Neurophysiological Diagnosis for ICU Septic Shock Patients

Centre Hospitalier Universitaire Vaudois20 enrolled

Overview

Patients hospitalized in the Intensive Care Unit (ICU) are at risk for developing severe disabilities, physical or cognitive. In particular, ICU-acquired weakness is frequent. The causes of this weakness are multiple and the physiopathology is still not fully understood. Immobilization in bed and sepsis are known risk factors. ICU-acquired weakness has been associated with prolonged mechanical ventilation duration, and increased in ICU and hospital length of stay. It has also been associated with significant decrease in functional capacity and with higher mortality. An early screening using a specific diagnostic protocol could help improving the management of patients suffering from ICU acquired weakness. The aim of this study is to early detect ICU acquired weakness in patients suffering from septic shock and ventilated for more than 72 hours.

Study Type

OBSERVATIONAL

Enrollment

Conditions

ICU Acquired Weakness

Interventions

Nerve conduction studyDIAGNOSTIC_TEST

Physical examination of muscle strength is conducted using the Medical Research Council (MRC) scale in 6 muscles bilaterally. Patients with an MRC score of less than 48 of 60 are diagnosed with critical illness polyneuromyopathy (CIPNM). The evaluation is completed by a routine neurological examination. In patients meeting the inclusion criteria, the screening Peroneal nerve test (PENT test) is performed on the day of study enrollment and subsequently in 1 week intervals until pathologic findings are detected or patient is discharged from the ICU. PENT measures the peroneal nerve Compound muscle action potential (CMAP) amplitude in one leg. If the PENT is normal, the contra-lateral peroneal nerve is measured. An abnormal condition is identified if the peroneal nerve CMAP amplitude is reduced below the normal limits of the participating centre in at least one leg. In Lausanne, the abnormal response is \< 2,5 mV.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: • Patients admitted to the ICU with a septic shock and ventilated for more than 72 hours. Exclusion Criteria: * Hospitalization for more than 7 days before intubation. * Functional disability at admission of ≥4 (Requires constant nursing care and attention, bedridden, incontinent) in the Modified Rankin Scale. * Lower limb disorders precluding nerve conduction studies (NCV) and electromyography (EMG), such as clinical edema of the lower limbs, or fractures, amputation, and plaster casts of the lower limbs. * Evidence of altered neuromuscular transmission at repetitive stimulation test either caused by neuromuscular blocking agents or disease. * Burn patients admitted to ICU. * Patient requesting withdrawal of therapies.

Outcomes

Primary Outcomes

Presence of ICU-acquired weakness in septic shock patients ventilated for more than 72 hours.

Medical Research Council strength scale

Time frame: 72 hours

Secondary Outcomes

ICU length of stay

Time frame: Up to 6 months

Hospital length of stay

Time frame: Up to 6 months

Discharge destination

Time frame: At discharge from hospital, up to 6 months

Length of ventilatory support

Time frame: At extubation, up to 6 months

Extubation failure rate

Patients requiring reintubation 72 hours after failed first extubation

Time frame: up to 72 hours, after first extubation

Time elapsed between endotracheal intubation and first out-of-bed mobilization

Time frame: up to 6 months, at first out-of-bed mobilization