Impact of Vasoactive Medications on ICU-Acquired Weakness in Mechanically Ventilated Patients

Abstract

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.

Keywords: ICUs; critical care outcomes; critical illness; humans; muscle weakness; vasoconstrictor agents.

Copyright © 2018 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

Incidence of ICU-acquired weakness (ICU-AW) with increasing cumulative dose of norepinephrine. *The proportion of patients with ICU-AW significantly increases with increasing cumulative dose of norepinephrine (χ2 for trend P < .0001).