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
Key Words
Abbreviations:
APACHE ( Acute Physiology and Chronic Health Evaluation), ICU-AW ( ICU-acquired weakness), OR ( odds ratio)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: September 11, 2018
Footnotes
FUNDING/SUPPORT: Fellow salary support for K. S. W. was funded by the NIH/NHLBI [Grant No. T32 HL007605 ]. Salary support for B. K. P. was provided by the Parker B. Francis Fellowship [Grant No. FP062541-01-PR ].
Identification
Copyright
© 2018 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
