ICU outcomes can be predicted by noninvasive muscle evaluation: a meta-analysis
Clément Medrinal, Yann Combret, Roger Hilfiker, Guillaume Prieur, Nadine Aroichane, Francis-Edouard Gravier, Tristan Bonnevie, Olivier Contal, Bouchra Lamia, Clément Medrinal, Yann Combret, Roger Hilfiker, Guillaume Prieur, Nadine Aroichane, Francis-Edouard Gravier, Tristan Bonnevie, Olivier Contal, Bouchra Lamia
Abstract
Background: The relationship between muscle function in critically ill patients assessed using bedside techniques and clinical outcomes has not been systematically described. We aimed to evaluate the association between muscle weakness assessed by bedside evaluation and mortality or weaning from mechanical ventilation, and the capacity of each evaluation tool to predict outcomes.
Methods: Five databases (PubMed, Embase, CINAHL, Cochrane Library, Science Direct) were searched from January 2000 to December 2018. Data were extracted and random effects meta-analyses were performed.
Results: 60 studies were analysed, including 4382 patients. Intensive care unit (ICU)-related muscle weakness was associated with an increase in overall mortality with odds ratios ranging from 1.2 (95% CI 0.60-2.40) to 4.48 (95% CI 1.49-13.42). Transdiaphragmatic twitch pressure had the highest predictive capacity for overall mortality, with a sensitivity of 0.87 (95% CI 0.76-0.93) and a specificity of 0.36 (95% CI 0.27-0.43). The area under the curve (AUC) was 0.74 (95% CI 0.70-0.78). Muscle weakness was associated with an increase in mechanical ventilation weaning failure rate with an odds ratio ranging from 2.64 (95% CI 0.72-9.64) to 19.07 (95% CI 9.35-38.9). Diaphragm thickening fraction had the highest predictive capacity for weaning failure with a sensitivity of 0.76 (95% CI 0.67-0.83) and a specificity of 0.86 (95% CI 0.78-0.92). The AUC was 0.86 (95% CI 0.83-0.89).
Conclusion: ICU-related muscle weakness detected by bedside techniques is a serious issue associated with a high risk of death or prolonged mechanical ventilation. Evaluating diaphragm function should be a clinical priority in the ICU.
Conflict of interest statement
Conflict of interest: C. Medrinal reports personal fees from Air Liquide, non-financial support from ADIR Assistance, outside the submitted work. Conflict of interest: Y. Combret has nothing to disclose. Conflict of interest: R. Hilfiker has nothing to disclose. Conflict of interest: G. Prieur has nothing to disclose. Conflict of interest: N. Aroichane has nothing to disclose. Conflict of interest: F-E. Gravier reports non-financial support for meeting attendance from ADIR Association, outside the submitted work. Conflict of interest: T. Bonnevie reports non-financial support for meeting attendance from ADIR Association, outside the submitted work. Conflict of interest: O. Contal has nothing to disclose. Conflict of interest: B. Lamia reports grants from Novartis, AstraZeneca, Chiesi, Lowenstein and Elivie, non-financial support from Respironics, outside the submitted work.
Copyright ©ERS 2020.
Source: PubMed