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Respir Care. 2015 Aug;60(8):1097-104. doi: 10.4187/respcare.03604. Epub 2015 Mar 10.

Handgrip Strength Predicts Difficult Weaning But Not Extubation Failure in Mechanically Ventilated Subjects.

Author information

1
Physiotherapy and Rehabilitation Department, Hôpital Antoine-Béclère, Clamart, France.
2
Intensive Care Department, Hôpital Bicêtre, Université Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, France.
3
Intensive Care Department, Hôpital Antoine-Béclère, Université Paris-Sud, Assistance Publique-Hôpitaux de Paris, Clamart, France.
4
Intensive Care Department, Hôpital Antoine-Béclère, Université Paris-Sud, Assistance Publique-Hôpitaux de Paris, Clamart, France. EA 4533, Université Paris-Sud, Le Kremlin-Bicêtre, France.
5
Intensive Care Department, Hôpital Bicêtre, Université Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, France. EA 4533, Université Paris-Sud, Le Kremlin-Bicêtre, France.
6
Intensive Care Department, Hôpital Antoine-Béclère, Université Paris-Sud, Assistance Publique-Hôpitaux de Paris, Clamart, France. EA 4533, Université Paris-Sud, Le Kremlin-Bicêtre, France. benjamin.sztrymf@abc.aphp.fr.

Abstract

BACKGROUND:

Muscle weakness, defined by the Medical Research Council scale, has been associated with delay in mechanical ventilation weaning. In this study, we evaluated handgrip strength as a prediction tool in weaning outcome.

METHODS:

This was a 1-y prospective study in 2 ICUs in 2 university hospitals. Adult patients who were on mechanical ventilation for at least 48 h and eligible for mechanical ventilation weaning were screened for inclusion. Handgrip strength was evaluated using a handheld dynamometer before each spontaneous breathing trial (SBT). Attending physicians were unaware of handgrip strength and decided on extubation according to guidelines.

RESULTS:

Eighty-four subjects were included (median age 66 [53-79] y, with a median Simplified Acute Physiology Score II of 49 [37-63]). At the first evaluation, median handgrip strength was significantly associated with weaning outcome as defined by international guidelines: simple (20 [12-26] kg), difficult (12 [6-21] kg), or prolonged (6 [3-11] kg) weaning (P = .008). Time to liberation from mechanical ventilation and ICU stay were significantly longer for subjects classified as having muscle weakness according to the handgrip strength-derived definition (P = .02 and P = .03, respectively). In multivariate analysis, known history of COPD (odds ratio [OR] 5.48, 95% CI 1.44-20.86, P = .01), sex (OR 6.16, 95% CI 1.64-23.16, P = .007), and handgrip strength at the first SBT (OR 0.89, 95% CI 0.85-0.97, P = .004) were significantly associated with difficult or prolonged weaning. Extubation failure, as defined by re-intubation or unscheduled noninvasive ventilation within 48 h after extubation, occurred 14 times after 92 attempts, leading to an extubation failure rate of 15%. No association was found between handgrip strength and extubation outcome.

CONCLUSIONS:

Muscle weakness, assessed by handgrip strength, is associated with difficult or prolonged mechanical ventilation weaning and ICU stay, but not with extubation outcome.

KEYWORDS:

handgrip strength; handheld dynamometry; intensive care unit-acquired weakness; mechanical ventilation; muscle weakness; weaning

PMID:
25759461
DOI:
10.4187/respcare.03604
[Indexed for MEDLINE]
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