Occurrence and Effects on Weaning From Mechanical Ventilation of Intensive Care Unit Acquired and Diaphragm Weakness: A Pilot Study

Michele Bertoni; Simone Piva; Alessandra Beretta; Federica Bongiovanni; Riccardo Contarino; Ricard Mellado Artigas; Lucia Ceresoli; Mattia Marchesi; Michele Falappi; Marta Belleri; Alberto Goffi; Matteo Pozzi; Frank Antonio Rasulo; Nicola Latronico

doi:10.3389/fmed.2022.930262

Occurrence and Effects on Weaning From Mechanical Ventilation of Intensive Care Unit Acquired and Diaphragm Weakness: A Pilot Study

Front Med (Lausanne). 2022 Jul 22:9:930262. doi: 10.3389/fmed.2022.930262. eCollection 2022.

Authors

Michele Bertoni¹, Simone Piva^{1

2}, Alessandra Beretta¹, Federica Bongiovanni², Riccardo Contarino¹, Ricard Mellado Artigas^{3

4}, Lucia Ceresoli², Mattia Marchesi², Michele Falappi², Marta Belleri², Alberto Goffi⁵, Matteo Pozzi⁶, Frank Antonio Rasulo^{1

2}, Nicola Latronico^{1

2}

Affiliations

¹ Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy.
² Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
³ Department of Anesthesiology, Surgical ICU, Hospital Clinic de Barcelona, Barcelona, Spain.
⁴ CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.
⁵ Department of Medicine and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
⁶ Department of Emergency and Intensive Care, ASST Monza, Monza, Italy.

Abstract

Purpose: Limb intensive care unit (ICU)-acquired weakness (ICUAW) and ICU acquired diaphragm weakness (DW) occur frequently in mechanically ventilated (MV) patients; their coexistence in cooperative and uncooperative patients is unknown. This study was designed to (1) describe the co-occurrence of the two conditions (2) evaluate the impact of ICUAW and DW on the ventilator-free days (VFDs) at 28 days and weaning success, and (3) assess the correlation between maximal inspiratory pressure (MIP) and thickening fraction (TFdi) in patients with DW.

Methods: This prospective pilot study was conducted in a single-center on 73 critically ill MV patients. Muscle weakness was defined as a Medical Research Council score < 48 in cooperative patients or a bilateral mean simplified peroneal nerve test < 5.26 mV in uncooperative patients. Diaphragm dysfunction was defined as MIP < 30 cm H₂O or as a TFdi < 29%. Weaning success was defined according to weaning according to a new definition (WIND).

Results: Fifty-seven patients (78%) had ICUAW and 59 (81%) had DW. The coexistence of the two conditions occurred in 48 patients (65%), without association (χ² = 1.06, p = 0.304). In the adjusted analysis, ICUAW was independently related to VFDs at 28-days (estimate difference 6 days, p = 0.016), and WIND (OR of 3.62 for having WIND different than short weaning), whereas DW was not. The linear mixed model showed a significant but weak correlation between MIP and TFdi (p < 0.001).

Conclusion: This pilot study is the first to explore the coexistence of ICUAW and DW in both cooperative and uncooperative patients; a lack of association was found between DW and ICUAW when considering both cooperative and uncooperative patients. We found a strong correlation between ICUAW but not DW with the VFDs at 28 days and weaning success. A future larger study is warranted in order to confirm our results, and should also investigate the use of transdiaphragmatic twitch pressure measurement during bilateral anterior magnetic phrenic nerve stimulation for the diagnosis of DW.

Keywords: coexistence; diaphragmatic weakness; intensive care unit-acquired weakness; maximum inspiratory pressure; simplified peroneal nerve test; thickening fraction of the diaphragm; weaning from mechanical ventilation.