Background Whereas ICU-acquired weakness may delay extubation in mechanically ventilated patients, its influence on extubation failure is poorly known. This study aimed at assessing the role of ICU-acquired weakness on extubation failure and the relation between limb weakness and cough strength. Methods A secondary analysis of two previous prospective studies including patients at high risk of reintubation after a planned extubation, i.e., age greater than 65 years, with underlying cardiac or respiratory disease, or intubated for more than 7 days prior to extubation. Patients intubated less than 24 h and those with a do-not-reintubate order were not included. Limb and cough strength were assessed by a physiotherapist just before extubation. ICU-acquired weakness was clinically diagnosed as limb weakness defined as Medical Research Council (MRC) score < 48 points and severe weakness as MRC sum-score < 36. Cough strength was assessed using a semi-quantitative 5-Likert scale. Extubation failure was defined as reintubation or death within the first 7 days following extubation. Results Among 344 patients at high risk of reintubation, 16% experienced extubation failure (56/344). They had greater severity and lower MRC sum-score (41 ± 16 vs. 49 ± 13, p < 0.001) and were more likely to have ineffective cough than the others. The prevalence of ICU-acquired weakness at the time of extubation was 38% (130/244). The extubation failure rate was 12% (25/214) in patients with no limb weakness vs. 18% (12/65) and 29% (19/65) in those with moderate and severe limb weakness, respectively ( p < 0.01). MRC sum-score and cough strength were weakly but significantly correlated (rho = 0.28, p < .001). After multivariate logistic regression analyses, the lower the MRC sum-score the greater the risk of reintubation; severe limb weakness was independently associated with extubation failure, even after adjustment on cough strength and severity at admission. Conclusion ICU-acquired weakness was diagnosed in 38% in this population of patients at high risk at the time of extubation and was independently associated with extubation failure in the ICU.

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ICU获得性虚弱对再插管高危患者拔管结果的影响

背景 虽然 ICU 获得性虚弱可能会延迟机械通气患者的拔管，但其对拔管失败的影响却知之甚少。本研究旨在评估 ICU 获得性虚弱对拔管失败的作用以及肢体虚弱与咳嗽强度之间的关系。方法 对先前两项前瞻性研究的二次分析，包括计划拔管后重新插管的高风险患者，即年龄大于 65 岁、有潜在心脏或呼吸系统疾病或拔管前插管时间超过 7 天的患者。插管时间少于 24 小时的患者和有不重新插管命令的患者不包括在内。在拔管前由物理治疗师评估肢体和咳嗽强度。ICU 获得性虚弱在临床上被诊断为肢体无力，定义为医学研究委员会 (MRC) 评分 < 48 分，严重虚弱定义为 MRC 总分 < 36。使用半定量 5-Likert 量表评估咳嗽强度。拔管失败定义为拔管后前 7 天内重新插管或死亡。结果 在 344 名再插管高风险患者中，16% 的患者经历了拔管失败 (56/344)。他们的严重程度更高，MRC 总分更低（41 ± 16 对 49 ± 13，p < 0.001），并且比其他人更可能出现无效咳嗽。拔管时 ICU 获得性虚弱的患病率为 38% (130/244)。无肢体无力患者拔管失败率为12%（25/214），中重度肢体无力患者拔管失败率为18%（12/65）和29%（19/65），分别 (p < 0.01)。MRC 总分和咳嗽强度微弱但显着相关（rho = 0.28，p < .001）。经过多变量逻辑回归分析，MRC 总分越低，再插管的风险越大；严重的肢体无力与拔管失败独立相关，即使在调整入院时咳嗽强度和严重程度后也是如此。结论 38% 的高危患者在拔管时被诊断为 ICU 获得性虚弱，并且与 ICU 拔管失败独立相关。严重的肢体无力与拔管失败独立相关，即使在调整入院时咳嗽强度和严重程度后也是如此。结论 38% 的高危患者在拔管时被诊断为 ICU 获得性虚弱，并且与 ICU 拔管失败独立相关。严重的肢体无力与拔管失败独立相关，即使在调整入院时咳嗽强度和严重程度后也是如此。结论 38% 的高危患者在拔管时被诊断为 ICU 获得性虚弱，并且与 ICU 拔管失败独立相关。