Diaphragmatic dysfunction in patients with ICU-acquired weakness and its impact on extubation failure

Boris Jung, Pierre Henri Moury, Martin Mahul, Audrey de Jong, Fabrice Galia, Albert Prades, Pierre Albaladejo, Gerald Chanques, Nicolas Molinari, Samir Jaber, Boris Jung, Pierre Henri Moury, Martin Mahul, Audrey de Jong, Fabrice Galia, Albert Prades, Pierre Albaladejo, Gerald Chanques, Nicolas Molinari, Samir Jaber

Abstract

Purpose: 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.

Methods: 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.

Results: Among 185 consecutive patients ventilated for more than 48 h, 40 (22 %) with a MRC score of 31 [20-36] 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.

Conclusion: 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.

Keywords: Diaphragmatic dysfunction; Intensive care unit-acquired weakness; Mechanical ventilation; Respiratory muscles; Weaning.

References

    1. Am J Respir Crit Care Med. 2015 Nov 1;192(9):1080-8
    1. Eur Respir J. 2007 May;29(5):1033-56
    1. Crit Care. 2014 Mar 18;18(2):209
    1. Crit Care Med. 2001 Jul;29(7):1325-31
    1. Intensive Care Med. 2013 Jan;39(1):85-92
    1. Am J Respir Crit Care Med. 2013 Jul 15;188(2):213-9
    1. Am J Respir Crit Care Med. 1997 May;155(5):1570-4
    1. Am J Respir Crit Care Med. 2014 Dec 15;190(12):1437-46
    1. N Engl J Med. 2012 Mar 8;366(10):932-42
    1. Am J Respir Crit Care Med. 2008 Aug 1;178(3):261-8
    1. Crit Care Med. 2011 Dec;39(12 ):2627-30
    1. Intensive Care Med. 2012 May;38(5):796-803
    1. Thorax. 2014 May;69(5):423-7
    1. Anesthesiology. 2014 May;120(5):1182-91
    1. Crit Care Med. 2007 Sep;35(9):2007-15
    1. N Engl J Med. 2011 Apr 7;364(14):1293-304
    1. Am J Respir Crit Care Med. 2002 Aug 15;166(4):518-624
    1. Am J Respir Crit Care Med. 2011 Feb 1;183(3):364-71
    1. Am J Respir Crit Care Med. 2013 Jun 15;187(12):1294-302
    1. Intensive Care Med. 2015 Apr;41(4):642-9
    1. Intensive Care Med. 2000 Sep;26(9):1360-3
    1. Crit Care. 2011 Mar 11;15(2):206
    1. Respir Care. 2012 Oct;57(10):1594-601
    1. Intensive Care Med. 2014 Apr;40(4):528-38
    1. Thorax. 2007 Nov;62(11):975-80
    1. Am J Respir Crit Care Med. 2004 Mar 15;169(6):679-86
    1. Crit Care. 2013 Oct 10;17(5):R229
    1. N Engl J Med. 2008 Mar 27;358(13):1327-35
    1. JAMA. 2002 Dec 11;288(22):2859-67
    1. Anesthesiology. 2010 Feb;112(2):453-61
    1. Anesthesiology. 2012 Sep;117(3):560-7
    1. JAMA. 1993 Dec 22-29;270(24):2957-63
    1. Am J Respir Crit Care Med. 2012 Dec 1;186(11):1140-9
    1. Muscle Nerve. 2012 Jan;45(1):18-25
    1. Muscle Nerve. 1991 Nov;14(11):1103-9
    1. Intensive Care Med. 1996 Jul;22(7):707-10
    1. Intensive Care Med. 2013 Dec;39(12):2200-3
    1. Am J Respir Crit Care Med. 2003 Jan 15;167(2):120-7
    1. Intensive Care Med. 2013 Nov;39(11):1885-95
    1. Intensive Care Med. 2013 May;39(5):801-10
    1. Intensive Care Med. 2004 Jun;30(6):1117-21
    1. Am J Respir Crit Care Med. 2014 Aug 15;190(4):410-20
    1. Intensive Care Med. 2014 Feb;40(2):280-3
    1. N Engl J Med. 2014 Apr 24;370(17):1626-35
    1. Crit Care. 2015 Apr 13;19:161
    1. Phys Ther. 2014 Jan;94(1):68-82
    1. Am J Respir Crit Care Med. 2013 Feb 1;187(3):238-46

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