Current practice and barriers to ICU-acquired weakness assessment: a cross-sectional survey. (September 2021)

• Record Type: Journal Article
• Authors: Wu, Yuchen; Zhang, Zhigang; Jiang, Biantong; Wang, Guoqiang; Wei, Huaping; Li, Bin; Shen, Xiping; Zhang, Caiyun
• Is Part Of: Physiotherapy. Volume 112(2021)
• Page Start: 135
• Page End: 142
• Publication Date: 2021-09
• Subjects: Intensive-care-unit-acquired weakness (ICU-AW) -- Assessment -- Critical illness; Physical therapy -- Periodicals; Therapeutics, Physiological -- Periodicals; 615.8205
• DOI: 10.1016/j.physio.2021.01.002
• Languages: English
• ISSNs: 0031-9406

Abstract

Abstract: Background: Intensive-care-unit-acquired weakness (ICU-AW) not only leads to difficulty weaning off mechanical ventilation, prolonged hospital stay and increased medical costs, but also reduces the patient's quality of life after discharge and increases the 1-year mortality rate. Early identification and intervention can improve the prognosis of critically ill patients. However, much remains unknown about current clinical practice for ICU-AW assessment by ICU staff in China. Objectives: To investigate current practices and barriers to ICU-AW assessment among ICU staff, and provide insights to improve ICU-AW assessment in ICUs in China. Methods: Qualitative interviews were used to construct a survey questionnaire (test–retest reliability 0.92, validity 0.96). This survey was subsequently completed by 3206 ICU staff from 31 provinces, municipalities and autonomous regions in China. Results: In total, 3206 ICU staff responded to the survey (response rate 90%): 616 doctors (19%), 2371 nurses (74%), 129 respiratory therapists (4%), 51 physiotherapists (2%) and 39 dieticians (1%). Only 27% of the respondents had treated/cared for patients with ICU-AW. Reported methods for ICU-AW assessment were clinical experience (53%), ICU-AW assessment tools (12%), and physiotherapy consultation (35%). Forty-three percent of respondents felt that their ICU-AW-related knowledge did not meet clinical needs, only 10% had received ICU-AW-related training, and 19% proactively assessed whether their patients had ICU-AW. In terms of frequency of assessment, 42%, 16% and 11% of respondents considered that ICU-AW should be assessed daily, every 3 days, and on ICU admission and discharge, respectively. The Medical Research Council scale, electrophysiological assessment and the Manual Muscle Testing scale were considered to be optimal tools for ICU-AW diagnosis by 79%, 70%, and 73% of respondents, respectively. The main reported barriers to ICU-AW assessment were lack of knowledge, cognitive impairment among patients, and lack of ICU-AW assessment guidelines and procedures. Conclusion: Current practices for ICU-AW assessment are non-specific, and the main barriers include lack of skills and knowledge.