Maximum inspiratory pressure, a surrogate parameter for the assessment of ICU-acquired weakness

Georgios Tzanis, Ioannis Vasileiadis, Dimitrios Zervakis, Eleftherios Karatzanos, Stavros Dimopoulos, Theodore Pitsolis, Elli Tripodaki, Vasiliki Gerovasili, Christina Routsi, Serafim Nanas, Georgios Tzanis, Ioannis Vasileiadis, Dimitrios Zervakis, Eleftherios Karatzanos, Stavros Dimopoulos, Theodore Pitsolis, Elli Tripodaki, Vasiliki Gerovasili, Christina Routsi, Serafim Nanas

Abstract

Background: Physical examination has been advocated as a primary determinant of ICU-acquired weakness (ICU-AW). The purpose of the study is to investigate ICU-AW development by using Maximum Inspiratory Pressure (MIP) as a surrogate parameter of the standardized method to evaluate patients' peripheral muscle strength.

Methods: Seventy-four patients were recruited in the study and prospectively evaluated in a multidisciplinary university ICU towards the appearance of ICU-AW. APACHE II admission score was 16 ± 6 and ICU stay 26 ± 18 days. ICU-AW was diagnosed with the Medical Research Council (MRC) scale for the clinical evaluation of muscle strength. MIP was measured using the unidirectional valve method, independently of the patients' ability to cooperate.

Results: A significant correlation was found between MIP and MRC (r = 0.68, p < 0.001). Patients that developed ICU-AW (MRC<48) had a longer weaning period compared to non ICU-AW patients (12 ± 14 versus 2 ± 3 days, p < 0.01). A cut-off point of 36 cmH2O for MIP was defined by ROC curve analysis for ICU-AW diagnosis (88% sensitivity,76% specificity). Patients with MIP below the cut-off point of 36 cmH2O had a significant greater weaning period (10 ± 14 versus 3 ± 3 days, p = 0.004) also shown by Kaplan-Meier analysis (log-rank:8.2;p = 0.004).

Conclusions: MIP estimated using the unidirectional valve method may be a potential surrogate parameter for the assessment of muscle strength compromise, useful for the early detection of ICU-AW.

Figures

Figure 1
Figure 1
Scattergram of maximum inspiratory pressure and medical research council scale for muscle strength in critical ill patients enrolled in the study, (r:0.68; p < 0.001, N = 33).
Figure 2
Figure 2
Kaplan-Meier curves of the probability of remaining under mechanical ventilation (MV) after the onset of weaning according to the presence or not of ICU-acquired weakness (ICU-AW). A cut off limit of 48, for the medical research council scale (MRC) muscle strength score, has been adopted for the diagnosis of ICU-AW.
Figure 3
Figure 3
Kaplan-Meier curves of the probability of remaining under mechanical ventilation (MV) after the onset of weaning according to maximum inspiratory pressure (MIP < or ≥ 36 cmH2O).

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