by Martin Dres, Boris Jung, Nicolas Molinari, Federico
Manna, Bruno-Pierre Dubé, Gerald Chanques, Thomas Similowski, Samir Jaber and
Alexandre Demoule
Critical Care volume 23,
Article number: 370 (2019)
Background:
Intensive care unit (ICU)-acquired weakness (ICU-AW) and
ICU-acquired diaphragm dysfunction (ICU-DD) occur frequently in mechanically
ventilated (MV) patients. It is unknown whether they have different risk
factors and different impacts on outcome. This study was designed to (1)
describe the respective risk factors associated with ICU-AW and severe ICU-DD
and (2) evaluate the respective impact of ICU-AW and severe ICU-DD on outcome.
Methods:
Post hoc analysis of two prospective cohort studies
conducted in two ICUs. In patients mechanically ventilated for at least 24 h
undergoing a first spontaneous breathing trial, severe ICU-DD was defined as
diaphragm twitch pressure < 7 cmH2O and ICU-AW was defined as Medical
Research Council Score < 48.
Results:
One hundred sixteen patients were assessed. Factors
independently associated with severe ICU-DD were age, longer duration of MV,
and exposure to sufentanil, and those factors associated with ICU-AW were
longer duration of MV and exposure to norepinephrine. Severe ICU-DD (OR
3.56, p = 0.008), but not ICU-AW, was independently associated with
weaning failure (59%). ICU-AW (OR 4.30, p = 0.033), but not severe ICU-DD,
was associated with ICU mortality. Weaning failure and mortality rate were
higher in patients with both severe ICU-DD and ICU-AW (86% and 39%,
respectively) than in patients with either severe ICU-DD (64% and 0%) or ICU-AW
(63% and 13%).
Conclusion:
Severe ICU-DD and ICU-AW have different risk factors and
different impacts on weaning failure and mortality. The impact of the
combination of ICU-DD and ICU-AW is more pronounced than their individual
impact.
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