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. 2022 Jul 22:9:930262.
doi: 10.3389/fmed.2022.930262. eCollection 2022.

Occurrence and Effects on Weaning From Mechanical Ventilation of Intensive Care Unit Acquired and Diaphragm Weakness: A Pilot Study

Michele Bertoni  1 , Simone Piva  1   2 , Alessandra Beretta  1 , Federica Bongiovanni  2 , Riccardo Contarino  1 , Ricard Mellado Artigas  3   4 , Lucia Ceresoli  2 , Mattia Marchesi  2 , Michele Falappi  2 , Marta Belleri  2 , Alberto Goffi  5 , Matteo Pozzi  6 , Frank Antonio Rasulo  1   2 , Nicola Latronico  1   2
Affiliations

Occurrence and Effects on Weaning From Mechanical Ventilation of Intensive Care Unit Acquired and Diaphragm Weakness: A Pilot Study

Michele Bertoni et al. Front Med (Lausanne). .

Abstract

Purpose: Limb intensive care unit (ICU)-acquired weakness (ICUAW) and ICU acquired diaphragm weakness (DW) occur frequently in mechanically ventilated (MV) patients; their coexistence in cooperative and uncooperative patients is unknown. This study was designed to (1) describe the co-occurrence of the two conditions (2) evaluate the impact of ICUAW and DW on the ventilator-free days (VFDs) at 28 days and weaning success, and (3) assess the correlation between maximal inspiratory pressure (MIP) and thickening fraction (TFdi) in patients with DW.

Methods: This prospective pilot study was conducted in a single-center on 73 critically ill MV patients. Muscle weakness was defined as a Medical Research Council score < 48 in cooperative patients or a bilateral mean simplified peroneal nerve test < 5.26 mV in uncooperative patients. Diaphragm dysfunction was defined as MIP < 30 cm H2O or as a TFdi < 29%. Weaning success was defined according to weaning according to a new definition (WIND).

Results: Fifty-seven patients (78%) had ICUAW and 59 (81%) had DW. The coexistence of the two conditions occurred in 48 patients (65%), without association (χ2 = 1.06, p = 0.304). In the adjusted analysis, ICUAW was independently related to VFDs at 28-days (estimate difference 6 days, p = 0.016), and WIND (OR of 3.62 for having WIND different than short weaning), whereas DW was not. The linear mixed model showed a significant but weak correlation between MIP and TFdi (p < 0.001).

Conclusion: This pilot study is the first to explore the coexistence of ICUAW and DW in both cooperative and uncooperative patients; a lack of association was found between DW and ICUAW when considering both cooperative and uncooperative patients. We found a strong correlation between ICUAW but not DW with the VFDs at 28 days and weaning success. A future larger study is warranted in order to confirm our results, and should also investigate the use of transdiaphragmatic twitch pressure measurement during bilateral anterior magnetic phrenic nerve stimulation for the diagnosis of DW.

Keywords: coexistence; diaphragmatic weakness; intensive care unit-acquired weakness; maximum inspiratory pressure; simplified peroneal nerve test; thickening fraction of the diaphragm; weaning from mechanical ventilation.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Study protocol. Patients admitted to intensive care medicine (ICU) for >72 h and mechanically ventilated for >48 h were screened. ICUAW was evaluated using MRC and PENT, and DW was diagnosed with MIP and TFdi. MV, mechanical ventilation; TFdi, diaphragm thickening fraction; MIP, maximal inspiratory pressure; MRC, medical research council scale; PENT, simplified peroneal nerve test; SBT, spontaneous breathing trial (PSV 6/6 cmH2O).
FIGURE 2
FIGURE 2
Venn diagram of ICUAW and DW coexistence. The coexistence of the two conditions occurred in 48 patients (65%); there was no association between ICUAW and DW (χ2 = 1.06, p = 0.304).
FIGURE 3
FIGURE 3
Plotting of model estimates of the correlation between MIP (maximal inspiratory pressure) and TFdi (thickening fraction of diaphragm).
See this image and copyright information in PMC

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