Handgrip Strength Predicts Difficult Weaning But Not Extubation Failure in Mechanically Ventilated Subjects.
BACKGROUND: Muscle weakness, defined by the Medical Research Council scale, has been associated with delay in mechanical ventilation weaning. In this study, we evaluated handgrip strength as a prediction tool in weaning outcome. METHODS: This was a 1-y prospective study in 2 ICUs in 2 university hos...
| Published in: | Respiratory Care Vol. 60; no. 8; pp. 1097 - 1105 |
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| Main Authors: | , , , , , , , , , |
| Format: | protocol research tables/charts Journal Article |
| Published: |
Mary Ann Liebert, Inc.
Aug2015
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109826254&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 109826254 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: Aug2015 vid: 60 iid: 8 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 109826254 108735514 10.4187/respcare.03604 NLM25759461 109826254 ppf: 1097 ppct: 8 formats: fmt: @attributes: type: P tig: atl: Handgrip Strength Predicts Difficult Weaning But Not Extubation Failure in Mechanically Ventilated Subjects. aug: au: Cottereau, Guillaume Dres, Martin Avenel, Alexandre Fichet, Jérome Jacobs, Frédéric M. Prat, Dominique Hamzaoui, Olfa Richard, Christian Antonello, Marc Sztrymf, Benjamin affil: Physiotherapy and Rehabilitation Department, Hopital Antoine-Bdclere, Clamart, France sug: subj: Respiration, Artificial Ventilator Weaning Extubation Grip Strength Muscle Weakness Treatment Failure Treatment Outcomes Human Descriptive Statistics Prospective Studies Academic Medical Centers Intensive Care Units Dynamometry Middle Age Aged Female Male Odds Ratio Confidence Intervals Multivariate Analysis Pulmonary Disease, Chronic Obstructive France Research Protocols Data Analysis Software Mann-Whitney U Test Kruskal-Wallis Test Chi Square Test Fisher's Exact Test Severity of Illness Indices Education, Continuing (Credit) Middle Aged: 45-64 years Aged: 65+ years Female Male ab: BACKGROUND: Muscle weakness, defined by the Medical Research Council scale, has been associated with delay in mechanical ventilation weaning. In this study, we evaluated handgrip strength as a prediction tool in weaning outcome. METHODS: This was a 1-y prospective study in 2 ICUs in 2 university hospitals. Adult patients who were on mechanical ventilation for at least 48 h and eligible for mechanical ventilation weaning were screened for inclusion. Handgrip strength was evaluated using a handheld dynamometer before each spontaneous breathing trial (SBT). Attending physicians were unaware of handgrip strength and decided on extubation according to guidelines. RESULTS: Eighty-four subjects were included (median age 66 [53-791 y, with a median Simplified Acute Physiology Score II of 49 [37-63]). At the first evaluation, median handgrip strength was significantly associated with weaning outcome as defined by international guidelines: simple (20 [12-26] kg), difficult (12 [6-21] kg), or prolonged (6 [3-11] kg) weaning (P = .008). Time to liberation from mechanical ventilation and ICU stay were significantly longer for subjects classified as having muscle weakness according to the handgrip strength-derived definition (P = .02 and P = .03, respectively). In multivariate analysis, known history of COPD (odds ratio [OR] 5.48, 95% Cl 1.44-20.86, P = .01), sex (OR 6.16, 95% Cl 1.64-23.16, P = .007), and handgrip strength at the first SBT (OR 0.89, 95% Cl 0.85-0.97, P = .004) were significantly associated with difficult or prolonged weaning. Extubation failure, as defined by re-intubation or unscheduled noninvasive ventilation within 48 h after extubation, occurred 14 times after 92 attempts, leading to an extubation failure rate of 15%. No association was found between handgrip strength and extubation outcome. CONCLUSIONS: Muscle weakness, assessed by handgrip strength, is associated with difficult or prolonged mechanical ventilation weaning and ICU stay, but not with extubation outcome. pubtype: Academic Journal doctype: protocol research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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