What Is ICU-Acquired Weakness?

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ICU-acquired weakness is a collection of dysfunctions experienced by critically ill patients as a consequence of prolonged bed rest. The symptoms that are specifically encountered are poor mobility, impaired muscle strength and diminished cardiopulmonary endurance.

These clinical manifestations are brought by extended immobilization, use of neuromuscular blocking agents and poor nutrition. A physical therapist is a part of a multidisciplinary team that is intended to implement an early mobilization (EM) program from passive ROM exercises to the novel use of cycle ergometer for muscle strengthening.

In this discussion assignment, I will be appraising the quality of the research articles that I have chosen using Jewel 's evidence-based
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Hashem, M. D., Nelliot, A., & Needham, D. M. (2016). Early mobilization and rehabilitation in the ICU: Moving back to the future. Respiratory Care, 61(7), 971-979. doi:10.4187/respcare.04741

Strengths: According to Jewell (2015, p. 254), the validity of the studies presents greater certainty if the research design is free from bias. In this article by Hashem, Nelliot, and Needham (2016, p. 974), I have seen that the researchers were able to randomly assigned mechanically ventilated patients to usual nursing care vs. early physical therapy and occupational therapy. By doing the aforementioned strategy, it eliminates the bias of the treatment intervention to take place.

Another strength I identified in this research is the similarity of clinical and prognostic features. All patients are critically ill and mechanically ventilated. Another justification that this study is free from bias.

Weakness: One of the shortcomings recognized is the use of manual muscle testing in assessing ICU-acquired weakness. In my experience, ICU resident physicians have shown inconsistencies in muscle grading. As a result, true weakness is not correctly discovered. Jewell (2015, p. 256) pointed out the importance of validity and reliability of the test to ensure no clinician preference is
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Yes. This research article was published on July 2016 in the Journal of Respiratory Care. It is a peer-reviewed journal.

2. Taito, S., Shime, N., Ota, K., & Yasuda, H. (2016). Early mobilization of mechanically ventilated patients in the intensive care unit. Journal of Intensive Care, 4(50), 1-7. doi:10.1186/s40560-016-0179-7

Strengths: The authors of this article explained the role of the ABCDE bundle (awakening, breathing coordination, delirium monitoring, and early exercise mobilization). Furthermore, the inclusion and exclusion of various criteria and protocols were also mentioned in the study. Moreover, the statistics of healthcare providers adopting the ABCDE bundle was also discussed which is important to know on how widespread this program being utilized worldwide.

Weakness: Taito, Shime, Ota, and Yasuda (2016, p. 6) states that there is a limited trial of the safety and effectiveness of EM, "early" has not been correctly defined and the number of studies included in this trial is not sufficient, and the sample sizes are inadequate.

Do they address the population you are addressing in your project?
Yes. The groups of patients that are involved in this project are the critically ill patients that are mechanically ventilated that experience an ICU-acquired

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