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Background This was a retrospective chart review of procedural pain assessments and interventions during arterial catheter insertion in an adult neurological intensive care unit where patients with impaired consciousness are common. Overall, pain assessment was well documented (100%) by Registered Nurses, but not specific to arterial line insertion. Nurse practitioners commonly placed arterial lines and used local analgesia in over 75% of the documented procedures. Aims The purpose of this study was to examine healthcare providers’ pain-related practices documented during arterial catheter insertion, one of the most painful procedures in a neurological intensive care unit. Secondary purposes were determining whether patient characteristics, procedure-related factors, or provider licensure were associated with pain assessment or procedural pain interventions. Design A retrospective records review design was used. Methods 120 electronic patient medical records were reviewed during a one-year period. Results 100 charts met inclusion criteria. Nurses assessed all pain within 4 hours following the procedure in all charts but procedure-specific pain assessments were documented in 4% of charts. Pain-related interventions for arterial line insertion were local analgesic (76% of charts) and other procedure-specific interventions (10%). Significant associations occurred between procedure specific pain assessments and decreased number of insertion attempts (p = .006) and between pain interventions and number of insertion attempts (p = .003). No provider documented procedural pain assessment regarding arterial line insertion. Associations between patient characteristics and pain interventions were significant for patient ethnicity (F = 8.967, p = .007). Conclusions Overall pain assessment was documented (100%) but not specific to arterial line insertion. Although arterial line insertion can be extremely painful, patients were rarely assessed for such pain by any clinician; 14% did not receive any preprocedural analgesia. Clinical Implications The lack of procedural pain assessment in this vulnerable population indicates a need for increased pain management education for clinicians and further investigations to determine whether sufficient analgesia is provided to reduce procedural pain during arterial line insertion.

A source of insecurity among new physicians and new nurses is communicating and managing acute changes in patient condition. Mock page programs are an effective method for teaching communication and clinical decision-making skills to medical students. Joint participation in a mock page program provides a unique opportunity for medical and nursing students to practice communication, collaboration, and clinical decision-making in a low-risk learning environment. The purpose of this pilot study was to examine attitudes toward communication and collaboration among medical and nursing students after participation in a mock page program.Twenty-four medical students participating in a surgical residency preparatory course were paired with 24 senior level nursing students. Over a period of 3 weeks, nursing students delivered 5 mock pages to the medical students. Mock pages consisted of peer-reviewed, prescripted scenarios depicting patients experiencing common postoperative complications. A 12-question survey measuring attitudes toward communication and collaboration between physicians and nurses was administered prior to delivery of the first page and after delivery of the last page. A dependent sample t test was used to perform item analysis.Individual item analysis of medical student surveys indicated significant improvement in attitudes toward communication and collaboration with nurses in 12 out of 12 survey items (p0.05). Individual item analysis of nursing student surveys indicated significant improvement in attitudes toward communication and collaboration with physicians in 6 out of 10 survey items (p0.05). There was no decline in attitudes among any of the survey items.The results from this study suggest that an interprofessional mock page program improves attitudes toward communication and collaboration between medical and nursing students. This program has the potential to improve the quality of education and increase confidence among medical and nursing students as they prepare for their professional roles.

This report is a secondary analysis of data from a larger study of a nurse-led early therapeutic mobility intervention among patients receiving mechanical ventilation. This analysis evaluated whether intervention frequency or intensity was associated with pain or fatigue. Frequency was defined as once-daily versus twice-daily interventions. Intensity was defined as low (in-bed activities) or moderate (out-of-bed activities). Thirty-nine patients self-reported pain and fatigue immediately before and after the intervention. Neither pain nor fatigue increased significantly (mean increase

Aims and objectives This project used the Patient Reported Outcomes Measurement Information System (PROMIS) tools to evaluate heart failure patient's experiences of dyspnea, fatigue, and physical mobility during initiation and up titration of drugs in an outpatient setting. Background Investigating patient reported outcome may improve adherence to GDMT. Theoretical support for this study is found in the University of California, Theory of Symptom Management. Design Exploratory, repeated measures design. Methods Patients (n = 21) completed three PROMIS questionnaires for dyspnea, fatigue and physical mobility when GDMT was started or up titrated, and again at a follow up appointment within 30 days (+/− 14 days) of the baseline measures. Patients were asked open- ended queries regarding the usefulness of these questionnaires in identifying and managing symptoms. Provider input was sought on usefulness of the tools in clinical practice and decision making. Results Dyspnea change scores significantly decreased (p = .001), physical mobility scores significantly increased (p = .017), and fatigue scores did not change (p = .319). Duration of HF diagnosis was associated with dyspnea change scores. Patients reported PROMIS tools were easy to use, while providers felt the tools were easy for patients to use but were too long and time intensive for usual office practice. Conclusions Dyspnea and physical mobility improved with up titration of GDMT but fatigue did not change. Relevance to clinical practice PROMIS tools could be helpful in tracking selected symptom changes during GDMT HF medication initiation or up titration for HF management if reformulated into shorter format.

Aims and objectives To examine what occurs after a recorded observation of at least one abnormal vital sign in the emergency department. The aims were to determine how often abnormal vital signs were recorded, what interventions were documented, and what factors were associated with documented follow-up for abnormal vital signs. Background Monitoring quality of care, and preventing or intervening before harm occurs to patients are central to nurses’ roles. Abnormal vital signs have been associated with poor patient outcomes and require follow-up after the observation of abnormal readings to prevent patient harm related to a deteriorating status. This documentation is important to quality and safety of care. Design Observational, retrospective chart review. Methods Modified Early Warning Score was calculated for all recorded vital signs for 195 charts. Comparisons were made between groups: (1) no abnormal vital signs, (2) abnormal vital sign present, but normal Modified Early Warning Score and (3) critically abnormal Modified Early Warning Score. Results About 62·1% of charts had an abnormal vital sign documented. Critically abnormal values were present in 14·9%. No documentation was present in 44·6% of abnormal cases. When interventions were documented, it was usually to notify the physician. The timing within the emergency department visit when the abnormalities were observed and the degree of abnormality had significant relationships to the presence of documentation. Conclusions It is doubtful that nurses do not recognise abnormalities because more severely abnormal vital signs were more likely to have documented follow-up. Perhaps the interruptive nature of the emergency department or the prioritised actions of the nurse impacted documentation within this study. Further research is required to determine why follow-up is not being documented. Relevance to clinical practice To ensure safety and quality of patient care, accurate documentation of responses to abnormal vital signs is required.

Objective: Investigate the feasibility of a nurse-led mobility protocol and compare the effects of once- versus twice-daily episodes of early therapeutic mobility (ETM) and low- versus moderate-intensity ETM on serum biomarkers of inflammation and selected outcomes in critically ill adults. Design: Randomized interventional study with repeated measures and blinded assessment of outcomes. Setting: Four adult intensive care units (ICUs) in two academic medical centers. Subjects: Fifty-four patients with > 48 hr of mechanical ventilation (MV). Intervention: Patients were assigned to once- or twice-daily ETM via sealed envelope randomization at enrollment. Intensity of (in-bed vs. out-of-bed) ETM was administered according to protocolized patient assessment. Measurements: Interleukins 6, 10, 8, 15, and tumor necrosis factor-α were collected from serum before and after ETM; change scores were used in the analyses. Manual muscle and handgrip strength, delirium onset, duration of MV, and ICU length of stay (LOS) were evaluated as patient outcomes. Main Results: Hypotheses regarding the inflammatory biomarkers were not supported based on confidence intervals. Twice-daily intervention was associated with reduced ICU LOS. Moderate-intensity (out-of-bed) ETM was associated with greater manual muscle test scores and handgrip strength and reduced occurrence of delirium. Conclusion: Findings from this study suggest that nurses can provide twice-daily mobility interventions that include sitting on the edge of the bed once patients have a stable status without altering a pro-inflammatory serum biomarker profile.

Successful hemodialysis treatments for patients with renal failure depend on patient adherence to prescribed treatment regimens. Lack of adherence may contribute to patient discomfort between hemodialysis treatments. This article reports a descriptive, correlational feasibility study that utilized Kolcaba's Comfort Theory as a framework. The purpose of the study was to determine a potential relationship between comfort and fluid retention (a proxy for adherence) in adults with end stage renal disease receiving hemodialysis. A convenience sample of 51 patients receiving hemodialysis was studied. Comparisons of patient weight gain between hemodialysis treatment sessions measured fluid retention by proxy. Results indicated no significant relationship between the variables of comfort and adherence to fluid restrictions. However, this finding has potential to support clinical practice to minimize weight gain to sustain comfort. Awareness of comfort as a consideration for adherence to prescribed treatment regimens may help nurses coach individuals to improve treatment adherence.

Author(s): Devlin, John W; Skrobik, Yoanna; Gelinas, Celine; Needham, Dale M; Slooter, Arjen JC; Pandharipande, Pratik P; Watson, Paula L; Weinhouse, Gerald L; Nunnally, Mark E; Rochwerg, Bram; Balas, Michele C; van den Boogaard, Mark; Bosma, Karen J; Brummel, Nathaniel E; Chanques, Gerald; Denehy, Linda; Drouot, Xavier; Fraser, Gilles L; Harris, Jocelyn E; Joffe, Aaron M; Kho, Michelle E; Kress, John P; Lanphere, Julie A; McKinley, Sharon; Neufeld, Karin J; Pisani, Margaret A; Payen, Jean-Francois; Pun, Brenda T; Puntillo, Kathleen A; Riker, Richard R; Robinson, Bryce RH; Shehabi, Yahya; Szumita, Paul M; Winkelman, Chris; Centofanti, John E; Price, Carrie; Nikayin, Sina; Misak, Cheryl J; Flood, Pamela D; Kiedrowski, Ken; Alhazzani, Waleed

Objective This study examined therapeutic mobility activity, and investigated whether serum levels of inflammatory biomarkers interleukin (IL)-6 and IL-10 varied between periods of rest and activity. Methods This observational, exploratory study took place in a medical intensive care unit and in stepdown units at an urban, academic medical center managed by intensivists. Our sample included 17 adults with exacerbations of chronic obstructive pulmonary disease (COPD). Results Our results indicate that activity can occur for about 20 minutes, early during a hospitalization, among critically ill adults with COPD exacerbations, and activity can progress safely over 2 days in an intensive-care or stepdown setting. Physical activity was low in intensity, as measured by actigraphy. Conclusion Although no significant differences were evident between serum inflammatory biomarkers at rest vs after activity in this small sample, trend-related data indicate that low-intensity activity has the potential to alter the inflammatory profile of hospitalized COPD adults.

Two endotracheal tubes (ETTs) are available for use in operative suites for intubation: the Parker Flex-Tip (PFT, Parker Medical) and the standard Mallinckrodt (Covidien). To the authors' knowledge, no study has compared these 2 ETTs with each other when the anesthesia provider uses the GlideScope video laryngoscope (Verathon) for intubation. The purpose of the study was to determine if there are differences related to ease of intubation reported by anesthesia providers who use the PFT tube compared with the standard tube while using the GlideScope. The study was a randomized block intervention design. The sample consisted of 58 observed intubations in an operating room setting. Data analysis was completed with a 2-factor analysis of covariance using 2 covariates. The PFT tube in suboptimal conditions demonstrated a significantly greater ease of intubation, as measured by decreased time for ETT insertion and greater ease of ETT insertion score. The number of redirections at the glottis to intubate the trachea once the glottis was visualized was not statistically different. Based on the findings from this study, anesthesia providers may want to consider the use of the PFT tube when using the GlideScope to promote ease of intubation.

This project described prospectively obese, critically ill patients and the resources critical care nurses used to care for these challenging patients. It also examined the relationship between resources used by nurses and patient outcomes, including complications and length of stay. Forty-three participants were enrolled. Patients with a body mass index (BMI) 40 kg/m2 used the majority of equipment and personnel resources and experienced a prolonged length of stay. The most common equipment used was a specialty bed or mattress; the most common complications were related to the pulmonary system. Initial use of multiple resources may indicate a patient at risk for adverse outcomes. Nurses can use findings to anticipate care needs and develop interventions, such as optimal positioning, to avoid adverse outcomes.

Hyponatremia commonly occurs in patients with aneurysmal subarachnoid hemorrhage. Two mechanisms have been proposed as causes: syndrome of inappropriate anti-diuretic hormone and cerebral salt wasting. Physical examination and laboratory results can assist a clinician in identifying which mechanism is responsible and thus determine proper treatment. When hyponatremia is treated promptly and appropriately, patients' sodium levels return to normal without detrimental effects.

Profound muscle weakness during and after critical illness is termed intensive care unit-acquired weakness (ICUAW).To develop diagnostic recommendations for ICUAW.A multidisciplinary expert committee generated diagnostic questions. A systematic review was performed, and recommendations were developed using the Grading, Recommendations, Assessment, Development, and Evaluation (GRADE) approach.Severe sepsis, difficult ventilator liberation, and prolonged mechanical ventilation are associated with ICUAW. Physical rehabilitation improves outcomes in heterogeneous populations of ICU patients. Because it may not be feasible to provide universal physical rehabilitation, an alternative approach is to identify patients most likely to benefit. Patients with ICUAW may be such a group. Our review identified only one case series of patients with ICUAW who received physical therapy. When compared with a case series of patients with ICUAW who did not receive structured physical therapy, evidence suggested those who receive physical rehabilitation were more frequently discharged home rather than to a rehabilitative facility, although confidence intervals included no difference. Other interventions show promise, but fewer data proving patient benefit existed, thus precluding specific comment. Additionally, prior comorbidity was insufficiently defined to determine its influence on outcome, treatment response, or patient preferences for diagnostic efforts. We recommend controlled clinical trials in patients with ICUAW that compare physical rehabilitation with usual care and further research in understanding risk and patient preferences.Research that identifies treatments that benefit patients with ICUAW is necessary to determine whether the benefits of diagnostic testing for ICUAW outweigh its burdens.

The benefits of early mobilization for adult patients in the intensive care unit (ICU) are reduced length of ICU and hospital stays, fewer readmissions to the ICU, decreased duration of mechanical ventilation, fewer days of detrimental bedrest, minimal adverse or unsafe events, and improved walking distance. Because there are no available tools to specifically measure mobility status of patients in the ICU setting, there is an urgent need to create a reliable tool that measures and standardizes the assessment of mobility status for these patients. The purpose of this study was to describe the development of this novel ICU-specific tool to assess a patient's mobility status, examine the initial reliability of the tool, and address its clinical application. The Perme ICU Score was quickly and easily administered by physical therapists. Overall, the inter-rater agreement was 94%. A total of six items had kappa values of < .6, and these low scores may have been the result of the procedure to collect inter-rater scores, wherein one rater assisted with the activity while a second rater observed. In order to improve reliability, the authors developed directions to standardize the assessment. The Perme ICU Mobility Score is a tool developed to measure the patient's mobility status starting with the ability to follow commands and culminating in the distance walked in two minutes. Preliminary data suggest that the validity of this tool is supported by expert concurrence, its overall reliability is high, and its clinical use is acceptable.

Introduction Vital signs are an important component of the nursing assessment and are used as early warning signs of changes in a patient's condition; however, little research has been conducted to determine how often vital signs are monitored in the emergency department. Additionally, it has not been determined what personal, social, and environmental factors affect the frequency of vital sign monitoring. The purpose of this study was to examine what factors may influence the time between recording vital signs in the emergency department. Methods We performed a descriptive, retrospective chart review of 202 randomly selected adult ED patients' charts from representative times to capture a variety of ED levels of occupancy in an urban, Midwestern, teaching hospital. Descriptive and hierarchical regression analyses were used. Results The strongest predictor of the increased time between vital signs from the personal health factors was lower patient acuity (Emergency Severity Index). This relationship remained strong even when social factors and environmental factors were included. Increased length of stay and fewer routes of medications also had significant relationships to the increased time between vital sign monitoring. Discussion These findings are clinically important because greater time between vital sign recordings can lead to errors of omission by not detecting changes in vital signs that could reveal changes in the patient's condition. The findings of this study provide direction for future research focusing on determining whether higher frequency of vital signs surveillance contributes to higher quality care and linking quality of care to missing vital signs/inadequate monitoring.

The knowledge and performance of hemodialysis nursing staff at Zagazig University Hospitals, Egypt, were evaluated using a quasi-experimental design. Participants received an educational program developed from international standards and national guidelines. The number of nurses who achieved satisfactory knowledge and performance scores increased significantly post-intervention, and were sustained for three months after the intervention. A strong, positive correlation was also found between the participants' knowledge and their performance.

Hospitals are under pressure to provide care that not only shortens hospital length of stay but also reduces subsequent hospital admissions. Hospital readmissions have received increased attention in outcome reporting. The authors identified survivors of acute respiratory failure who then required subsequent hospitalization. A cohort of acute respiratory failure survivors, who participated in an early intensive care unit (ICU) mobility program, was assessed to determine if variables from the index hospitalization predict hospital readmission or death, within 12 months of hospital discharge.Hospital database and responses to letters mailed to 280 acute respiratory failure survivors. Univariate predictor variables shown to be associated with hospital readmission or death (P0.1) were included in a multiple logistic regression. A stepwise selection procedure was used to identify significant variables (P0.05).Of the 280 survivors, 132 (47%) had at least 1 readmission or died within the first year, 126 (45%) were not readmitted and 22 (8%) were lost to follow-up. Tracheostomy [odds ratio (OR), 4.02 (95%CI, 1.72-9.40)], female gender [OR, 1.94 (95%CI, 1.13-3.32)], a higher Charlson Comorbidity Index assessed upon index hospitalization discharge [OR, 1.15 (95%CI, 1.01-1.31)] and lack of early ICU mobility therapy [OR, 1.77 (95%CI, 1.04-3.01)] predicted readmission or death in the first year postindex hospitalization.Tracheostomy, female gender, higher Charlson Comorbidity Index and lack of early ICU mobility were associated with readmissions or death during the first year. Although the mechanisms of increased hospital readmission are unclear, these findings may provide further support for early ICU mobility for patients with acute respiratory failure.

Extremely low birth-weight infants are prone to fluid and electrolyte imbalance due to multiple etiologies. Hypernatremia can occur in this gestational age group during the first week of life. One therapy that many NICUs initiate to treat hypernatremia is enteral sterile water feeds (SWFs). The use of free water is an adjunct therapy in place of large volumes of intravenous fluids. This article presents a review of renal physiology and 3 case studies of infants, less than 27 weeks' gestational age and less than 1000-g birth weight, treated with SWFs for hypernatremia. Commonalities and differences in treatment are addressed. There is limited evidence-based research using enteral SWFs for the treatment of hypernatremia.

Respiratory disorders are common problems for adults and children in North America and generally represent the outcome of gene–environment interactions. Some problems are considered genetic in origin, such as cystic fibrosis, and others are considered environmental in origin, such as respiratory infections. Emerging information indicates that even genetic-based disorders are influenced by the environment and that environmental-based disorders are modified by personal genetic factors in individual physiologic responses. An understanding of an individual's personal risk factors for disease or health problem development can allow health care professionals to tailor health promotion strategies and treatment plans with appropriate environmental manipulation. This article explores the genetic influences that may affect the individual's physiologic responses and the consequences of environmental stimuli.

In this review, we analyzed literature related to the clinical, theoretical, and empirical determinants of mild traumatic brain injury (MTBI) in adults, with a focus on outcomes. Consequences after MTBI were summarized, patient outcomes were organized following Ferrans and Powers' conceptual model of quality of life, and gaps in knowledge were identified. The following databases were searched for publications related to MTBI: PubMed, PsycINFO, CINAHL, and Digital Dissertation. A total of 44 publications related to MTBI in adults were identified. Neither clinical nor theoretical definitions nor empirical descriptions agreed on the determinants of MTBI in adults. Nine reports included a holistic evaluation of outcomes after MTBI; an additional 35 studies examined health and functioning, psychological, or socioeconomic consequences. Results were mixed regarding how MTBI affects individuals in overall quality of life and which domains of quality of life are affected. With more than one million adults experiencing MTBI annually in the United States, it benefits the healthcare professional to understand the challenges of identifying adults who experience MTBI. Furthermore, the consequences of MTBI may be clinically important. Further research about MTBI using clear definitions and a holistic approach to recovery is warranted.

Disrupted sleep in hospitalized patients is widely reported, and ambient environmental lighting may be both a contributor to and a modifier of sleep/wake patterns. This is the first study to examine the congruence between two types of light meters, a wrist-worn device and a stand-alone device, and their respective light intensity measurements. The study sample included 20 light trials in 17 patients for a total of 480 paired light measurements. Descriptive data analysis indicated that both light meters dependably recorded changes in light levels, and Bland Altman plots demonstrated congruence between data from the two types of light meters. The results provide promising data on how to measure patient exposure to ambient light dependably in the continuously changing and unpredictable clinical setting.

This study examined whether air or saline, used for the loss-of-resistance (LOR) technique, resulted in a difference in pain relief or adverse events for laboring parturients. Previous studies had mixed findings regarding the onset of analgesia and subsequent pain relief. Research questions were as follows: Is there difference in analgesic onset for patients receiving air vs saline during the LOR technique? Do women receiving the air method for LOR experience any difference in the quality of pain relief from that of women receiving saline? Is there any difference in the incidence of analgesic distribution or segmental pain relief in women receiving the air vs the saline method? Is there any difference in the incidence of adverse effects in women receiving air vs saline during the LOR technique? This was an experimental, prospective study with 50 women. Subjects were randomized to receive air or saline. The visual analogue scale was used to measure pain. A dermatome level recorded the spread of analgesia. No significant differences were found between groups for onset or quality of analgesia. There was a significant increase in the number of subjects who experienced segmental blocks after receiving air during the LOR technique.

Objective The purpose of this article is to examine the agreement between two measures of pain in laboring women who receive epidural analgesia for relief to support validity and reliability of the Visual Analog Scale (VAS) in this population. Background There are several different approaches to measuring pain in laboring women. However, the psychometric properties of pain relief measures in this population are not well established. This investigation examines agreement (i.e., concordance) between the visual analog scale for pain sensation and sensation measured by dermatome level assessment. Method Fifty pregnant women in labor who underwent epidural placement recorded their sensation of pain on the VAS simultaneously with the certified nurse anesthetist recording sensation by using a standard dermatome chart after administration of epidural analgesia. Results There was moderate, significant correlation between the two measures. However, agreement between the two measures did not meet preset standards with Bland–Altman analysis, suggesting that one measure cannot be substituted for the other. Overall, the average dermatome levels alone underestimated pain in laboring women as recorded by the VAS, although both under-and overestimation of pain relief occurred during the series of observations.

article i nfo Purpose: The purpose of this study was to determine the interrater reliability of the Perme Intensive Care Unit Mobility Score. Materials and methods: This was a prospective observational study. Data were collected from 20 patients admitted in a cardiovascular intensive care unit. The interrater reliability was tested using the intraclass correlation coefficient with 95% confidence interval and the Cohen κ coefficient of 0.9, using a 2-tailed α of .05 to provide a 90% power. Results: The 15 items of the Perme ICU Mobility Score were individually analyzed. Interrater reliability (Cohen κ coefficient) for items 2, 3, 5, 6, 7, 8, 13, and 15 was 1.0000; for item 1, 0.8276; item 4, 0.8000; item 9, 0.6000; item 10, 0.7297; item 11, 0.7260; item 12, 0.7872; and item 14, 0.9048; the intraclass correlation coefficient (95% confidence interval) was 0.9880 (0.97743-0.99859). Conclusions: The Perme ICU Mobility Score is a reliable tool to assess mobility status of patients admitted to the cardiovascular intensive care unit in a specific moment in time, which can be an important tool for research and clinical practice.

Non-excitable muscle membrane indicates critical illness myopathy (CIM) during early critical illness. We investigated predisposing risk factors for non-excitable muscle membrane at onset of critical illness.We performed sequential measurements of muscle membrane excitability after direct muscle stimulation (dmCMAP) in 40 intensive care unit (ICU) patients selected upon a simplified acute physiology (SAPS-II) scoreOR= 20 on 3 successive days within 1 week after ICU admission. We then investigated predisposing risk factors, including the insulin-like growth factor (IGF)-system, inflammatory, metabolic and hemodynamic parameters, as well as suspected medical treatment prior to first occurrence of abnormal dmCMAP. Nonparametric analysis of two-factorial longitudinal data and multivariate analysis were used for statistical analysis.22 patients showed abnormal muscle membrane excitability during direct muscle stimulation within 7 (5 to 9.25) days after ICU admission. Significant risk factors for the development of impaired muscle membrane excitability in univariate analysis included inflammation, disease severity, catecholamine and sedation requirements, as well as IGF binding protein-1 (IGFBP-I), but did not include either adjunctive hydrocortisone treatment in septic shock, nor administration of neuromuscular blocking agents or aminoglycosides. In multivariate Cox regression analysis, interleukin-6 remained the significant risk factor for the development of impaired muscle membrane excitability (HR 1.006, 95%-CI (1.002 to 1.011), P = 0.002).Systemic inflammation during early critical illness was found to be the main risk factor for development of CIM during early critical illness. Inflammation-induced impairment of growth-factor mediated insulin sensitivity may be involved in the development of CIM.