus, S. (2014). Early mobility activities during continuous renal replacement therapy. American Journal of Critical Care, 23(4), 348-351. http://dx.doi.org/10.4037/ajcc2014889
  4. Castro-Avila, A. C., Seron, P., Fan, E., Gaete, M., & Mickan, S. (2015). Effect of early rehabilitation during intensive care unit stay on functional status: Systematic review and meta-analysis. PLos One, 10(7), e0130722. http://dx.doi.org/10.1371/journal.pone.0130722
  5. Corcoran, J. R., Herbsman, J. M., Bushnik, T., Van Lew, S., Stolfi, A., Parkin, K., et al. (2016). Early rehabilitation in the medical and surgical intensive care units for patients with and without mechanical ventilation: An interprofessional performance improvement project.. PM&R. forthcoming. http://dx.doi.org/10.1016/j.pmrj.2016.06.015.
  6. de Jonghe, B., Lacherade, J. C., Sharshar, T., & Outin, H. (2009). Intensive care unit-acquired weakness: risk factors and prevention. Critical Care Medicine, 37(10 Suppl), S309-315. http://dx.doi.org/10.1097/CCM.0b013e3181b6e64c
  7. de Jonghe B, Sharshar T, Lefaucheur JP, Authier FJ, Durand-Zaleski I, Boussarsar M, et al. (2002). Paresis acquired in the intensive care unit. A prospective multicenter Study. JAMA, 288(22), 2859-2867. https://doi.org/10.1001/jama.288.22.2859
  8. Friedrich, O., Reid, MB., Van den Berghe, G., Vanhorebeek, I., Hermans, G., Rich, M. M., wt al. (2015). The sick and the weak:.Neuropathies/myopathies in the critically ill. Physiological Reviews, 95(3), 1025-1109. http://dx.doi.org/10.1152/physrev.00028.2014
  9. Griffiths, R.D. & Hall, J. B. (2010). Intensive care unit-acquired weakness. Critical Care Medicine, 38(3), 779-787. http://dx.doi.org/10.1097/CCM.0b013e3181cc4b53
  10. Harvey, M. A. (2012). The truth about consequences-post-intensive care syndrome in intensive care unit survivors and their families. Critical Care Medicine, 40(8), 2506-2507. http://dx.doi.org/10.1097/CCM.0b013e318258e943
  11. Hermans, G., Casaer, M. P., Clerckx, B., Guiza, F., Vanhullebusch, T., Derde, S., et al. (2013). Effect of tolerating macronutrient deficit on the development of intensive-care unit acquired weakness: a subanalysis of the EPaNIC trial. Lancet Respiratory Medicine, 1(8), :621629. http://dx.doi.org/10.1016/S2213-2600(13)70183-8
  12. Hermans, G., & Van den Berghe, G. (2015). Clinical review: intensive care unit acquired weakness. Critical Care Medicine, 5(19), 274-283. http://dx.doi.org/10.1186/s13054-015-0993-7
  13. Herridge, M. S., Cheung, A. M., Tansey, C. M., Matte-Martyn, A., Diaz-Granados, N., Al-Saidi F, et al. (2003). One-year outcomes in survivors of the acute respiratory distress syndrome. New England Journal of Medicine. 348(8), 683-693. https://doi.org/10.1056/NEJMoa022450
  14. Hwang, Y., & Choe, M. (2008). Study on the changes in limb circumferences and muscle areas of critically ill patients using ventilators. Journal of Korean Academy of Nursing, 38(6), 874-880. http://dx.doi.org/10.4040/jkan.2008.38.6.87
  15. Iwashyna, T. J., & Hodgson, C. L. (2013). Early mobilisation in ICU is far more than just exercise. Lancet. 388(10052):1351-1352. http://dx.doi.org/10.1016/S0140-6736(16)31745-7
  16. Jolley, S. E., Bunnell, A., & Hough, C. L. (2016). Intensive care unit acquired weakness. Chest, forthcoming. http://dx.doi.org/10.1016/j.chest.2016.03.045
  17. Kang, J., Lee, E., Park, E. Y., Lee, Y., & Lee, M. M. (2013). Emotional response of ICU patients' family toward physical restraints. Korean Journal of Adult Nursing, 25(1), 148-156. http://dx.doi.org/10.7475/kjan.2013.25.1.148
  18. Kim, J. K. (2010). Risk Factors of Critical Illness Polyneuropathy on Intensive Care Unit Patients. Unpublished master's thesis, Ajou University, Suwon.
  19. Kress, J. P., & Hall, J. B. (2014). ICU-Acquired weakness and recovery from critical illness. New England Journal of Medicine. 370(17), 1626-1635. http://dx.doi.org/10.1056/NEJMra1209390
  20. Lee, S. S., Chin, J., Lim, C., & Koh, Y. (2005). Clinical findings of critical illness polyneuropathy in patients with mechanical ventilator treatment. Journal of Korean Critical Care Medicine, 20(1), 38-43.
  21. Lodeserto, F., & Yende, S. (2014). Understanding skeletal muscle wasting in critically ill patients. Critical Care Medicine, 18(6), 617. http://dx.doi.org/10.1186/s13054-014-0617-7
  22. Meduri, G. U., Schwingshackl, A., & Hermans, G. (2016). Prolonged glucocorticoid treatment in ARDS: Impact on intensive care unit-acquired weakness. Frontiers in Pediatrics, 2(4), 69. http://dx.doi.org/10.3389/fped.2016.00069
  23. Nordon-Craft, A., Schenkman, M., Edbrooke, L., Malone, D. J.,Moss,M., & Denehy, L. (2014). The physical function intensive care test: implementation in survivors of critical illness. Physical Therapy, 94(10), 1499-1507. http://dx.doi.org/10.2522/ptj.20130451
  24. Patt, H., Bandgar, T., Lila, A., & Shah, N. (2013). Management issues with exogenous steroid therapy. Indian Journal of Endocrinology and Metabolism, 17(S3), S612617. http://dx.doi.org/10.4103/2230-8210.123548
  25. Pthucheary, Z. A., Rawal, J., McPhail, M., Connolly, B., Ratnayake, G., Chan, P., et al. (2013). Acute skeletal muscle wasting in critical illness. JAMA, 310(15), 1591-1600. http://dx.doi.org/10.1001/jama.2013.278481
  26. Schefold, . C., Bierbrauer, J., & Weber-Carstens, S. (2010). Intensive care unit-acquired weakness (ICUAW) and muscle wasting in critically ill patients with severe sepsis and septic shock. Journal of Cachexia, Sarcopenia, and Muscle, 1(2), 147-157. http://dx.doi.org/10.1007/s13539-010-0010-6
  27. Stevens, R. D., Dowdy, D. W., Michaels, R. K., Mendez-Tellez, P. A., Pronovost, P. J., & Needham, D. M. (2007). Neuromuscular dysfunction acquired in critical illness: a systematic review. Intensive Care Medicine, 33(11):1876-1891. http://dx.doi.org/10.1007/s00134-007-0772-2
  28. Wieske, L., Chan Pin Yin D. R., Verhamme, C., Schultz, M. J., van Schaik, I. N., & Horn, J. (2013). Autonomic dysfunction in ICU-acquired weakness: a prospective observational pilot study. Intensive Care Medicine, 39(9), 1610-1617. http://dx.doi.org/10.1007/s00134-013-2991-z