Please select the eligibility criteria that correspond to the clinical trial below.
Title: Intensive Care Unit(ICU)-Acquired Paresis and the Risk for Mortality and Recurrent ICU Admission (Weakness and ICU Readmission Evaluation-WIRE)
Brief Summary: This study seeks to define the morbidity of critical care polyneuropathy and to confirm that this diagnosis is, in fact, independently associated with increased mortality. Secondary information regarding the reasons for ICU readmission in patients with weakness may help in formulating cogent discharge strategies for these patients. Measurement of weakness using handgrip strength may provide a useful surrogate marker for weakness that may be more easily and uniformly applied.

Primary hypothesis:

* The development of ICU-associated weakness is independently associated with excess attributable mortality.

Secondary hypothesis:

* The development of ICU-associated weakness is associated with an increased need for ICU readmission.
* Readmission to the ICU will be a result of the development of recurrent respiratory failure or insufficiency
* Handgrip strength testing will detect ICU-associated weakness with an equivalent sensitivity as the comprehensive bedside muscle strength exam.


Options:
A: Inclusion Criteria:

* all patients admitted in ICU of Evaggelismos Hospital

Exclusion Criteria:

* age \< 18 years
* pregnancy
* pre-existing neuromuscular disease (e.g. Gravis)
* connective tissue disease
* fractures or skin lesions that do not allow the implementation of EMS
* BMI \> 35 kg/m2
* brain death
* terminal disease
* length of stay \< 48 hours
* presence of pacemaker
B: Inclusion Criteria:

* Adult (age \> or = 18) patients admitted to the Medical ICU
* Respiratory failure requiring mechanical ventilation \> or = 5 days
* Reasonable expectation for a subsequent return of mental status

Exclusion Criteria:

* Patient's family, physician, or both not in favor of aggressive treatment of patient or presence of an advanced directive to withhold life-sustaining treatment
* Pregnancy
* Admitted to ICU from outside hospital
* New or pre-existing diagnosis causing current neuromuscular weakness
* Profound and uncorrectable hypokalemia or hypophosphatemia \[K \< 2.5 or P \< 1.0 throughout enrollment window\]
* Inability to assess muscle strength in more than six muscle groups in at least two extremities \[Bilateral amputation (BKA or AKA), severe burns, skin lesions or dressings limiting ability of examiner to access and forcibly resist movement of the patients extremities\]
* Inability to communicate or follow commands of the examiner \[persistent coma, severe MRDD (mental retardation and developmental disabilities) or continuing necessary medication use that impairs consciousness (i.e. narcotics), non-English speaker\]
* Concurrent enrollment in another clinical trial involving steroids \> 20 mg/day prednisone equivalent for \> 3 days, neuromuscular blockade for \> 24 hours or any aminoglycosides.
* Prisoner or other subject where legal surrogate decision maker is in question
C: Inclusion criteria:

* COPD exacerbation, admitted to the respiratory units
* Informed consent
* Age \< 80
* No critical comorbidity compromising outcome up to one month.
* No suspect of malignancy

Exclusion criteria:

* Patient is involved in a rehabilitation program with a frequency \>1/wk during one month after inclusion in the study
* NIMV or ICU on admission
* Patient scheduled for procedure (LTX/LVRS) within one month after discharge
* Readmission \<14 days after previous hospitalization
* Significant pathology that would hinder the participation in resistance training (gonarthrosis, arthritis to be judged by the investigator)
* Clinical signs of pulmonary hypertension
D: Inclusion Criteria:

* 1 day of mechanical ventilation with an expectation of requiring ≥2 additional days of ICU stay in a Johns Hopkins Intensive Care Unit (ICU)

Exclusion Criteria:

* Unable to understand or speak English due to language barrier or cognitive impairment prior to admission
* Unable to independently transfer from bed to chair at baseline prior to hospital admission
* Known primary systemic neuromuscular disease (e.g. Guillian-Barre) at ICU admission
* Known intracranial process that is associated with localizing weakness (e.g. cerebral vascular accident) at ICU admission
* Transferred from another ICU outside of the Johns Hopkins system after \>4 consecutive days of mechanical ventilation
* Moribund (i.e. \>90% probability of patient mortality in the next 96 hours)
* Anticipated transfer to another ICU for care (e.g. awaiting organ transplantation and transfer to surgical ICU)
* Any pacemaker (e.g., cardiac, diaphragm) or implanted cardiac defibrillator
* Pregnancy
* Body mass index ≥35 kg/m2
* Any limitation in life support other than a sole no-CPR order
* Known or suspected malignancy in the legs
* Unable to treat or evaluate both lower extremities (e.g., bilateral amputation, bilateral skin lesions)
* ICU length of stay \>7 days prior to enrollment

Answer: B