Journal
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
Volume 195, Issue 1, Pages 57-66Publisher
AMER THORACIC SOC
DOI: 10.1164/rccm.201602-0367OC
Keywords
diaphragm dysfunction; intensive care unit-acquired weakness; weaning from mechanical ventilation
Categories
Funding
- French Intensive Care Society (SRLF Bourse de Mobilite)
- European Respiratory Society
- European Society of Intensive Care Medicine
- Assistance Publique Hopitaux de Paris
- Fondation pour la Recherche Medicale [20150734498]
- Mitacs Globalink Sorbonne Universites
- Investissement d'avenir program of the French Government [ANR-10-AIHU 06]
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Rationale: Intensive care unit (ICU)- and mechanical ventilation (MV)-acquired limb muscle and diaphragm dysfunction may both be associated with longer length of stay and worse outcome. Whether they are two aspects of the same entity or have a different prevalence and prognostic impact remains unclear. Objectives: To quantify the prevalence and coexistence of these two forms of ICU-acquired weakness and their impact on outcome. Methods: In patients undergoing a first spontaneous breathing trial after at least 24 hours of MV, diaphragm dysfunction was evaluated using twitch tracheal pressure in response to bilateral anterior magnetic phrenic nerve stimulation (a pressure <11 cm H2O defined dysfunction) and ultrasonography (thickening fraction [TFdi] and excursion). Limb muscle weakness was defined as a Medical Research Council (MRC) score less than 48. Measurements and Main Results: Seventy-six patients were assessed at their first spontaneous breathing trial: 63% had diaphragm dysfunction, 34% had limb muscle weakness, and 21% had both. There was a significant but weak correlation between MRC score and twitch pressure (rho = 0.26; P = 0.03) and TFdi (rho = 0.28; P= 0.01), respectively. Low twitch pressure (odds ratio, 0.60; 95% confidence interval, 0.45-0.79; P < 0.001) and TFdi (odds ratio, 0.84; 95% confidence interval, 0.76-0.92; P < 0.001) were independently associated with weaning failure, but the MRC score was not. Diaphragm dysfunction was associated with higher ICU and hospital mortality, and limb muscle weakness was associated with longer duration of MV and hospital stay. Conclusions: Diaphragm dysfunction is twice as frequent as limb muscle weakness and has a direct negative impact on weaning outcome. The two types of muscle weakness have only limited overlap.
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