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Table 2 Characteristics of included studies assessing ICU-acquired weakness

From: The rate and assessment of muscle wasting during critical illness: a systematic review and meta-analysis

Author/References

Design/Country/Setting

No. of Population

Inclusion criteria

Exclusion criteria

Tool

Score

Prevalence of ICU-AW

1. Van Aerde et al. [50]

RC

Single centre

Belgium

ICU

50

COVID-19

Adult patients (> 18 years old) requiring mechanical ventilation

N/A

Clinical examination

MRC sum score

(36/50) 72%

2. Ballve et al. [51]

PC

Single centre

Brasil

111

Adult patients (> 18 years old), mechanically ventilated for ≥ 24 h

Pre-existing neurological conditions (central or peripheral nervous system disease, stroke), orthopaedic or traumatic limitations

Clinical examination

MRC sum score

(66/111) 59%

3. Nguyen et al. [52]

PC

Single centre

Vietnam

133

 > 15 years old, residents of ICU for at least 10 days

N/A

Clinical examination

MRC sum score and neuropathy limitation scale (ONLS)

(73/133) 55%

4. Parry et al. [25]

PC

Single centre

Australia

60

Mechanical ventilation for at least 48 h

Pre-existing neurological conditions (central or peripheral nervous system disease, stroke)

Clinical examination

MRC sum score and a new 4-point scoring system as well as handgrip dynamometry

Diagnosis: MRC-SS: < 48/60, MRC 4-point score: < 24/36

(25/60) 42%

5. Hough et al. [53]

PC

Single centre

USA

30

 > 3 days of mechanical ventilation

Pre-existing neurological conditions (central or peripheral nervous system disease, stroke), language barriers

Clinical examination

MRC sum score

Diagnosis: MRC < 48/60

(6/30) 20%

6. Brunello et al. [54]

PC

Single centre

Switzerland

39

Systemic Inflammatory Response Syndrome (SIRS) diagnosis, Mechanical Ventilation for > 2 days

Pre-existing neurological conditions, paediatric patients

Clinical examination

Physical and Neurological examination: assessment of 10 muscle groups, skin sensorimotor response and tendon reflexes Diagnosis: Modified MRC Score of < 35/50

(13/39) 33%

7. Carstens et al. [55]

PC

Single centre

Germany

56

Patients on mechanical ventilation with a SAPS II score of ≥ 20

 < 18 years old, patients diagnosed with other known myopathies or neuropathies, thrombocytopenia

Electrophysiological examination

Diagnosis: CMAP < 3 mV in at least one investigation before awakening

(34/56) 61%

8. Sharshar et al. [57]

PC

Multi-centre

France

115

Mechanical ventilation for > 7 days

Pre-existing neuromuscular conditions, or other myopathies

Clinical examination

MRC sum score

Diagnosis: MRC < 48/60

(75/115) 65%

9. Nanas et al. [58]

PC

Single centre

Greece

185

Mechanical ventilation for at least 10 days

Muscle weakness before ICU admission, muscle relaxant administration, pre-existing neuromuscular conditions

Clinical examination

MRC sum score

Diagnosis: MRC < 48/60

(44/185) 23.8%

10. Ali et al. [59]

PC

Multi-centre

USA

136

Age ≥ 18 years old, mechanical ventilation for ≥ 5 days

Mechanically ventilated before referral to ICU, limb amputation ≥ 2 parts, subject unable to communicate

Clinical examination

MRC-ss and handgrip dynamometry

Diagnosis: MRC < 48/60

(35/136) 25.5%

11. Latronico et al. [60]

PC

Multi-centre

Italy

92

 > 15 years old, score 35–70 in SAPS II

Pre-existing neuromuscular conditions, multiple organ failure, amputations, fractures, oedema in legs

Electrophysiological examination

CMAP or SNAP amplitude reduced by > 2 Standard Deviations (SD) of normal limits

(28/92) 30.4%

12. Villar et al. [61]

PC

Single centre

Spain

30

Mechanical ventilation for >or = 48 h, IV corticosteroids (> or = 240 mg methylprednisolone) during admission, admitted as a result of COPD exacerbation

 > 80 years old, comorbidities of cardiogenic, renal or pulmonary origin

Electrophysiological examination

Electromyography after weaning from ventilation

Muscle biopsy obtained if the patients diagnosed with myopathy from the electrophysiological examination

(9/30) 34.6%

13.  Bednarik et al. [62]

PC

Single centre

Czech Republic

51

SOFA score grades 3 or 4 in two organ systems, admission in ICU within 24 h of critical illness

Pre-existing neuromuscular conditions

Clinical examination and electrophysiological examination

Clinical examination: daily from the day of admission until day 28

Performance of electrophysiological analysis twice: the first week of admission and the fifth week

Diagnosis: MRC grade ≤ 2 in examined muscles

CIPM diagnosis if there are fibrillation potentials, reduced CMAP amplitude

Clinical examination: (17/51) 27.9%

Electrophysiological examination: (35/51) 57.4%

14. Montero et al. [64]

PC

Single centre

Spain

26

Patients diagnosed with septic shock, mechanically ventilated for at least one week

Between 18 and 80 years old, pre-existing neuropathies or myopathies, infected with HIV, renal failure

Electrophysiological examination once the patient weans from mechanical ventilation

reduction in CMAP and SNAP amplitudes

(34/64) 53.1%

15. Bercker et al. [65]

RC

Single centre

Germany

45

Patient diagnosed with ARDS

Pre-existing neuromuscular conditions

Clinical examination and electrophysiological examination

Clinical assessment using MRC-SS

Electrophysiological examination at early days of admission

(27/45) 60%

16. Jonghe et al. [66]

PC

Multi-centre

France

95

Mechanical ventilation for ≥ 1 week

Pre-existing neuromuscular conditions, language barrier

Clinical examination and electrophysiological examination

Clinical assessment using MRC-SS once patient awake

Electrophysiological examination at day 10

Diagnosis: MRC-SS < 48, Reduced CMAP

(24/95) 25.3%

17. Letter et al. [3]

PC

Single centre

Netherlands

98

Mechanical ventilation for at least 4 days

Pre-existing spinal cord injuries or pre-existing diagnosed myopathy

Clinical examination and electrophysiological examination

Clinical examination twice weekly during admission

Electrophysiological nerve conduction studies on days 4, 11, 25 after initiation of mechanical ventilation

Diagnosis: Motor sum score < 26 with absent tendon reflexes, CMAP < 2.6 mV (peroneal nerve) and CMAP < 4.2 mV (ulnar nerve)

(32/98) 33%

18. Druschky et al. [67]

PC

Single centre

Germany

28

Mechanical ventilation for > or = 4 days

Pre-existing neuromuscular conditions or other known myopathies

Clinical examination and electrophysiological examination

Examinations on days 4,8 and 14 after initiation of mechanical ventilation

Clinical examination: functional disability score (FDS) calculated

Electrophysiological examination: electromyography

Diagnosis: Reduced Compound Muscle and sensory nerve action potentials with fibrillation potentials and positive sharp waves, low FDS

(16/28) 57%

19. Montero et al. [64]

PC

Single centre

Spain

73

Septic patients with evidence of multi-organ dysfunction and mechanical ventilation for ≥ ten days

 < 18 years or > 80 years old, comorbidities such as other known myopathies, infection with HIV, renal failure, liver cirrhosis

Electrophysiological examination

Electrophysiological examinations on day 10 and day 21 from initiation of mechanical ventilation

Diagnosis: reduced CMAP and SNAP amplitudes with fibrillation potentials

(50/73) 69%

20. Tepper et al. [69]

PC

Single centre

Netherlands

25

Diagnosis of septic shock

Age > 80 years old, pre-existing neuromuscular conditions, neuropathies/myopathies, renal disease, diabetes, alcohol abuse

Electrophysiological examination

Electrophysiological examination within 72 h of admission

Diagnosis: Reduced velocity, CMAP and spontaneous activity presence

(19/25) 76%

  1. PC prospective cohort, RC retrospective cohort, RCT randomised controlled trial, ICU intensive care unit, MRC sum muscle power assessment scale, SAPS simplified acute physiology score