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New research sheds light on how drugs used to help patients in intensive care units (ICU) might actually lengthen recovery time after discharge from the hospital.

Beyond their struggle for survival in an ICU, patients often face a long road to recovery when they return home.  A recent study published in the journal CHEST suggests the administration of certain drugs may have something to do with the muscular weakness these patients experience upon discharge.

Recognizing the burden of recovery after an ICU stay, a team led by the Department of Medicine at the University of Chicago took a closer look at the impact of certain drugs administered to patients who are on mechanical ventilation, a machine that helps a patient breath.  A ventilator can stabilize and sustain respiration when a person is ill or injured and is unable to breathe properly.

Procedures and Drugs Save Lives but What of the Side Effects?

In the ICU, procedures and prescription drugs are used to sustain life while the body works to heal.  Some of the drugs used during treatment have a longer term, negative effect on patients, like reducing their muscle strength.  In this study, researchers examined the healthcare data of 172 patients who were enrolled in a randomized clinical trial. Part of this trial involved bedside testing of muscle strength during their ICU stay.

In some of these cases, patients are either brought to the ICU with septic shock, or developed it during their stay.  Vasopressors are drugs that are used to raise the blood pressure when a patient suffers different forms of shock—such as sepsis.  Shock caused by sepsis occurs when blood pressure drops along with blood circulation in the body.  Without intervention, breathing is slowed, major organs are starved of blood and oxygen and a patient can quickly die.

Placed on a ventilator and treated with drugs like norephinephrine and epinephrine, among others, both breath and circulation are restored as the machine takes over breathing and the drugs raise blood pressure by causing blood vessels to contract.

While it is known that patients released from an ICU often suffer muscle weakness (myopathy) and peripheral nerve damage (neuropathy), it had not been considered that efforts, like drug administration, could be the cause of longer term health challenges.

The Findings of the Study

Scientists evaluated how different drugs, and types of drugs, might impact ICU patients who are ventilated and given vasopressors to help them manage shock syndromes.  Findings of the study include:

  • Ventilated ICU patients given vasopressors were three times more likely to develop muscle weakness. Each additional day on the drugs increased their chances of developing ICU-related muscle weakness by 35 percent.
  • Only certain vasopressors were aligned with longer term muscle weakness. The difference was in the types of neurological receptors targeted by the drugs.
  • For some of the drugs found to cause ICU-related weakness, such as norepinephrine, the greater the dose, the more significant the muscle weakness.

Senior investigator, Dr. John Kress with the University of Chicago, said, “Vasopressors are medications commonly used in the ICU that have not traditionally been thought to independently contribute to the development of weakness. Recognition of this potential effect of vasopressors is important…to reduce the risk of developing weakness during critical illness.”

Seriously ill patients are unable to direct their own care.  Research studies like these help physicians make the best choices for the long term quality of life of their patients.

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