Abstract
Background The relationship between muscle function in critically ill patients assessed using bedside techniques and clinical outcomes has not been systematically described. We aimed to evaluate the association between muscle weakness assessed by bedside evaluation and mortality or weaning from mechanical ventilation, and the capacity of each evaluation tool to predict outcomes.
Methods Five databases (PubMed, Embase, CINAHL, Cochrane Library, Science Direct) were searched from January 2000 to December 2018. Data were extracted and random effects meta-analyses were performed.
Results 60 studies were analysed, including 4382 patients. Intensive care unit (ICU)-related muscle weakness was associated with an increase in overall mortality with odds ratios ranging from 1.2 (95% CI 0.60–2.40) to 4.48 (95% CI 1.49–13.42). Transdiaphragmatic twitch pressure had the highest predictive capacity for overall mortality, with a sensitivity of 0.87 (95% CI 0.76–0.93) and a specificity of 0.36 (95% CI 0.27–0.43). The area under the curve (AUC) was 0.74 (95% CI 0.70–0.78). Muscle weakness was associated with an increase in mechanical ventilation weaning failure rate with an odds ratio ranging from 2.64 (95% CI 0.72–9.64) to 19.07 (95% CI 9.35–38.9). Diaphragm thickening fraction had the highest predictive capacity for weaning failure with a sensitivity of 0.76 (95% CI 0.67–0.83) and a specificity of 0.86 (95% CI 0.78–0.92). The AUC was 0.86 (95% CI 0.83–0.89).
Conclusion ICU-related muscle weakness detected by bedside techniques is a serious issue associated with a high risk of death or prolonged mechanical ventilation. Evaluating diaphragm function should be a clinical priority in the ICU.
Abstract
Tools that evaluated diaphragm function were better at predicting mortality in ICU or weaning failure https://bit.ly/2VHC0WH
Footnotes
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Additional collaborators: Naeem Ali, University Hospital, Division of Pulmonary, Critical Care, and Sleep Medicine, Columbus, OH, USA, provided data and information for the conduct and analysis of the work; Cédric Carrié, Critical Care Department, Centre Hospitalier Robert Boulin, Libourne, France, provided data and information for the conduct and analysis of the work; Guillaume Cottereau, Physiotherapy and Rehabilitation Dept, Hôpital Antoine-Béclère, Clamart, France, provided data and information for the conduct and analysis of the work; Alexandre Demoule, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie, Médecine Intensive et Réanimation (Département R3S), AP-HP, INSERM, UMRS1158 neurophysiologie respiratoire expérimentale et clinique, Sorbonne Université, Paris, France, provided data and information for the conduct and analysis of the work and critical revision of the manuscript for important intellectual content; Martin Dres, Sorbonne University, Experimental and Clinical Neurophysiology, National Institute for Health and Medical Research (INSERM, UMRS-1158) the Pneumology and Intensive Care Dept, Pitie Salpetriere Hospital, Paris, France, provided data and information for the conduct and analysis of the work and critical revision of the manuscript for important intellectual content; Bruno Pierre Dubé, Département de Médecine, Service de Pneumologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Canada, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada, provided data and information for the conduct and analysis of the work and critical revision of the manuscript for important intellectual content; Ewan Goligher, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada, Department of Medicine, Division of Respirology, University Health Network, Toronto, Canada and Toronto and General Hospital Research Institute, Toronto, ON, Canada, provided data and information for the conduct and analysis of the work; Greet Hermans, Dept of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium and Medical Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium, provided data and information for the conduct and analysis of the work; Aliae Mohamed Hussein, Chest Dept, Faculty of Medicine, Assiut University, Assiut, Egypt, provided data and information for the conduct and analysis of the work; Savino Spadaro, Dept of Morphology, Experimental Medicine and Surgery, Section of Anaesthesia and Intensive Care, Arcispedale Sant’ Anna, University of Ferrara, Ferrara, Italy, provided data and information for the conduct and analysis of the work; Eva María Tenza-Lozano, Intensive Care Unit of the General University Hospital of Elche, Spain, provided data and information for the conduct and analysis of the work; Luuk Wieske, Dept of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands, provided data and information for the conduct and analysis of the work; Esther Witteveen, Dept of Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands and Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Amsterdam University Medical Centers, Amsterdam, The Netherlands, provided data and information for the conduct and analysis of the work.
Author contributions: Guarantor: C. Medrinal; study concept and design: C. Medrinal, Y. Combret, G. Prieur, O. Contal and B. Lamia; acquisition of data: all authors; analysis and interpretation of pooled data: C. Medrinal, Y. Combret, R. Hilfiker, G. Prieur, F-E. Gravier, T. Bonnevie, O. Contal and B. Lamia; drafting of the manuscript: C. Medrinal, Y. Combret, R. Hilfiker and G. Prieur; critical revision of the manuscript for important intellectual content: all authors; statistical analysis of pooled data: R. Hilfiker. C. Medrinal had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
This study was registered as a systematic review: PROSPERO 2019, CRD42019122081. The study specific summary data included in the meta-analysis can be obtained from the corresponding author.
Conflict of interest: C. Medrinal reports personal fees from Air Liquide, non-financial support from ADIR Assistance, outside the submitted work.
Conflict of interest: Y. Combret has nothing to disclose.
Conflict of interest: R. Hilfiker has nothing to disclose.
Conflict of interest: G. Prieur has nothing to disclose.
Conflict of interest: N. Aroichane has nothing to disclose.
Conflict of interest: F-E. Gravier reports non-financial support for meeting attendance from ADIR Association, outside the submitted work.
Conflict of interest: T. Bonnevie reports non-financial support for meeting attendance from ADIR Association, outside the submitted work.
Conflict of interest: O. Contal has nothing to disclose.
Conflict of interest: B. Lamia reports grants from Novartis, AstraZeneca, Chiesi, Lowenstein and Elivie, non-financial support from Respironics, outside the submitted work.
- Received December 24, 2019.
- Accepted April 22, 2020.
- Copyright ©ERS 2020