الفهرس 
IntroductionOnly 14 pages are availabe for public view
Abstract
Critically ill patients exhibit a dramatic loss of lean body mass, particularly skeletal muscle. Muscle wasting is one of many common problems in ICU have to deal with it. Many patients admitted to ICU develop a syndrome of neuromuscular dysfunction characterized by generalized muscle weakness, bilateral deficit of muscle strength in all limbs and inability to separate from mechanical ventilation (Bunnell, Ney, Gellhorn & Hough, 2015).
This syndrome is called ICU-acquired muscle weakness (ICU-AW), which is multi-factorial caused by prolonged immobility, systemic inflammation, corticosteroids, neuromuscular blocking agents, malnutrition and hyperglycemia. Good glycemic control, use corticosteroids with caution, participating in mobility strategies (eg, passive range of motion, active range of motion/bed exercises, chair sitting and walking exercise), using of new technology (EMS and cycle ergometer) help in the prevention of ICU-AW (Puthucheary, 2017).
Aim of the study:
This study aimed to assess factors contributing to acquired muscle weakness among critical ill patients.
Research question:
What are the factors contributing to acquired muscle weakness among critical ill patients?
Subjects and Methods
Research design:
In the current study a descriptive exploratory study design was used to achieve the aim of this study.
Setting:
The study was carried out at Intensive Care Units of Beni–Suef University Hospital (general, chest and internal medicine ICU).
Subjects:
Purposive sample of 75 patients were included in the study.
Tools of data collection
Three tools were constructed and tested to collect data pertinent to this study these tools were:
Tool (1): Patients assessment tool
This tool was developed by the researcher after reviewing the literature review (Goldman & Andrew, 2015 and John & Flavio, 2016). It was included 2 parts as following:
Part I: Concerned with demographic characteristic of patients involved in the study as age, gender, level of education, occupation and residence.
Part II: Concerned with medical data of patients involved in the study as type of patient intensive care unit, date of admission, admission medical diagnosis, length of stay, past medical and surgical history, and lab investigations.
Scoring System:
This part was scored in form of number and percentage except for age was done in form of number, percentage, mean and standard deviation (SD).
Tool (2): Muscle Strength Scale/ Medical Research Council (MRC) and Indicators to Incidence of ICU-AW
It was a standardized tool and adopted from (Hrmans et al., 2012). It was used to assess muscle strength of the studied patients and monitor critically ill patients’ indicators of ICU-AW.
Calculation of muscle strength score:
• This scale was based on to assess muscle strength of upper limb (right and left hand) and lower limb (right and left leg).
• The researcher asked the patient to make the following movement for upper and lower limb:
- For upper limb (shoulder abduction, elbow flexion, wrist extension).
- For lower limb (hip flexion, knee extension, ankle dorsiflexion).
• When the limb achieved the movement at any degree; give it score based on muscle strength scale that is designed for that purpose as the following:
• Grades of muscle strength scale:
Grade 0 No contraction visible or palpable.
Grade 1 Flicker of contraction visible or palpable,
although no limb movement.
Grade 2 Movement with gravity eliminated over
almost full range of motion.
Grade 3 Movement against gravity over almost full range of motion.
Grade 4 Movement against moderate resistance over
full range of motion.
Grade 5 Normal power.
• Ideally each limb should achieve the 3 movements normally (Grade 5 Normal power), this mean each limb took (3x5) = 15degrees.
• For the upper limb (right and left hand) and lower limb (right and left leg) (15x4)=60.
Scoring system:
* If muscle strength score was < 48, this indicates that patient had ICU- AW.
* If muscle strength score was 48-60, this indicated absence of ICU-AW.
Tool (3): Factors contributing to Intensive Care Unit Acquired Muscle Weakness (ICU-AW) assessment tool.
It was concerned with assessment of factors affecting incidence of ICU-AW. This tool was developed by the researcher after reviewing the related literatures (Goldman & Andrew, 2015 and John & Flavio, 2016). It included three parts.
• Part (I): Procedures related factors:-
This part was used to assess application of ICU-AW preventive measures and contain four main items as following:
• Positioning and repositioning
• Range of motion exercises
• Chair sitting exercises
• Walking exercises
Scoring system
- Each procedure done to the patient was given one degree.
-While the procedure not done to the patient was given zero.
• Part (II): Drug related factor:-
It was included prescribed medications lead to muscle weakness during the ICU stay such as corticosteroid therapy.
Scoring system:
o Patient who received corticosteroid therapy, put yes― was given one degree.
o Patient who didn’t receive corticosteroid therapy, put no ―was given zero.
• Part (III):Nutritional related factor:
It was included actual nutritional intake and the ideal nutritional requirements needed for each patient.
• The researcher calculated the ideal nutritional intake for each patient using the following equations:
• (Harris & Benedict, 1919) equations to calculate the ideal nutritional intake.
Basal Energy Expenditure (BEE) equal
• For men,
B.E.E. = 66.5 + (13.75 x weight (kg)) + (5.003 x height (cm)) - (6.775 x age (year)
• For women,
B.E.E. = 655.1 + (9.563 x weight (kg)) + (1.850 x height (cm)) - (4.676 x age (year)
• Total Caloric Requirements = B.E.E. x the sum of the stress and activity factors.
• Scoring system:
- The patient who was well nourished ― give one degree.
- The patient who was malnourished ― given zero degree.