Editorials and CommentariesMuscle strength measurement in the intensive care unit: Not everything that can be counted counts
Section snippets
Variability of muscle strength measurements
Obtaining accurate strength measures in the critical care setting can be a complex task influenced by a variety of factors (see Fig. 1). Clinical examination of muscle strength in ICU patients is often limited by inadequate arousal, attention, or cognitive performance. The impact of altered levels of arousal on the reliability of measurement is likely to increase with rising complexity of the measurement method. Even in patients without impaired wakefulness or cognition, CIP-associated distal
What does the work of Baldwin et al add to the existing literature?
In their sample of 17 patients of 189 screened, the authors found good interrater consistency and test-retest reliability of dynamometry and MRC grading for all tested muscle groups, with the exception of left elbow flexion. These results are in line with recently published findings of Hermans et al [9], which showed good interrater reliability for MRC score and dynamometry in a sample of 75 critically ill surgical and medical ICU patients [9]. However, Baldwin et al found wide variability in
Does technique used for measuring voluntary contraction force matter in the ICU population?
The authors found a wide variation of dynamometry forces representing MRC grades 4 and 5 throughout all muscle groups. Prior research has suggested that handgrip dynamometry might serve as a surrogate for overall body strength in the ICU population [3]. The findings in this article support the view that measurement of strength from a singular muscle does not reliably reflect overall strength, which is further supported by our own data [5], [6]. In a recent prospective study [11], we examined
Future direction for research
The authors have added important new evidence to the body of literature regarding strength testing in the ICU. As a stand-alone measure, dynamometry may be useful for tracking change within a given patient over time. As an outcome prediction instrument, the MRC scale seems superior given that reliability is high both in grading strength and diagnosing ICU-acquired weakness and that its validity has been demonstrated in multiple studies. Further research is needed to examine the predictive
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Relevance to assess and preserve muscle strength in aging field
2019, Progress in Neuro-Psychopharmacology and Biological PsychiatryCitation Excerpt :During the standardized evaluation, the subject need to be sitting on a standard chair with their forearms resting flat on the armchairs. Clinicians should demonstrate the use of the dynamometer and encourage the patients to squeeze the dynamometer as hard and as tightly as possible during 3–5 s. Three measures of each arm should be performed and, usually, the highest reading of the 6 measurements is reported as the final result (Waak et al., 2013). A variety of thresholds of grip strength have been proposed to characterize low muscle strength, ranging from 16 to 20 kg for women and 26–30 kg for men (Cruz-Jentoft et al., 2010; Studenski et al., 2014; Lauretani et al., 2003; Dodds et al., 2014).
Influence of muscle strength on early mobility in critically ill adult patients: Systematic literature review
2018, Heart and Lung: Journal of Acute and Critical CareCitation Excerpt :Muscle weakness, prevalent in the critically ill patient, is multi-factorial in its causes and may be compounded by neuromuscular, cardiovascular, pulmonary, psychological, pharmacological and equipment barriers.9,21,27 Intensive care unit (ICU) patients may experience deficits in their attention, arousal and cognitive abilities26, especially if neuromuscular blocking agents and sedatives have been administered as part of their plan of care. Neuromuscular dysfunction has been identified as an etiology of muscle weakness due to disease processes found in the ICU patient population, such as sepsis, multiple organ dysfunction syndromes, and acute respiratory distress syndrome.11,15
Muscle weakness and nutrition in critical illness: Matching nutrient supply and use
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2021, Scientific ReportsIntensive Care Unit-Acquired Weakness (ICUAW): Usefulness of Bedside Ultrasound
2021, Neurosonology in Critical Care: Monitoring the Neurological Impact of the Critical PathologyPhysical Performance and Muscle Strength Tests: Pros and Cons
2021, Practical Issues in Geriatrics