Handgrip strength is an alternative measure to assess peripheral muscle strength and is correlated with the Medical Research Council (MRC) scale, with promising values for diagnosing ICU-acquired weakness (ICUAW). Because ICUAW has been associated with delayed weaning from mechanical ventilation, we hypothesized that ICUAW evaluated with both the MRC scale score and handgrip strength are associated with failure of a spontaneous breathing trial (SBT) and duration of mechanical ventilation weaning.
METHODS:
We conducted a prospective observational study in 3 general ICUs with a total of 54 beds at 2 academic hospitals. Adult subjects with > 48 h of mechanical ventilation who were eligible for weaning were included in the study.
RESULTS:
In the evaluation before the first SBT, the MRC score (P < .001) and handgrip strength (P < .001) were significantly different between subjects extubated after a successful first SBT (simple weaning) and those extubated any time after a failed first SBT (difficult weaning). Only the MRC score discriminated between first SBT success or failure (P < .001); in multivariate analysis, the MRC score was significantly associated with first SBT failure (odds ratio 0.91, 95% CI 0.88–0.97, P < .001) and difficult weaning (odds ratio 0.91, 95% CI 0.87–0.96, P < .001). Handgrip strength exhibited good accuracy in identifying ICUAW.
CONCLUSIONS:
MRC score was independently associated with SBT failure and difficult or prolonged weaning.
SharsharT, Bastuji-GarinS, StevensRD, DurandMC, MalissinI, RodriguezP, et al. Presence and severity of intensive care unit acquired paresis at time of awakening are associated with increased intensive care unit and hospital mortality. Crit Care Med, 2009; 37(12):3047–3053.
2.
De JongheB, SharsharT, LefaucheurJP, AuthierFJ, Durand-ZaleskiI, BoussarsarM, et al. Paresis acquired in the intensive care unit: a prospective multicenter study. JAMA, 2002; 288(22):2859–2867.
3.
DresM, DubéBP, MayauxJ, DelemazureJ, ReuterD, BrochardL, et al. Coexistence and impact of limb muscle and diaphragm weakness at time of liberation from mechanical ventilation in medical intensive care unit patients. Am J Respir Crit Care Med, 2017; 195(1):57–66.
4.
van der SchaafM, DettlingDS, BeelenA, LucasC, DongelmansDA, NolletF. Poor functional status immediately after discharge from an intensive care unit. Disabil Rehabil, 2008; 30(23):1812–1818.
5.
HerridgeMS, TanseyCM, MattéA, TomlinsonG, Diaz-GranadosN, CooperA, et al. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med, 2011; 364(14):1293–1304.
6.
De JongheB, Bastuji-GarinS, DurandMC, MalissinI, RodriguesP, CerfC, et al. Respiratory weakness is associated with limb weakness and delayed weaning in critical illness. Crit Care Med, 2007; 35(9):2007–2015.
7.
Garnacho-MonteroJ, Amaya-VillarR, García-GarmendíaJL, Madrazo-OsunaJ, Ortiz-LeybaC. Effect of critical illness polyneuropathy on the withdrawal from mechanical ventilation and the length of stay in septic patients. Crit Care Med, 2005; 33(2):349–354.
8.
StevensRD, MarshallSA, CornblathDR, HokeA, NeedhamDM, de JongheB, et al. A framework for diagnosing and classifying intensive care unit-acquired weakness. Crit Care Med, 2009; 37(10 Suppl):S299–S308.
9.
De JongheB, Bastuji-GarinS, SharsharT, OutinH, BrochardL. Does ICU acquired paresis lengthen weaning from mechanical ventilation?. Intensive Care Med, 2004; 30(6):1117–1121.
10.
VisserJ, MansE, de VisserM, van den Berg-VosRM, FranssenH, de JongJM, et al. Comparison of maximal voluntary isometric contraction and hand-held dynamometry in measuring muscle strength of patients with progressive lower motor neuron syndrome. Neuromuscul Disord, 2003; 13(9):744–750.
11.
MerliniL, MazzoneES, SolariA, MorandiL. Reliability of hand-held dynamometry in spinal muscular atrophy. Muscle Nerve, 2002; 26(1):64–70.
12.
BaldwinCE, ParatzJD, BerstenAD. Muscle strength assessment in critically ill patients with handheld dynamometry: an investigation of reliability, minimal detectable change, and time to peak force generation. J Crit Care, 2013; 28(1):77–86.
13.
AliNA, O'BrienJMJr, HoffmannSP, PhillipsG, GarlandA, FinleyJCW, et al. Acquired weakness, handgrip strength, and mortality in critically ill patients. Am J Respir Crit Care Med, 2008; 178(3):261–268.
14.
CottereauG, DresM, AvenelA, FichetJ, JacobsFM, PratD, et al. Handgrip strength predicts difficult weaning but not extubation failure in mechanically ventilated subjects. Respir Care, 2015; 60(8):1097–1104.
15.
Mohamed-HusseinAAR, MakhloufHA, SelimZI, GamaleldinSW. Association between hand grip strength with weaning and intensive care outcomes in COPD patients: a pilot study. Clin Respir J, 2018; 12(10):2475–2479.
KnausWA, DraperEA, WagnerDP, ZimmermanJE. APACHE II: a severity of disease classification system. Crit Care Med, 1985; 13(10):818–829.
18.
HermansG, ClerckxB, VanhullebuschT, SegersJ, VanpeeG, RobbeetsC, et al. Interobserver agreement of Medical Research Council sum-score and handgrip strength in the intensive care unit. Muscle Nerve, 2012; 45(1):18–25.
19.
ParrySM, BerneyS, GrangerCL, DunlopDL, MurphyL, El-AnsaryD, et al. A new two-tier strength assessment approach to the diagnosis of weakness in intensive care: an observational study. Crit Care, 2015; 19(1):52.
20.
BolesJM, BionJ, ConnorsA, HerridgeM, MarshB, MelotC, et al. Weaning from mechanical ventilation. Eur Respir J, 2007; 29(5):1033–1056.
21.
SellaresJ, FerrerM, CanoE, LoureiroH, ValenciaM, TorresA. Predictors of prolonged weaning and survival during ventilator weaning in a respiratory ICU. Intensive Care Med, 2011; 37(5):775–784.
22.
EpsteinSK. Weaning from ventilatory support. Curr Opin Crit Care, 2009; 15(1):36–43.
23.
ElyEW, BakerAM, DunaganDP, BurkeHL, SmithAC, KellyPT, et al. Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med, 1996; 335(25):1864–1869.
24.
Frutos-VivarF, FergusonND, EstebanA, EpsteinSK, ArabiY, ApezteguíaC, et al. Risk factors for extubation failure in patients following a successful spontaneous breathing trial. Chest, 2006; 130(6):1664–1671.
25.
MacIntyreNR, CookDJ, ElyEWJr, EpsteinSK, FinkJB, HeffnerJE, et al. Evidence-based guidelines for weaning and discontinuation of ventilatory support: a collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine. Chest, 2001; 120(6 Suppl):375S–395S.
26.
FontelaPC, LisboaTC, Forgiarini-JúniorLA, FriedmanG. Early mobilization practices of mechanically ventilated patients: a 1-day point-prevalence study in Southern Brazil. Clinics, 2018; 73:e241.
27.
LiZ, PengX, ZhuB, ZhangY, XiX. Active mobilization for mechanically ventilated patients: a systematic review. Arch Phys Med Rehabil, 2013; 94(3):551–561.
28.
GosselinkR, NeedhamD, HermansG. ICU-based rehabilitation and its appropriate metrics. Curr Opin Crit Care, 2012; 18(5):533–539.
29.
HermansG, CasaerMP, ClerckxB, GüizaF, VanhullebuschT, DerdeS, et al. Effect of tolerating macronutrient deficit on the development of intensive-care unit acquired weakness: a subanalysis of the EPaNIC trial. Lancet Respir Med, 2013; 1(8):621–629.
30.
HermansG, Van den BergheG. Clinical review: intensive care unit acquired weakness. Crit Care, 2015; 19:274.
31.
BaldwinCE, BerstenAD. Alterations in respiratory and limb muscle strength and size in patients with sepsis who are mechanically ventilated. Phys Ther, 2014; 94(1):68–82.
32.
OuelletteDR, PatelS, GirardTD, MorrisPE, SchmidtGA, TruwitJD, et al. Liberation from mechanical ventilation in critically ill adults: an official American College of Chest Physicians/American Thoracic Society Clinical Practice Guideline: inspiratory pressure augmentation during spontaneous breathing trials, protocols minimizing sedation, and noninvasive ventilation immediately after extubation. Chest, 2017; 151(1):166–180.
33.
CabriniL, LandoniG, OrianiA, PlumariVP, NobileL, GrecoM, et al. Noninvasive ventilation and survival in acute care settings: a comprehensive systematic review and metaanalysis of randomized controlled trials. Crit Care Med, 2015; 43(4):880–888.
34.
EstebanA, Frutos-VivarF, FergusonND, ArabiY, ApezteguíaC, GonzálezM, et al. Noninvasive positive-pressure ventilation for respiratory failure after extubation. N Engl J Med, 2004; 350(24):2452–2460.
35.
TzanisG, VasileiadisI, ZervakisD, KaratzanosE, DimopoulosS, PitsolisT, et al. Maximum inspiratory pressure, a surrogate parameter for the assessment of ICU-acquired weakness. BMC Anesthesiol, 2011; 11:14.
36.
DresM, JungB, MolinariN, MannaF, DubéBP, ChanquesG, et al. Respective contribution of intensive care unit-acquired limb muscle and severe diaphragm weakness on weaning outcome and mortality: a post hoc analysis of two cohorts. Crit Care, 2019; 23(1):370.
