Dados do Trabalho

Título

Association between peripheral muscle weakness and diaphragmatic dysfunction and prevalence in patients with difficult weaning and long ICU stays.

Objetivo

A progressive deterioration of muscle strength with reduced mass and impaired function is common among patients in intensive care units (ICU) and can be considered an independent predictor for morbidity, institutionalization and mortality. Considering that mechanical ventilation (MV) is determinant in ICU length of stay (LOS), we speculate that peripheral and ventilatory muscle impairment might be associated with difficult MV weaning and thus with prolonged ICU LOS.

Métodos

In this prospective observational study, 216 ICU patients with more than 48hs of MV were enrolled from September/2016 to October/2020. Hemodynamic instability and Richmond Agitation Sedation Scale less than zero were excluded. Peripheral muscle strength was assessed by MRC muscle scale (medical research council), palmar grip test (PG) and measuring the calf perimeter (CP) in the first day of weaning from MV. Ventilatory muscle strength was assessed by the maximal inspiratory pressure (PiMax). Difficult MV weaning was defined as a weaning higher than 7 days.

Resultados

Both MRC and PG indexes were significantly lower in the group with a difficult weaning (both with p value < 0,001), and lower in patients with prolonged ICU LOS (p < 0,005). Other predictors of difficult weaning were lower values of PiMax (p value< 0,005) and CP (p value < 0,005).

Conclusão

The results suggest that peripheral and ventilatory muscle impairment can be associated with difficult MV weaning and with prolonged ICU LOS. Patients who achieved a ventilatory disconnect in more than 7 days had lower MRC, PG and worse performance at PiMax.