This January the POWER study (Prediction and Outcome of Weakness in the intEnsive caRe) started in the AMC. In a joined venture, the departments of Neurology, Clinical Neurophysiology and Intensive Care aim to develop an easy to use screening tool to predict early after intensive care admission which patient will develop so called intensive care unit acquired weakness (ICU-AW) and is in need of early started physiotherapy and tracheotomy placement. Long-term follow-up of patients suffering from this debilitating condition will also be investigated in this study. During the study data on immunological processes are collected, to enable further unravelling of the pathophysiological processes leading to ICU-AW.
ICU-AW is a frequent and important complication occurring in critically ill patients admitted to the ICU leading to increased mortality and morbidity. Weakness is caused by muscle dysfunction, nerve dysfunction, or a mixed form, the so called critical illness neuromyopathy. Diagnosis is often made late in the disease process due to concomitant disorders of consciousness early after admission, hampering clinical neurological investigation. Recent studies have shown that early start of physiotherapy, mobilisation and placement of a tracheostomy for weaning off the ventilator can decrease the number of days spent on the ICU. It is therefore necessary to identify the patients who will develop this ICU-AW and need these additional therapies.
The POWER study will include patients who are on ventilator support for 3 days or more. A simplified EMG will be used to assess neuromuscular function shortly after admission when this function can not be assessed with neurological examination. This EMG will be repeated every week until the patient wakes up. After awakening, EMG results will be compared to the conventional neurological examination to assess the sensitivity and specificity of the EMG for predicting ICU-AW. Patients identified with ICU-AW will be followed for 12 months after ICU discharge to assess recovery by using the AMC linear disability scale, the overall neuropathy limitations scale and the SF-36 health survey. Delayed or incomplete recovery will be linked to clinical, electrophysiological and immunological data from the ICU admission to investigate risk factors.
The POWER study will run for two years. Results are expected in 2013.
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