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Role of ICU-acquired weakness on extubation outcome among patients at high risk of reintubation
BACKGROUND: Whereas ICU-acquired weakness may delay extubation in mechanically ventilated patients, its influence on extubation failure is poorly known. This study aimed at assessing the role of ICU-acquired weakness on extubation failure and the relation between limb weakness and cough strength. ME...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7069045/ https://www.ncbi.nlm.nih.gov/pubmed/32164739 http://dx.doi.org/10.1186/s13054-020-2807-9 |
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author | Thille, Arnaud W. Boissier, Florence Muller, Michel Levrat, Albrice Bourdin, Gaël Rosselli, Sylvène Frat, Jean-Pierre Coudroy, Rémi Vivier, Emmanuel |
author_facet | Thille, Arnaud W. Boissier, Florence Muller, Michel Levrat, Albrice Bourdin, Gaël Rosselli, Sylvène Frat, Jean-Pierre Coudroy, Rémi Vivier, Emmanuel |
author_sort | Thille, Arnaud W. |
collection | PubMed |
description | BACKGROUND: Whereas ICU-acquired weakness may delay extubation in mechanically ventilated patients, its influence on extubation failure is poorly known. This study aimed at assessing the role of ICU-acquired weakness on extubation failure and the relation between limb weakness and cough strength. METHODS: A secondary analysis of two previous prospective studies including patients at high risk of reintubation after a planned extubation, i.e., age greater than 65 years, with underlying cardiac or respiratory disease, or intubated for more than 7 days prior to extubation. Patients intubated less than 24 h and those with a do-not-reintubate order were not included. Limb and cough strength were assessed by a physiotherapist just before extubation. ICU-acquired weakness was clinically diagnosed as limb weakness defined as Medical Research Council (MRC) score < 48 points and severe weakness as MRC sum-score < 36. Cough strength was assessed using a semi-quantitative 5-Likert scale. Extubation failure was defined as reintubation or death within the first 7 days following extubation. RESULTS: Among 344 patients at high risk of reintubation, 16% experienced extubation failure (56/344). They had greater severity and lower MRC sum-score (41 ± 16 vs. 49 ± 13, p < 0.001) and were more likely to have ineffective cough than the others. The prevalence of ICU-acquired weakness at the time of extubation was 38% (130/244). The extubation failure rate was 12% (25/214) in patients with no limb weakness vs. 18% (12/65) and 29% (19/65) in those with moderate and severe limb weakness, respectively (p < 0.01). MRC sum-score and cough strength were weakly but significantly correlated (rho = 0.28, p < .001). After multivariate logistic regression analyses, the lower the MRC sum-score the greater the risk of reintubation; severe limb weakness was independently associated with extubation failure, even after adjustment on cough strength and severity at admission. CONCLUSION: ICU-acquired weakness was diagnosed in 38% in this population of patients at high risk at the time of extubation and was independently associated with extubation failure in the ICU. |
format | Online Article Text |
id | pubmed-7069045 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-70690452020-03-18 Role of ICU-acquired weakness on extubation outcome among patients at high risk of reintubation Thille, Arnaud W. Boissier, Florence Muller, Michel Levrat, Albrice Bourdin, Gaël Rosselli, Sylvène Frat, Jean-Pierre Coudroy, Rémi Vivier, Emmanuel Crit Care Research BACKGROUND: Whereas ICU-acquired weakness may delay extubation in mechanically ventilated patients, its influence on extubation failure is poorly known. This study aimed at assessing the role of ICU-acquired weakness on extubation failure and the relation between limb weakness and cough strength. METHODS: A secondary analysis of two previous prospective studies including patients at high risk of reintubation after a planned extubation, i.e., age greater than 65 years, with underlying cardiac or respiratory disease, or intubated for more than 7 days prior to extubation. Patients intubated less than 24 h and those with a do-not-reintubate order were not included. Limb and cough strength were assessed by a physiotherapist just before extubation. ICU-acquired weakness was clinically diagnosed as limb weakness defined as Medical Research Council (MRC) score < 48 points and severe weakness as MRC sum-score < 36. Cough strength was assessed using a semi-quantitative 5-Likert scale. Extubation failure was defined as reintubation or death within the first 7 days following extubation. RESULTS: Among 344 patients at high risk of reintubation, 16% experienced extubation failure (56/344). They had greater severity and lower MRC sum-score (41 ± 16 vs. 49 ± 13, p < 0.001) and were more likely to have ineffective cough than the others. The prevalence of ICU-acquired weakness at the time of extubation was 38% (130/244). The extubation failure rate was 12% (25/214) in patients with no limb weakness vs. 18% (12/65) and 29% (19/65) in those with moderate and severe limb weakness, respectively (p < 0.01). MRC sum-score and cough strength were weakly but significantly correlated (rho = 0.28, p < .001). After multivariate logistic regression analyses, the lower the MRC sum-score the greater the risk of reintubation; severe limb weakness was independently associated with extubation failure, even after adjustment on cough strength and severity at admission. CONCLUSION: ICU-acquired weakness was diagnosed in 38% in this population of patients at high risk at the time of extubation and was independently associated with extubation failure in the ICU. BioMed Central 2020-03-12 /pmc/articles/PMC7069045/ /pubmed/32164739 http://dx.doi.org/10.1186/s13054-020-2807-9 Text en © The Author(s). 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Thille, Arnaud W. Boissier, Florence Muller, Michel Levrat, Albrice Bourdin, Gaël Rosselli, Sylvène Frat, Jean-Pierre Coudroy, Rémi Vivier, Emmanuel Role of ICU-acquired weakness on extubation outcome among patients at high risk of reintubation |
title | Role of ICU-acquired weakness on extubation outcome among patients at high risk of reintubation |
title_full | Role of ICU-acquired weakness on extubation outcome among patients at high risk of reintubation |
title_fullStr | Role of ICU-acquired weakness on extubation outcome among patients at high risk of reintubation |
title_full_unstemmed | Role of ICU-acquired weakness on extubation outcome among patients at high risk of reintubation |
title_short | Role of ICU-acquired weakness on extubation outcome among patients at high risk of reintubation |
title_sort | role of icu-acquired weakness on extubation outcome among patients at high risk of reintubation |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7069045/ https://www.ncbi.nlm.nih.gov/pubmed/32164739 http://dx.doi.org/10.1186/s13054-020-2807-9 |
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