WC is associated with hypertensive blood pressure, dyslipidemia, and insulin resistance in adults with CP regardless of age, gender, or gross motor functioning. WC provides additional information above that obtained from BMI. WC therefore presents as a quick and easy clinical measure, which should be used instead of or in conjunction with BMI, to identify adults with CP at risk of cardiovascular disease and type 2 diabetes mellitus. Future research should validate cutoffs for elevated waist circumference in adults with CP. a. Omron Healthcare UK Ltd, Opal Dr, Fox Milne, Milton Keynes, MK15 0DG, UK. “
THE POPULATION AGES and mortality from critical illness declines, selleck chemicals the number of ICU survivors is selleck compound growing.1 and 2 These survivors commonly experience neuromuscular weakness that may be severe and prolonged.1, 2 and 3
Particularly in mechanically ventilated patients, heavy sedation and bed rest are common in the ICU.4, 5 and 6 Immobility plays an important role in the development of neuromuscular weakness,7 and 8 which is associated with impairment in ICU survivors’ physical function, quality of life, and return to work.3 and 9 Physical inactivity also contributes to the development of atelectasis, insulin resistance, and joint contractures.10 and 11 Mobilizing mechanically ventilated patients in the ICU has a historical precedent and has been demonstrated as feasible, safe, and beneficial in improving physical function.12, 13 and 14 However, early mobilization is not practiced on a widespread basis in ICUs.15 Neuromuscular complications after critical illness and early mobilization of mechanically ventilated patients became areas of interest at our institution. Our university is the lead institution for a multisite Endonuclease prospective cohort study evaluating the long-term physical and mental health outcomes of patients who survived acute lung injury/acute respiratory
distress syndrome.16 Experience from follow-up of these research participants increased awareness of the prolonged neuromuscular complications faced by patients discharged from our MICU. Moreover, analysis of preliminary data from this study demonstrated that only 24% of patients ever received consultation for PT and/or OT in our MICU, which was almost 50% lower than for similar patients at 2 other academic hospitals in the same city.17 These data also demonstrated a higher prevalence of deep sedation in our MICU patients (58% vs 27% of ICU patient days) and a low proportion (≤15%) of ICU days in which patients were not deeply sedated or delirious. Additional observational work in our MICU further motivated the need for quality improvement through confirming that heavy sedation represented an important barrier to implementing early PM&R and that our MICU survivors experienced important impairments in strength, range of motion, and physical function at hospital discharge.18 Based on this experience, we wanted to improve PM&R services in the MICU.