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01-05-2016 | Original

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

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

Published in: Intensive Care Medicine | Issue 5/2016

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.

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Title: Diaphragmatic dysfunction in patients with ICU-acquired weakness and its impact on extubation failure
Authors: Boris Jung
Pierre Henri Moury
Martin Mahul
Audrey de Jong
Fabrice Galia
Albert Prades
Pierre Albaladejo
Gerald Chanques
Nicolas Molinari
Samir Jaber
Publication date: 01-05-2016
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 5/2016
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-015-4125-2

At a glance: The STEP trials

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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