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

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, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 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.
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https://hal.umontpellier.fr/hal-01780240
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Soumis le : jeudi 5 décembre 2019 - 15:07:23
Dernière modification le : lundi 9 décembre 2019 - 15:53:19

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2016 Jung et al., Diaphragmat...
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Boris Jung, Pierre Moury, Martin Mahul, Audrey de Jong, Fabrice Galia, et al.. Diaphragmatic dysfunction in patients with ICU-acquired weakness and its impact on extubation failure. Intensive Care Medicine, Springer Verlag, 2016, 42 (5), pp.853-861. ⟨10.1007/s00134-015-4125-2⟩. ⟨hal-01780240⟩

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