Respiratory and limb muscles' ability to repeatedly generate maximal isometric strength in patients with intensive care unit-acquired weakness: an observational study.

IF 2.3 3区 医学 Q2 ANESTHESIOLOGY
Margaux Machefert, Guillaume Prieur, Solène Aubry, Yann Combret, Clément Medrinal
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引用次数: 0

Abstract

Background: Intensive care unit-acquired weakness (ICU-Aw) is a prevalent complication in critically ill patients, affecting both limb and respiratory muscles, individually or concurrently. The precise mechanisms by which muscle weakness influences the distinct functional roles of each muscle group remain to be fully elucidated. The objective of this study was to compare the time course evolution of inspiratory and quadriceps muscles strength during repeated maximal isometric contractions in patients with limb muscles and inspiratory muscles weakness.

Methods: A single-center, observational study was conducted in critically ill patients after extubation, presenting with both inspiratory and limb muscle weakness (defined as maximal inspiratory pressure (Pimax) < 30 cmH2O and an MRC score < 48). The patients' ability to sustain maximal voluntary effort was measured using electronic manometers and dynamometers, with repeated efforts performed 10 times. Following each measurement, a 10-second rest period was observed, and strength measurements were repeated to evaluate recovery.

Results: A total of 20 patients (90% male, mean age 61 ± 10 years, SAPS II score 28 ± 17) were included. The mean first maximal inspiratory pressure was 32.6 ± 17 cmH2O, and the mean first quadriceps maximal force was 135 ± 90 Newtons (N). Investigation revealed a decline in quadriceps muscle force of -15.45 ± 28.61 N (95% CI: -28.84 to -2.05) while inspiratory muscles demonstrated stability (mean difference: 1.75 ± 7.57 cmH2O (95% CI: -1.80 to 5.30)). A statistically significant interaction between time and muscle group was identified (p = 0.0017), suggesting a different time course evolution of maximal voluntary strength between muscle groups. After a one-minute recovery, significant improvement in quadriceps strength was observed (p = 0.009), while no statistically significant change was detected in inspiratory muscle strength (p = 0.16).

Conclusions: The results of this study indicate potential disparities in the maximum force maintenance capacity between the quadriceps muscles and inspiratory muscles in patients with ICU-acquired weakness.

Trial registration: Registered on ClinicalTrials.gov Identifier NCT05396066.

重症监护室乏力患者呼吸肌和四肢肌肉反复产生最大等长力量的能力:一项观察性研究。
背景:重症监护病房获得性虚弱(ICU-Aw)是危重患者常见的并发症,可单独或同时影响肢体和呼吸肌。肌无力影响每个肌群的不同功能作用的确切机制仍有待充分阐明。本研究的目的是比较四肢肌肉和吸气肌无力患者在重复最大等长收缩时吸气肌和股四头肌力量的时间过程演变。方法:对拔管后出现吸气和肢体肌肉无力(定义为最大吸气压(Pimax) 2O和MRC评分)的危重患者进行单中心观察性研究。结果:共纳入20例患者(90%为男性,平均年龄61±10岁,SAPS II评分28±17)。平均第一次最大吸气压力为32.6±17 cmH2O,平均第一次股四头肌最大力量为135±90牛顿(N)。调查显示股四头肌力量下降为-15.45±28.61 N (95% CI: -28.84至-2.05),而吸气肌肉表现稳定(平均差异:1.75±7.57 cmH2O (95% CI: -1.80至5.30))。时间和肌肉群之间存在显著的交互作用(p = 0.0017),表明不同肌肉群之间最大自主力量的时间过程演化不同。恢复1分钟后,观察到股四头肌力量有显著改善(p = 0.009),而吸气肌力量无统计学意义的变化(p = 0.16)。结论:本研究结果提示icu获得性无力患者股四头肌和吸气肌的最大力量维持能力存在潜在差异。试验注册:在ClinicalTrials.gov注册,注册号NCT05396066。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BMC Anesthesiology
BMC Anesthesiology ANESTHESIOLOGY-
CiteScore
3.50
自引率
4.50%
发文量
349
审稿时长
>12 weeks
期刊介绍: BMC Anesthesiology is an open access, peer-reviewed journal that considers articles on all aspects of anesthesiology, critical care, perioperative care and pain management, including clinical and experimental research into anesthetic mechanisms, administration and efficacy, technology and monitoring, and associated economic issues.
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