Respective contRibution of intensive caRe unit-acquiRed limb muscle and seveRe diaphRagm weakness on weaning outcome and moRtality Intensive care unit (ICU) acquired weakness (AW) and diaphragm dysfunction (DD) contribute to morbidity and mortality in critically ill patients. Dres et al (Critical Care 2019;23:370) set out to identify risk factors and evaluate the relative impact on weaning and mortality of ICUAW and ICUDD. Posthoc analysis was performed on 2 merged cohorts, with 116 patients included. DD was assessed by twitch tracheal pressure in response to bilateral phrenic nerve stimulation (cutoff<7 cmH20). AW was assessed using the Medical Research Council score (cutoff<48). Multivariate logistic regression identified age, sulfentanil exposure and ventilation duration as independent factors associated with DD. Exposure to norepinephrine and ventilation duration were associated with AW. Interestingly, DD but not AW was associated with weaning failure, whereas AW but not DD was associated with increased mortality. Combined DD and AW was associated with higher weaning failure and mortality rates. The study is the largest to concurrently evaluate both ICUAW and ICUDD providing an insight into the potential different risk factors and impacts of these common clinical phenomena. While providing data to identify those at risk, potential interventions to prevent or improve outcomes in these conditions need to be identified and examined.

中文翻译：

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杂志社

重症监护病房获得性肢体肌肉和严重膈肌无力对脱机结果和死亡率的各自贡献 重症监护病房 (ICU) 获得性无力 (AW) 和膈肌功能障碍 (DD) 导致危重患者的发病率和死亡率。Dres 等人 (Critical Care 2019;23:370) 着手确定危险因素并评估对 ICUAW 和 ICUDD 撤机和死亡率的相对影响。对 2 个合并队列进行了事后分析，其中包括 116 名患者。通过响应双侧膈神经刺激的抽搐气管压力评估DD（截止值<7 cmH2O）。使用医学研究委员会评分（截止值<48）评估 AW。多变量逻辑回归将年龄、磺胺太尼暴露和通气持续时间确定为与 DD 相关的独立因素。暴露于去甲肾上腺素和通气时间与 AW 相关。有趣的是，DD 而非 AW 与断奶失败相关，而 AW 而非 DD 与死亡率增加相关。联合 DD 和 AW 与较高的断奶失败率和死亡率相关。该研究是同时评估 ICUAW 和 ICUDD 的最大研究，提供了对这些常见临床现象的潜在不同风险因素和影响的洞察。在提供数据以识别高危人群的同时，还需要识别和检查在这些情况下预防或改善结果的潜在干预措施。联合 DD 和 AW 与较高的断奶失败率和死亡率相关。该研究是同时评估 ICUAW 和 ICUDD 的最大研究，提供了对这些常见临床现象的潜在不同风险因素和影响的洞察。在提供数据以识别高危人群的同时，还需要识别和检查在这些情况下预防或改善结果的潜在干预措施。联合 DD 和 AW 与较高的断奶失败率和死亡率相关。该研究是同时评估 ICUAW 和 ICUDD 的最大研究，提供了对这些常见临床现象的潜在不同风险因素和影响的洞察。在提供数据以识别高危人群的同时，还需要识别和检查在这些情况下预防或改善结果的潜在干预措施。