Does ICU-acquired paresis lengthen weaning from mechanical ventilation?
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To determine whether ICU-acquired paresis (ICUAP) is an independent risk factor of prolonged weaning.
Second study of a prospective cohort of 95 patients who were enrolled in an incidence and risk factor study of ICUAP.
Three medical and two surgical ICUs in four hospitals.
Patients and participants
Ninety-five patients without pre-existing neuromuscular disease recovering from the acute phase of critical illness after ≥7 days of mechanical ventilation.
Measurements and results
Duration of weaning from mechanical ventilation was defined as the duration of mechanical ventilation between awakening (day 1) and successful weaning. Muscle strength was evaluated at day 7 after awakening using the Medical Research Council (MRC) score. Patients with an MRC <48 were considered to have ICUAP. Among the 95 patients (mean age 62.0±15.3 years, SAPS 2 on admission 48.7±17.4) who regained satisfactory awakening after 7 or more days of mechanical ventilation, 67 (70.5%) were hospitalized in a medical ICU and 28 (29.5%) in a surgical ICU. Median duration (25th–75th percentiles) of weaning was longer in patients with ICUAP than in those without ICUAP: 6 days (1–22 days) vs 3 days (1–7 days); p=0.01; log-rank analysis. In multivariate analysis, the two independent predictors of prolonged weaning were ICUAP [hazard ratio (HR): 2.4; 95% confidence interval (CI): 1.4–4.2] and chronic obstructive pulmonary disease (HR: 2.7; 95% CI: 1.6–4.5)
ICU-acquired paresis is an independent predictor of prolonged weaning. Prevention of ICU-acquired neuromuscular abnormalities in patients recovering from severe acute illness should result in shorter weaning duration.
KeywordsArtificial respiration Ventilator weaning Neuromuscular disease Intensive care Chronic obstructive pulmonary disease
- 4.Kaplan EL, Meier P (1958) Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:457–481Google Scholar
- 7.Cox DR (1972) Regression models and life-tables. J R Stat Soc 34:187–220Google Scholar
- 10.Garnacho-Montero J, Madrazo-Osuna J, Garcia-Garmendia JL, Ortiz-Leyba C, Jimenez-Jimenez FJ, Barrero-Almodovar A, Garnacho-Montero MC, Moyano-Del-Estad MR (2001) Critical illness polyneuropathy: risk factors and clinical consequences. A cohort study in septic patients. Intensive Care Med 27:1288–1296Google Scholar
- 13.Sassoon CS, Caiozzo VJ, Manka A, Sieck GC (2002) Altered diaphragm contractile properties with controlled mechanical ventilation. J Appl Physiol 92:2585–2595Google Scholar