الفهرس 
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Abstract
Intensive care unit acquired weakness is independently linked with prolonged hospital and ICU stay, prolonged MV, difficult weaning, increased mortality, and in-hospital cost. The etiology of ICUAW is multifactorial and related to various risk factors, such as prolonged immobility, MV, MOF, sepsis, hypoalbuminemia, and use of vasopressors, corticosteroids, and neuromuscular blocking drugs.
Early interventions to prevent or diminish the devastating consequences of ICUAW are important. Critical care nurses can collaborate to create practices that are known to prevent and alleviate the long term consequences of critical illness. Risk factors reduction remains the foundation of preventing the development or worsening of ICUAW. Since the increase in patients with activity restrictions resulting from ICUAW, the paradigm of treatment has moved from the copious use of sedation and immobilization to mobilization.
Aim of the study
A descriptive research design was used to identify the factors associated with intensive care unit acquired weakness in critically ill patients.
This study was carried out at the Alexandria Main University Hospital ICUs, namely; unit I, unit II, unit III, unit IV, and renal dialysis ICU.
A convenience sample of 60 newly admitted adult critically ill patients to the above-mentioned settings was included in the studywith the following inclusion criteria: aged 18 years or more of both sexes, who are cooperative and can follow simple commands with BMI between 18.5 and 30 kg/m2. Patients with central or peripheral nervous system injury, history of neuromuscular diseases, cognitive disorders that prevent the understanding of simple order or orthopedic or traumatic limitations upon admission have been excluded from the study.
A sequential sample of 60 patients was enrolled in this study during the period of data collection from October 2019 to January 2020.
Materials and method
To accomplish the aim of the current study; one tool was used for data collection namely ”Intensive care unit acquired weakness associated factors”. The tool was developed by the researcher after reviewing the related literature except forthe MRC scale from part I was adopted by the researcher from the Medical Research Council.
The study design was accomplished as follow:
Approval from the ethical committee, Faculty of Nursing, Alexandria University was obtained. An official letter from the faculty of nursing was delivered to the hospital authorities in the Main University Hospital and approval to conduct this study was obtained after explaining the aim of the study.
The tool of the study was developedafter reviewing the related literature by the researcher and was assessed for clarity and content validity. A pilot study was carried out on 6 patients (10% of the sample) to assess the clarity and applicability of the tool. The patient’s anonymity, confidentiality, and privacy were maintained during the implementation of the study.
Patients who met the previous inclusion criteria were enrolled in this study and assessed for socio-demographic and clinical data.The enrolled patient’s muscle strength was assessed by the researcher upon admission as a baseline value and daily for 7 consecutive days using part I.Factors associated with ICUAW were assessed and recorded by the researcher using part II of the tool daily from the first day of admission until the seventh day on a consecutive basis. Data were fed to the computer and analysis using statistical package for social sciences (SPSS / version 25) software.
Results of the study
Most of the studied patients in this study were females; aged more than fifty years old and the most commonly encountered reason for admission of the studied critically ill patients to ICU was respiratory disorders.
As regards the total MRC levels over a week mean percentage, it can be observed that there was a progressive decrease in the mean from the 1stday till the 7th day.Moreover, 26.7% of studied patients developed intensive care unit acquired muscle weakness. While 73.3% of studied patients did not develop intensive care unit acquired muscle weakness.
Regarding the occurrence day of weakness, the result reveals that 26.70% of the studied patients developed muscle weakness on the 3rd day of admission. While 43.30% of the studied patients developed muscle weakness by the 5th and 6th days of admission.
In regard, the handgrip levels, near half of the studied patients (48.3%) developed right arm weakness. while 45% maintained normal strength and more than half (51.7%) of the studied patients developed left arm weakness. While 43.3% maintained normal strength.
The study reveals that there was no significant difference between the occurrence of ICUAW regards socio-demographic and clinical data namely; sex, age, diagnosis, BMI, APACHE II, and SOFA scores.
Regarding the morbidity related factors, there is a statistically significant relationship between the occurrence of ICUAW and CKD. While there was no statistically significant relationship between the occurrence of ICUAW and other comorbidities.
Regarding the treatment-related factors, there are no significant differences were found between the occurrence of ICUAW regarding either pharmacological; corticosteroids, vasopressors, and insulin infusion or interventional related factors; MV, parental nutrition, and renal replacement therapy.Regarding the environmental-related factors, shows that there is no significant relationship between sleeping hours and sleeps efficiency with the occurrences of ICUAW.
Concerning the metabolic related factors, it can be observed that there is a significant relationship between hypokalemia and the occurrence of ICUAW. While there is no significant relationship between the occurrence of ICUAW and other electrolytes disturbance including hyponatremia, hypernatremia, hyperkalemia, hypocalcemia, or hypophosphatemia. Furthermore, there is a highly significant difference was observed between the occurrence of ICUAW and hypoalbuminemia, anemia and risk for malnutrition.
In relation to the nursing practices related factors, it shows that there is no significant relationship between positioning, walking, and chair setting with the occurrence of ICUAW.The result of multiple regression analysis shows that the variables which independently associated with the development of ICUAW were hypokalemia, anemia, hypoalbuminemia, and risk for malnutrition.
Conclusion
• Based on the results of this study, it can be concluded that more than one-quarter of patients developed ICUAW during their ICU stay. Most of them have developed the weakness by the fifth day of ICU stay.
• There wasa statistically significant relationship between the occurrence of ICUAW and CKD, hypokalemia, hypoalbuminemia, the risk for malnutrition, and anemia.
• Likewise, there was no statistically significant relationship between the occurrence of ICUAW and patient age, gender, other co-morbidities, MV, renal replacement therapy, steroids and vasoactive therapies, administration of parenteral nutrition, and application of positioning and walking exercises.
Based on the present study findings, the following recommendations are suggested:
• Assess muscle strength of all admitted patients to ICU using muscle strength scale as a routine practice.
• Shift ICU culture from one in which patients are on bed rest and not moving as the norm to one in which mobilization enables the prevention of complications and faster healing and recovery.
• Eliminate the barriers for critically ill patient’s early mobilization including patients, nursing, environmental and administrative barriers.
• Perform certain laboratory investigations e.g serum hemoglobin, albumin, and serum electrolytes as a daily routine for all critically ill patients.
• Hold training sessions and workshops to increase the awareness about assessment, risk factors, management, and prevention of ICUAW among critically ill patients.
• Replicate this study on larger samples in different hospitals to generalize the results.