The objective is to diagnose earlier and more precisely the occurrence of a weakness neuromuscular syndrome at the end of intensive care, or within 28 days if the stay is longer than 28 days. The amyotrophy has been shown to be proportional to muscle strength in healthy subjects. The amyotrophy can be reliably evaluated by measuring the cross-sectional area of the right femoral muscle. The hypothesis is that amyotrophy measured by muscle ultrasound can allow an early and reliable diagnosis of neuromuscular weakness syndrome (NMWS), even though the measurement of the MRC score (the Gold Standard), has shown its limitations in intensive care in terms of reliability and delayed diagnosis. Moreover, this syndrome is associated with a loss of functionality and a deterioration of long-term quality of life. One of the objectives is thus to determine if the muscular ultrasound allows a prediction of the occurrence of these alterations far from the intensive care. Early rehabilitation has shown a benefit on mortality, duration of stay, mechanical ventilation and on functional alteration after intensive care. This is why an earlier and more precise means of diagnostic of this pathology is searched. The target population is therefore patients from 18 to 80 years hospitalized in intensive care for prolonged stay (\> 5 days), and prolonged ventilation (\> 48H).
Neuromuscular weakness syndrome post intensive care is a generalized muscular weakness with amyotrophy caused by the stay in the intensive care unit. This pathology is frequent, under diagnosed, increases the length of stay and mortality in intensive care and alters the functional status in the long term (mobility, autonomy, cognitive abilities). The gold standard is the MRC score. It must be under 48/60. But this means of diagnostic is unreliable and tardive (problem of voluntary cooperation, confusion, sedation). This study allows the earlier diagnosis of neuromuscular weakness syndrome, by muscular ultrasound. Ultrasound of the right femoral muscle allows evaluation of the amyotrophy, which is related to the maximum muscular strength. The early rehabilitation enable improved prognosis. This is an observational, prospective, single-center, blinded, observational study. The objective is to determine the day of ultrasound examination with the highest diagnostic performance to predict with a maximum of specificity the occurrence of post-intensive care neuromuscular weakness syndrome, defined by an MRC score \<48/60 at the end of intensive care or if the duration of stay exceeds 28 days on the 28th day of hospitalization in intensive care unit.
Study Type
OBSERVATIONAL
Enrollment
60
measurement of right femoral cross-section
CHU Grenoble Alpes
Grenoble, France
Determination of the day of ultrasound examination having the highest diagnostic performance to predict with a maximum of specificity the occurrence of a neuromuscular weakness syndrome post-intensive care unit
Two-to-two comparison of the AUCs of 3 ROC curves corresponding to 3 measurements by ultrasound of decreasing muscles between J1-J5, J1-J7 and J1-J10
Time frame: through study completion, an average of 1 year
Determination of the perfect threshold of muscular decrease allowing the prediction with the maximum of specificity of a post-intensive care neuromuscular weakness syndrome
Look for the 3 ROC curves corresponding to 3 measurements of ultrasound muscle reduction between J1-J5, J1-J7 and J1-J10, the optimal threshold for measuring the cross sectional area of the right femoral muscle
Time frame: through study completion, an average of 1 year
comparison of the persistence of neuromuscular weakness into 2 cohorts of patients (probably not affected by the syndrome, and probably affected)
MRC score : Medical Research Council (muscular testing), from 0 to 5 for each muscular group, and from 0 (complete tetraplegia) to 60 (normal muscular strength) for the total. The 6 subscales are summed.
Time frame: 3 months after discharge from hospital
comparison of functional alteration into 2 cohorts of patients (probably not affected by the syndrome, and probably affected)
SF12 score (short form - 12) : quality of life questionnaire, range from 0 to 100. Each standardized data are summed
Time frame: 3 months after discharge from hospital
comparison of functional alteration into 2 cohorts of patients (probably not affected by the syndrome, and probably affected)
walk test of 6 minuts (Detect abnormalities of gas exchange during exercise)
Time frame: 3 months after discharge from hospital
comparison of functional alteration into 2 cohorts of patients (probably not affected by the syndrome, and probably affected)
Get up and Go test (evaluates sit-stand transfers, walking, and patient directional changes) : ranges from 1 (no instability) to 5 (very abnormal)
Time frame: 3 months after discharge from hospital
comparison of functional alteration into 2 cohorts of patients (probably not affected by the syndrome, and probably affected)
ADL score (autonomy scale) : ranging from 0 (dependant) to 6 (independent)
Time frame: 3 months after discharge from hospital
comparison of functional alteration into 2 cohorts of patients (probably not affected by the syndrome, and probably affected)
the Karnofsky index (description of the general condition of the patient) : from 0% (dead) to 100% (normal state)
Time frame: 3 months after discharge from hospital
comparison of mortality at discharge of intensive care unit into 2 cohorts of patients (probably not affected by the syndrome, and probably affected)
mortality rate
Time frame: during hospitalization in intensive care, at hospital discharge, and 3 months after hospital discharge
Comparison of length of stay in intensive care unit and hospital into 2 cohorts of patients (probably not affected by the syndrome, and probably affected)
calculation of the length of stay
Time frame: through study completion, an average of 1 year
Comparison of duration of mechanical ventilation, Optiflow, NIV, and number of days without ventilation into 2 cohorts of patients (probably not affected by the syndrome, and probably affected)
calculation of the duration of ventilation and no-ventilation
Time frame: through study completion, an average of 1 year
Comparison of malnutrition into 2 cohorts of patients (probably not affected by the syndrome, and probably affected)
Variation of albuminemia
Time frame: at intensive care discharge, within a limit of 28 days, at 3 months
Comparison of malnutrition into 2 cohorts of patients (probably not affected by the syndrome, and probably affected)
Variation of pre-albuminemia
Time frame: at intensive care discharge, within a limit of 28 days, at 3 months
Comparison of malnutrition into 2 cohorts of patients (probably not affected by the syndrome, and probably affected)
Variation of creatinine
Time frame: at intensive care discharge, within a limit of 28 days, at 3 months
Comparison of malnutrition into 2 cohorts of patients (probably not affected by the syndrome, and probably affected)
Variation of weight
Time frame: at intensive care discharge, within a limit of 28 days, at 3 months
Comparison of malnutrition into 2 cohorts of patients (probably not affected by the syndrome, and probably affected)
Variation of arm circumference
Time frame: at intensive care discharge, within a limit of 28 days, at 3 months
Comparison of malnutrition into 2 cohorts of patients (probably not affected by the syndrome, and probably affected)
Variation NUTRIC score ; ranging from 0 (low malnutrition risk) to 10 (the most likely to benefit from aggressive nutrition therapy).
Time frame: at intensive care discharge, within a limit of 28 days, at 3 months
Comparison of calorie intake into 2 cohorts of patients (probably not affected by the syndrome, and probably affected)
Daily calorie intake
Time frame: through study completion, an average of 1 year
Comparison of drug intake into 2 cohorts of patients (probably not affected by the syndrome, and probably affected)
the number of days with sedation in intensive care
Time frame: through study completion, an average of 1 year
Comparison of drug intake into 2 cohorts of patients (probably not affected by the syndrome, and probably affected)
the number of days with curarization in intensive care
Time frame: through study completion, an average of 1 year
Comparison of drug intake into 2 cohorts of patients (probably not affected by the syndrome, and probably affected)
the dose of opioids in intensive care
Time frame: through study completion, an average of 1 year
Comparison of drug intake into 2 cohorts of patients (probably not affected by the syndrome, and probably affected)
the number of days with sedation and curarization in intensive care, the dose of opioids and the administration of corticosteroids in intensive care
Time frame: During stay in intensive care
Comparison of drug intake into 2 cohorts of patients (probably not affected by the syndrome, and probably affected)
the administration of corticosteroids in intensive care
Time frame: through study completion, an average of 1 year
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