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Master Thesis

Diaphragm Dysfunction and weaning in patients with Intensive Care Unit Acquired Weakness

Abstract : Introduction: Intensive Care Unit acquired Weakness (ICUAW) following sepsis is frequent and contribute to impaired outcome. Medical Research Council score (MRC) provides information on peripheral muscle weakness but does not explore diaphragm strength. Objective: To assess whether ICUAW patients (MRC<48/60) following sepsis also present a diaphragmatic dysfunction (DD) using a multimodal evaluation and describing whether these patients will be difficult to wean from the ventilator Methods: All patient consecutively diagnosed for ICUAW on the day of their spontaneous breathing trial (SBT) were included in this prospective monocentrique observational study. Diaphragm strength was assessed by phrenic nerve stimulation (Ptr,stim), Maximal Inspiratory Pressure (MIP) and ultrasonographically. A Ptr,stim < 11cmH2O defined DD. Demographical data and patient extubation outcome were collected. During the SBT, were collected: diaphragm excursion, thickness during expiration and inspiration (Tee and Tei), MIP and Thickening Fraction (TF=(Tei-Tee)/Tee X 100). Results: Forty patients were include in 6 months (length of stay 25d [15-35]) with Ptr,stim at 6.5cmH20 [3-10] and MRC 31 [20-36]. 32 patients (80%) had a Ptr,stim < 11cmH20 (R=-0.01;p=0.9). MIP was correlated with MRC score (r=0.34; p=0.02) and Ptr,stim (r=0.43;p=0.005). Diaphragm excursion was 0.85cm [0.8-1.3]; Tee was 2.2mm [2-3] and FE was 15.9% [12-24]. Twenty patients were successfully extubated (50%).Conclusion: 80% of the ICUAW patient had a DD but 50% were successfully extubated. No statistical links were found between ICUAW and DD. Extubation in ICUAW patient shouldn't be withhold without strength assessment.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01072379
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Submitted on : Wednesday, October 8, 2014 - 2:34:22 PM
Last modification on : Wednesday, July 15, 2020 - 8:58:04 AM
Long-term archiving on: : Friday, January 9, 2015 - 10:35:12 AM

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  • HAL Id : dumas-01072379, version 1

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Pierre-Henri Moury. Diaphragm Dysfunction and weaning in patients with Intensive Care Unit Acquired Weakness. Human health and pathology. 2014. ⟨dumas-01072379⟩

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