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document
Impact of early mobilization on glycemic control and ICU-acquired weakness in critically ill patients who are mechanically ventilated . BACKGROUND ICU-acquired weakness ( ICU-AW ) has immediate and long-term consequences for critically ill patients . Strategies for the prevention of weakness include modification of known risk factors , such as hyperglycemia and immobility . Intensive insulin therapy ( IIT ) has been proposed to prevent critical illness polyneuropathy . However , the effect of insulin and early mobilization on clinically apparent weakness is not well known . METHODS This is a secondary analysis of all patients with mechanical ventilation ( N = 104 ) previously enrolled in a randomized controlled trial of early occupational and physical therapy vs conventional therapy , which evaluated the end point of functional independence . Every patient had IIT and blinded muscle strength testing on hospital discharge to determine the incidence of clinically apparent weakness . The effects of insulin dose and early mobilization on the incidence of ICU-AW were assessed . RESULTS On logistic regression analyses , early mobilization and increasing insulin dose prevented the incidence of ICU-AW ( OR , 0.18 , P = .001 ; OR , 0.001 , P = .011 ; respectively ) independent of known risk factors for weakness . Early mobilization also significantly reduced insulin requirements to achieve similar glycemic goals as compared with control patients ( 0.07 units/kg/d vs 0.2 units/kg/d , P < .001 ) . CONCLUSIONS The duel effect of early mobilization in reducing clinically relevant ICU-AW and promoting euglycemia suggests its potential usefulness as an alternative to IIT .
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Intervention_Physical
early mobilization
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Intervention_Physical
Intensive insulin therapy
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Outcome_Physical
glycemic control
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Outcome_Adverse-effects
ICU-acquired weakness
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Outcome_Adverse-effects
ICU-acquired weakness ( ICU-AW )
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Outcome_Physical
functional independence .
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Outcome_Adverse-effects
clinically apparent weakness .
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Outcome_Physical
effects of insulin dose
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Outcome_Adverse-effects
incidence of ICU-AW
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Outcome_Adverse-effects
incidence of ICU-AW
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Outcome_Physical
insulin requirements
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Outcome_Physical
achieve similar glycemic goals
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Outcome_Adverse-effects
clinically relevant ICU-AW
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Outcome_Physical
promoting euglycemia
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Participant_Condition
critically ill patients who are mechanically ventilated
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Participant_Condition
critically ill patients
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Participant_Condition
all patients with mechanical ventilation
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Participant_Sample-size
( N = 104
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Participant_Condition
previously enrolled in a randomized controlled trial of early occupational and physical therapy vs conventional therapy , which evaluated the end point of functional independence
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Participant_Condition
Every patient had IIT and blinded muscle strength testing on hospital discharge