Volume 64, Issue 1 pp. 77-82

CLINICAL RESEARCH ARTICLE

Hyperlactacidemia as a risk factor for intensive care unit-acquired weakness in critically ill adult patients

Tao Yang MD,

Tao Yang MD

Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

Department of Critical Care Medicine, Fu Xing Hospital, Capital Medical University, Beijing, China

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Zhiqiang Li MD,

Zhiqiang Li MD

Department of Critical Care Medicine, North China University of Science and Technology Affiliated Hospital, Tangshan, China

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Li Jiang MD,

Li Jiang MD

Department of Critical Care Medicine, Fu Xing Hospital, Capital Medical University, Beijing, China

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Xiuming Xi MD,

Corresponding Author

Xiuming Xi MD

[email protected]

orcid.org/0000-0001-7228-0302

Department of Critical Care Medicine, Fu Xing Hospital, Capital Medical University, Beijing, China

Correspondence

Xiuming Xi, Department of Critical Care Medicine, Fu Xing Hospital, Capital Medical University, No. 20 Fuxingmenwai Street, Xicheng District, Beijing 100038, China.

Email: [email protected]

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Tao Yang MD,

Tao Yang MD

Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

Department of Critical Care Medicine, Fu Xing Hospital, Capital Medical University, Beijing, China

Search for more papers by this author

Zhiqiang Li MD,

Zhiqiang Li MD

Department of Critical Care Medicine, North China University of Science and Technology Affiliated Hospital, Tangshan, China

Search for more papers by this author

Li Jiang MD,

Li Jiang MD

Department of Critical Care Medicine, Fu Xing Hospital, Capital Medical University, Beijing, China

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Xiuming Xi MD,

Corresponding Author

Xiuming Xi MD

[email protected]

orcid.org/0000-0001-7228-0302

Department of Critical Care Medicine, Fu Xing Hospital, Capital Medical University, Beijing, China

Correspondence

Xiuming Xi, Department of Critical Care Medicine, Fu Xing Hospital, Capital Medical University, No. 20 Fuxingmenwai Street, Xicheng District, Beijing 100038, China.

Email: [email protected]

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First published: 08 April 2021

https://doi.org/10.1002/mus.27248

Citations: 2

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Abstract

Introduction/Aims

Intensive care unit-acquired weakness (ICUAW) is a severe neuromuscular complication of critical illness. Serum lactate is a useful biomarker in critically ill patients. The relationship between serum lactate level and ICUAW remains controversial. This study evaluated whether hyperlactacidemia (lactate level >2 mmol/L) was an independent risk factor for ICUAW in critically ill adult patients.

Methods

An observational cohort study was performed in a general multidisciplinary intensive care unit (ICU). Sixty-eight consecutive adult critically ill patients without preexisting neuromuscular disease or a poor pre-ICU functional status whose length of ICU stay was 7 or more days were evaluated. Patients were screened daily for signs of awakening. Muscle strength assessment using the Medical Research Council score was performed on the first day a patient was considered awake. Patients with clinical muscle weakness were considered to have ICUAW.

Results

Among the 68 patients who achieved a satisfactory state of consciousness, the diagnosis of ICUAW was made in 30 patients (44.1%). After multivariate analysis, hyperlactacidemia (P = .02), Acute Physiology and Chronic Health Evaluation II score (P = .04), duration of mechanical ventilation (P = .02), and the use of norepinephrine (P = .04) were found to be significantly associated with the development of ICUAW in critically ill patients.

Discussion

This study shows a number of risk factors to be significantly associated with the development of ICUAW in critically ill adults. These factors should be considered when building early prediction models or designing prevention strategies for ICUAW in future studies.

CONFLICT OF INTEREST

None of the authors has any conflict of interest to disclose.

Open Research

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.

REFERENCES

1Stevens RD, Dowdy DW, Michaels RK, Mendez-Tellez PA, Pronovost PJ, Needham DM. Neuromuscular dysfunction acquired in critical illness: a systematic review. Intensive Care Med. 2007; 33(11): 1876-1891.
10.1007/s00134-007-0772-2
PubMed Web of Science® Google Scholar
2Yang T, Li Z, Jiang L, Wang Y, Xi X. Risk factors for intensive care unit-acquired weakness: a systematic review and meta-analysis. Acta Neurol Scand. 2018; 138(2): 104-114.
10.1111/ane.12964
PubMed Web of Science® Google Scholar
3Penuelas O, Muriel A, Frutos-Vivar F, et al. Prediction and outcome of intensive care unit-acquired paresis. J Intensive Care Med. 2018; 33(1): 16-28.
10.1177/0885066616643529
PubMed Web of Science® Google Scholar
4Nguyen The L, Nguyen HC. Critical illness polyneuropathy and myopathy in a rural area in Vietnam. J Neurol Sci. 2015; 357(1–2): 276-281.
10.1016/j.jns.2015.08.005
PubMed Web of Science® Google Scholar
5Hermans G, Van Mechelen H, Clerckx B, et al. Acute outcomes and 1-year mortality of intensive care unit-acquired weakness. A cohort study and propensity-matched analysis. Am J Respir Crit Care Med. 2014; 190(4): 410-420.
10.1164/rccm.201312-2257OC
PubMed Web of Science® Google Scholar
6Fan E, Cheek F, Chlan L, et al. An official American Thoracic Society Clinical Practice guideline: the diagnosis of intensive care unit-acquired weakness in adults. Am J Respir Crit Care Med. 2014; 190(12): 1437-1446.
10.1164/rccm.201411-2011ST
PubMed Web of Science® Google Scholar
7Lipshutz AK, Gropper MA. Acquired neuromuscular weakness and early mobilization in the intensive care unit. Anesthesiology. 2013; 118(1): 202-215.
10.1097/ALN.0b013e31826be693
PubMed Web of Science® Google Scholar
8Novak KR, Nardelli P, Cope TC, et al. Inactivation of sodium channels underlies reversible neuropathy during critical illness in rats. J Clin Invest. 2009; 119(5): 1150-1158.
10.1172/JCI36570
CAS PubMed Web of Science® Google Scholar
9Latronico N, Shehu I, Guarneri B. Use of electrophysiologic testing. Crit Care Med. 2009; 37(10 Suppl): S316-S320.
10.1097/CCM.0b013e3181b6f9f3
PubMed Google Scholar
10Casserly B, Phillips GS, Schorr C, et al. Lactate measurements in sepsis-induced tissue hypoperfusion: results from the surviving sepsis campaign database. Crit Care Med. 2015; 43(3): 567-573.
10.1097/CCM.0000000000000742
CAS PubMed Web of Science® Google Scholar
11Levy B, Gibot S, Franck P, Cravoisy A, Bollaert P-E. Relation between muscle Na+K+ ATPase activity and raised lactate concentrations in septic shock: a prospective study. Lancet. 2005; 365(9462): 871-875.
10.1016/S0140-6736(05)71045-X
CAS PubMed Web of Science® Google Scholar
12Anastasopoulos D, Kefaliakos A, Michalopoulos A. Is plasma calcium concentration implicated in the development of critical illness polyneuropathy and myopathy? Crit Care. 2011; 15(5): R247.
10.1186/cc10505
PubMed Web of Science® Google Scholar
13Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of clinical criteria for sepsis: for the third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016; 315(8): 762-774.
10.1001/jama.2016.0288
CAS PubMed Web of Science® Google Scholar
14van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke. 1988; 19(5): 604-607.
10.1161/01.STR.19.5.604
PubMed Web of Science® Google Scholar
15De Jonghe B, Bastuji-Garin S, Sharshar T, Outin H, Brochard L. Does ICU-acquired paresis lengthen weaning from mechanical ventilation? Intensive Care Med. 2004; 30(6): 1117-1121.
10.1007/s00134-004-2174-z
PubMed Web of Science® Google Scholar
16Masiero E, Agatea L, Mammucari C, et al. Autophagy is required to maintain muscle mass. Cell Metab. 2009; 10(6): 507-515.
10.1016/j.cmet.2009.10.008
CAS PubMed Web of Science® Google Scholar
17Villet S, Chiolero RL, Bollmann MD, et al. Negative impact of hypocaloric feeding and energy balance on clinical outcome in ICU patients. Clin Nutr. 2005; 24(4): 502-509.
10.1016/j.clnu.2005.03.006
PubMed Web of Science® Google Scholar
18Kleyweg RP, van der Meche FG, Schmitz PI. Interobserver agreement in the assessment of muscle strength and functional abilities in Guillain-Barre syndrome. Muscle Nerve. 1991; 14(11): 1103-1109.
10.1002/mus.880141111
CAS PubMed Web of Science® Google Scholar
19Stevens RD, Marshall SA, Cornblath DR, et al. A framework for diagnosing and classifying intensive care unit-acquired weakness. Crit Care Med. 2009; 37(10 Suppl): S299-S308.
10.1097/CCM.0b013e3181b6ef67
PubMed Google Scholar
20Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985; 13(10): 818-829.
10.1097/00003246-198510000-00009
CAS PubMed Web of Science® Google Scholar
21Vincent JL, Moreno R, Takala J, et al. The SOFA (sepsis-related organ failure assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996; 22(7): 707-710.
10.1007/BF01709751
CAS PubMed Web of Science® Google Scholar
22Rhodes A, Evans LE, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017; 43(3): 304-377.
10.1007/s00134-017-4683-6
PubMed Web of Science® Google Scholar
23Garnacho-Montero J, Madrazo-Osuna J, Garcia-Garmendia JL, et al. Critical illness polyneuropathy: risk factors and clinical consequences. A cohort study in septic patients. Intensive Care Med. 2001; 27(8): 1288-1296.
10.1007/s001340101009
CAS PubMed Web of Science® Google Scholar
24Giugliano D, Marfella R, Coppola L, et al. Vascular effects of acute hyperglycemia in humans are reversed by L-arginine. Evidence for reduced availability of nitric oxide during hyperglycemia. Circulation. 1997; 95(7): 1783-1790.
10.1161/01.CIR.95.7.1783
CAS PubMed Web of Science® Google Scholar
25Hermans G, Casaer MP, Clerckx B, et al. Effect of tolerating macronutrient deficit on the development of intensive-care unit acquired weakness: a subanalysis of the EPaNIC trial. Lancet Respir Med. 2013; 1(8): 621-629.
10.1016/S2213-2600(13)70183-8
PubMed Web of Science® Google Scholar
26Patel BK, Pohlman AS, Hall JB, Kress JP. Impact of early mobilization on glycemic control and ICU-acquired weakness in critically ill patients who are mechanically ventilated. Chest. 2014; 146(3): 583-589.
10.1378/chest.13-2046
CAS PubMed Web of Science® Google Scholar
27Nanas S, Kritikos K, Angelopoulos E, et al. Predisposing factors for critical illness polyneuromyopathy in a multidisciplinary intensive care unit. Acta Neurol Scand. 2008; 118(3): 175-181.
10.1111/j.1600-0404.2008.00996.x
CAS PubMed Web of Science® Google Scholar
28Gupta S, Mishra M. Acute physiology and chronic health evaluation II score of >/=15: a risk factor for sepsis-induced critical illness polyneuropathy. Neurol India. 2016; 64(4): 640-645.
10.4103/0028-3886.185356
PubMed Web of Science® Google Scholar
29Green JP, Berger T, Garg N, Shapiro NI. Serum lactate is a better predictor of short-term mortality when stratified by C-reactive protein in adult emergency department patients hospitalized for a suspected infection. Ann Emerg Med. 2011; 57(3): 291-295.
10.1016/j.annemergmed.2010.10.016
PubMed Web of Science® Google Scholar
30Okorie ON, Dellinger P. Lactate: biomarker and potential therapeutic target. Crit Care Clin. 2011; 27(2): 299-326.
10.1016/j.ccc.2010.12.013
CAS PubMed Web of Science® Google Scholar
31Nichol AD, Egi M, Pettila V, et al. Relative hyperlactatemia and hospital mortality in critically ill patients: a retrospective multi-centre study. Crit Care. 2010; 14(1): R25.
10.1186/cc8888
PubMed Web of Science® Google Scholar
32Mikkelsen ME, Miltiades AN, Gaieski DF, et al. Serum lactate is associated with mortality in severe sepsis independent of organ failure and shock. Crit Care Med. 2009; 37(5): 1670-1677.
10.1097/CCM.0b013e31819fcf68
CAS PubMed Web of Science® Google Scholar
33van Hall G. Lactate kinetics in human tissues at rest and during exercise. Acta Physiol (Oxf). 2010; 199(4): 499-508.
10.1111/j.1748-1716.2010.02122.x
CAS PubMed Web of Science® Google Scholar
34Brooks GA. Lactate production under fully aerobic conditions: the lactate shuttle during rest and exercise. Fed Proc. 1986; 45(13): 2924-2929.
CAS PubMed Web of Science® Google Scholar
35Wieske L, Witteveen E, Verhamme C, et al. Early prediction of intensive care unit-acquired weakness using easily available parameters: a prospective observational study. PLoS One. 2014; 9(10):e111259.
10.1371/journal.pone.0111259
PubMed Web of Science® Google Scholar
36Witteveen E, Wieske L, Sommers J, et al. Early prediction of intensive care unit-acquired weakness: a multicenter external validation study. J Intensive Care Med. 2020; 35(6): 595-605.
10.1177/0885066618771001
PubMed Web of Science® Google Scholar
37Garnacho-Montero J, Amaya-Villar R, Garcia-Garmendia JL, Madrazo-Osuna J, Ortiz-Leyba C. Effect of critical illness polyneuropathy on the withdrawal from mechanical ventilation and the length of stay in septic patients. Crit Care Med. 2005; 33(2): 349-354.
10.1097/01.CCM.0000153521.41848.7E
PubMed Web of Science® Google Scholar
38De Jonghe B, Sharshar T, Lefaucheur JP, et al. Paresis acquired in the intensive care unit: a prospective multicenter study. JAMA. 2002; 288(22): 2859-2867.
10.1001/jama.288.22.2859
PubMed Web of Science® Google Scholar
39De Jonghe B, Bastuji-Garin S, Durand MC, et al. Respiratory weakness is associated with limb weakness and delayed weaning in critical illness. Crit Care Med. 2007; 35(9): 2007-2015.
10.1097/01.ccm.0000281450.01881.d8
PubMed Web of Science® Google Scholar
40Anekwe DE, Biswas S, Bussières A, Spahija J. Early rehabilitation reduces the likelihood of developing intensive care unit-acquired weakness: a systematic review and meta-analysis. Physiotherapy. 2020; 107: 1-10.
10.1016/j.physio.2019.12.004
PubMed Web of Science® Google Scholar
41Dantas CM, Silva PF, Siqueira FH, et al. Influence of early mobilization on respiratory and peripheral muscle strength in critically ill patients. Rev Bras Ter Intensiva. 2012; 24(2): 173-178.
10.1590/S0103-507X2012000200013
PubMed Google Scholar

Citing Literature

Volume64, Issue1

July 2021

Pages 77-82

Hyperlactacidemia as a risk factor for intensive care unit-acquired weakness in critically ill adult patients

Abstract

Introduction/Aims

Methods

Results

Discussion

CONFLICT OF INTEREST

Open Research

DATA AVAILABILITY STATEMENT

REFERENCES

Citing Literature

References

Information

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Hyperlactacidemia as a risk factor for intensive care unit-acquired weakness in critically ill adult patients

Abstract

Introduction/Aims

Methods

Results

Discussion

CONFLICT OF INTEREST

Open Research

DATA AVAILABILITY STATEMENT

REFERENCES

Citing Literature

References

Related

Information