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Feasibility and Diagnostic Accuracy of Early Electrophysiological Recordings for ICU-Acquired Weakness: An Observational Cohort Study

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Abstract

Background

An early diagnosis of ICU-acquired weakness (ICU-AW) is difficult because disorders of consciousness frequently preclude muscle strength assessment. In this study, we investigated feasibility and accuracy of electrophysiological recordings to diagnose ICU-AW early in non-awake critically ill patients.

Methods

Newly admitted patients, mechanically ventilated ≥2 days and unreactive to verbal stimuli, were included in this study. Electrophysiological recordings comprised nerve conduction studies (NCS) of three nerves and, if coagulation was normal, myography in three muscles. Upon awakening, strength was assessed (ICU-AW: average Medical Research Council score <4), blinded for electrophysiological recordings. Feasibility was expressed as the percentage of recordings that were both possible and had sufficient technical quality. Diagnostic accuracy of feasible (i.e., feasibility >75 %) recordings was analyzed based on cut-off values from healthy controls and from critically ill patients with and without ICU-AW.

Results

Thirty-five patients were included (17 with ICU-AW). Recordings were obtained on day 4 (IQR: 3–6). Feasibility was acceptable for ulnar and peroneal nerve recordings, and low for sural recordings and myography. Diagnostic accuracy based on cut-off values from healthy controls was low. When using cut-off values from critically ill patients with and without ICU-AW, the peroneal compound muscle action potential amplitude and ulnar sensory nerve action potential amplitude had good diagnostic accuracy.

Conclusion

Nerve conduction studies of the ulnar and peroneal nerve are feasible in critically ill patients. The diagnostic accuracy is low using cut-off values from healthy controls. Cut-off values validated specifically for discrimination between critically ill patients with and without ICU-AW may improve diagnostic accuracy.

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Acknowledgments

This research was performed within the framework of CTMM, the Center for Translational Molecular Medicine (www.ctmm.nl), project MARS (Grant 04I-201).

Conflict of interest

This study was not sponsored. Dr. L. Wieske is currently receiving a personal grant (ZonMw–AGIKO grant [project number 40-00703-98-11636]) from the Netherlands Organization for Health Research and Development, Prof. I.N. van Schaik received departmental honoraria for serving on scientific advisory boards and a steering committee for CSL-Behring. For the remaining authors none were declared.

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Authors and Affiliations

  1. Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, room C3-311, PO box 22700, 1105 AZ, Amsterdam, The Netherlands

    Luuk Wieske, Esther Witteveen, Aline Bouwes, Marcus J. Schultz & Janneke Horn

  2. Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands

    Luuk Wieske, Camiel Verhamme & Ivo N. van Schaik

  3. Laboratory of Experimental Anesthesiology and Intensive Care (LEICA), Academic Medical Center, Amsterdam, The Netherlands

    Luuk Wieske, Esther Witteveen & Marcus J. Schultz

  4. Department of Rehabilitation, Academic Medical Center, Amsterdam, The Netherlands

    Daniela S. Dettling-Ihnenfeldt & Marike van der Schaaf

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  1. Luuk Wieske
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Correspondence to Luuk Wieske.

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Wieske, L., Verhamme, C., Witteveen, E. et al. Feasibility and Diagnostic Accuracy of Early Electrophysiological Recordings for ICU-Acquired Weakness: An Observational Cohort Study. Neurocrit Care 22, 385–394 (2015). https://doi.org/10.1007/s12028-014-0066-9

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  • DOI: https://doi.org/10.1007/s12028-014-0066-9

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