BACKGROUND Intensive care unit (ICU)-acquired weakness and diaphragm dysfunction are frequent conditions, both associated with poor prognosis in critically ill patients. While it is well established that ICU-acquired weakness severely impairs long-term prognosis, the association of diaphragm dysfunction with this outcome has never been reported. This study investigated whether diaphragm dysfunction is associated with negative long-term outcomes and whether the coexistence of diaphragm dysfunction and ICU-acquired weakness has a particular association with 2-year survival and health-related quality of life (HRQOL). METHODS This study is an ancillary study derived from an observational cohort study. Patients under mechanical ventilation were enrolled at the time of their first spontaneous breathing trial. Diaphragm dysfunction was defined by tracheal pressure generated by phrenic nerve stimulation < 11 cmH2O and ICU-acquired weakness was defined by Medical Research Council (MRC) score < 48. HRQOL was evaluated with the SF-36 questionnaire. RESULTS Sixty-nine of the 76 patients enrolled in the original study were included in the survival analysis and 40 were interviewed. Overall 2-year survival was 67% (46/69): 64% (29/45) in patients with diaphragm dysfunction, 71% (17/24) in patients without diaphragm dysfunction, 46% (11/24) in patients with ICU-acquired weakness and 76% (34/45) in patients without ICU-acquired weakness. Patients with concomitant diaphragm dysfunction and ICU-acquired weakness had a poorer outcome with a 2-year survival rate of 36% (5/14) compared to patients without diaphragm function and ICU-acquired weakness [79% (11/14) (p < 0.01)]. Health-related quality of life was not influenced by the presence of ICU-acquired weakness, diaphragm dysfunction or their coexistence. CONCLUSIONS ICU-acquired weakness but not diaphragm dysfunction was associated with a poor 2-year survival of critically ill patients.

中文翻译：

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重症患者的ICU获得性无力，diaphragm肌功能障碍和长期结局。

背景技术重症监护病房（ICU）引起的无力和diaphragm肌功能障碍是常见病，均与重症患者的预后不良有关。公认的是，ICU后天性肌无力严重损害了长期预后，但of肌功能障碍与这种预后的相关性尚未见报道。这项研究调查了diaphragm肌功能障碍是否与负的长期预后相关，以及diaphragm肌功能障碍和ICU获得性衰弱的并存是否与2年生存率和与健康相关的生活质量（HRQOL）尤其相关。方法该研究是一项辅助研究，来自一项观察性队列研究。机械通气的患者在首次自发呼吸试验时入组。肌功能障碍由by神经刺激产生的气管压力<11 cmH2O定义，ICU获得性肌无力由医学研究理事会（MRC）得分<48定义。HRQOL用SF-36问卷进行评估。结果纳入原始研究的76例患者中有69例被纳入生存分析，并采访了40例。总的2年生存率是67％（46/69）：46肌功能障碍的患者为64％（29/45），无diaphragm肌功能障碍的患者为71％（17/24），有diaphragm肌功能障碍的患者为46％（11/24） ICU获得性弱点，无ICU获得性弱点的患者为76％（34/45）。与没有diaphragm肌功能和ICU并发肌无力的患者相比，伴有diaphragm肌功能障碍和ICU并发肌无力的患者的不良预后差，2年生存率为36％（5/14）[79％（11/14）（p <0.01）]。与健康相关的生活质量不受ICU后天性肌无力，diaphragm肌功能障碍或其共存的影响。结论ICU获得性肌无力而非associated肌功能障碍与危重患者2年生存期差有关。