Diaphragmatic dysfunction in patients with ICU-acquired weakness and its impact on extubation failure
- 3.2k Downloads
Diaphragm function is rarely studied in intensive care patients with unit-acquired weakness (ICUAW) in whom weaning from mechanical ventilation is challenging. The aim of the present study was to evaluate the diaphragm function and the outcome using a multimodal approach in ICUAW patients.
Patients were eligible if they were diagnosed for ICUAW [Medical Research Council (MRC) Score <48], mechanically ventilated for at least 48 h and were undergoing a spontaneous breathing trial. Diaphragm function was assessed using magnetic stimulation of the phrenic nerves (change in endotracheal tube pressure), maximal inspiratory pressure and ultrasonographically (thickening fraction). Diaphragmatic dysfunction was defined by a change in endotracheal tube pressure below 11 cmH2O. The endpoints were to describe the correlation between diaphragm function and ICUAW and its impact on extubation.
Among 185 consecutive patients ventilated for more than 48 h, 40 (22 %) with a MRC score of 31 [20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36] were included. Diaphragm dysfunction was observed with ICUAW in 32 patients (80 %). Change in endotracheal tube pressure and MRC score were not correlated. Maximal inspiratory pressure was correlated with change in endotracheal tube pressure after magnetic stimulation of the phrenic nerves (r = 0.43; p = 0.005) and MRC score (r = 0.34; p = 0.02). Thickening fraction was less than 20 % in 70 % of the patients and was statistically correlated with change in endotracheal tube pressure (r = 0.4; p = 0.02) but not with MRC score. Half of the patients could be extubated without needing reintubation within 72 h.
Diaphragm dysfunction is frequent in patients with ICU-acquired weakness (80 %) but poorly correlated with the ICU-acquired weakness MRC score. Half of the patients with ICU-acquired weakness were successfully extubated. Half of the patients who failed the weaning process died during the ICU stay.
KeywordsDiaphragmatic dysfunction Mechanical ventilation Weaning Intensive care unit-acquired weakness Respiratory muscles
Compliance with ethical standards
Conflicts of interest
Boris Jung reports personal fees from Merck (Whitehouse Station, NJ, USA) and Astellas (Tokyo, Japan) without relations with the present study. Samir Jaber reports personal fees from Maquet, Draeger, Hamilton Medical, Fisher Paykel and Abbott without relations with the present study. Pierre Henri Moury, Martin Mahul, Audrey De Jong, Fabrice Gallia, Albert Prades, Pierre Albaladejo, Gerald Chanques and Nicolas Molinari have nothing to disclose related to the subject of the article.
Source of funding
This study was supported by University Hospital of Montpellier.
- 46.Vincent JL, Moreno R, Takala J et al (1996) The SOFA (Sepsis-related Organ Failure Assessment) Score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 22:707–710CrossRefPubMedGoogle Scholar