Kress JP, Pohlman AS, O`Connor MF, Hall JB: Daily interruption of tranquilizer infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 2000, 342: 1471-1477. 10.1056/NEJM2000051834222002 Prospective studies by ICUAW have identified problems with the feasibility of MMT in critically ill patients. De Jonghe et al.  identified 332 critically ill medical and surgical patients who met the admission requirement of 7 days or more of mechanical ventilation. One hundred one patients were excluded because of neurological diseases and 10 because of language barriers or lack of evaluable limbs. Of the remaining 206 patients, more than half (n-111) did not wake up often enough to be evaluated before release or death. It is not clear whether most resistance assessments were conducted in intensive care or at the station in their study, but the authors indicated that the average deceleration between the onset of mechanical ventilation was 12.4 days (SD, 6.8 days). We can conclude that even among the minority of eligible patients selected for their ability to collaborate with force tests, MMT has generally not been performed during their critical illness. We conducted a prospective study of critical disease patients at a single University Hospital in Seattle County, VA, USA, for 4 months in 2006 and 2007.
We have obtained the approval of the University of Washington`s Institutional Review Committee for all study procedures. Patients with continuous treatment admitted to a medical-surgical intensive care unit (ICU) were routinely monitored throughout their intensive care period using 12 CGs and cTn measures. Regardless of this, 4 advisors interpreted ECGs suggesting changes that suggest ischemia, and then ranked each patient to see if they met the criteria for diagnosing IEM based on CTN screening measures and ECG results. On the face of it, two councillors were designated as the main adjurs and their consensus was used as a reference for contract statistics. The agreement on the diagnosis of MI was calculated for the 4 raters and expressed as an agreement, a crude agreement (agreement corrected for the odds) and φ (no chance agreement calculated on the basis of pairs). Helliwell TR, Coakley JH, Wagenmakers AJ, Griffiths RD, Campbell IT, Green CJ, McClelland P, Bone JM: Necrotizing myopathy in critically-ill patients. J Pathol 1991, 164: 307-314. 10.1002/path.1711640406 This study is limited by the small sample size and low incidence of ICUAW in evaluable patients.
The strengths of this study are the diversity of the critically ill patient population and the emphasis on the feasibility and reliability of resistance tests in intensive care units. Intensive training in MMT performance probably reduced variability among observers, allowing this study to highlight problems of attention and consequent cooperation between critically ill patients. Conclusions: Manual muscle testing (MMT) for critical illness was not possible for most patients due to coma, delirium and/or lesions. Among patients who were able to participate in tests, we found that the Interobserver agreement was good for iCUAW, especially if they were evaluated after being discharged from the intensive care unit.