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Intensive Care Med. 2004 Jun;30(6):1117-21. Epub 2004 Feb 6.

Does ICU-acquired paresis lengthen weaning from mechanical ventilation?

Author information

  • 1Réanimation Médicale, Centre Hospitalier de Poissy-Saint-Germain en Laye, 10 rue du Champ-Gaillard, 78300 Poissy, France. bdejonghe@chi-poissy-st-germain.fr

Abstract

OBJECTIVE:

To determine whether ICU-acquired paresis (ICUAP) is an independent risk factor of prolonged weaning.

DESIGN:

Second study of a prospective cohort of 95 patients who were enrolled in an incidence and risk factor study of ICUAP.

SETTING:

Three medical and two surgical ICUs in four hospitals.

PATIENTS AND PARTICIPANTS:

Ninety-five patients without pre-existing neuromuscular disease recovering from the acute phase of critical illness after > or =7 days of mechanical ventilation.

INTERVENTIONS:

None.

MEASUREMENTS AND RESULTS:

Duration of weaning from mechanical ventilation was defined as the duration of mechanical ventilation between awakening (day 1) and successful weaning. Muscle strength was evaluated at day 7 after awakening using the Medical Research Council (MRC) score. Patients with an MRC <48 were considered to have ICUAP. Among the 95 patients (mean age 62.0+/-15.3 years, SAPS 2 on admission 48.7+/-17.4) who regained satisfactory awakening after 7 or more days of mechanical ventilation, 67 (70.5%) were hospitalized in a medical ICU and 28 (29.5%) in a surgical ICU. Median duration (25th-75th percentiles) of weaning was longer in patients with ICUAP than in those without ICUAP: 6 days (1-22 days) vs 3 days (1-7 days); p=0.01; log-rank analysis. In multivariate analysis, the two independent predictors of prolonged weaning were ICUAP [hazard ratio (HR): 2.4; 95% confidence interval (CI): 1.4-4.2] and chronic obstructive pulmonary disease (HR: 2.7; 95% CI: 1.6-4.5)

CONCLUSIONS:

ICU-acquired paresis is an independent predictor of prolonged weaning. Prevention of ICU-acquired neuromuscular abnormalities in patients recovering from severe acute illness should result in shorter weaning duration.

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