ICU outcomes can be predicted by non invasive muscle evaluation : a meta-analysis

Medrinal, Clément (Normandie Univ, UNIROUEN, EA3830-GRHV, Rouen, France ; Institute for Research and Innovation in Biomedicine (IRIB), Rouen, France ; Groupe Hospitalier du Havre, Intensive Care Unit department, Montivilliers, France) ; Combret, Yann (Groupe Hospitalier du Havre, Intensive Care Unit department, Montivilliers, France ; Research and Clinical Experimentation Institute (IREC), Pulmonology, ORL and Dermatology, Louvain Catholic University, Brussels, Belgium) ; Hilfiker, Roger (School of Health Sciences, HES-SO Valais-Wallis, Leukerbad, Switzerland) ; Prieur, Guillaume (Normandie Univ, UNIROUEN, EA3830-GRHV, Rouen, France ; Institute for Research and Innovation in Biomedicine (IRIB), Rouen, France ; Institute for Research and Innovation in Biomedicine (IRIB), Rouen, France ; Groupe Hospitalier du Havre, Intensive Care Unit department, Montivilliers, France ; Research and Clinical Experimentation Institute (IREC), Pulmonology, ORL and Dermatology, Louvain Catholic University, Brussels, Belgium) ; Aroichane, Nadine (School of Physiotherapy, Rouen University Hospital, Rouen, France) ; Gravier, Francis-Edouard (Normandie Univ, UNIROUEN, EA3830-GRHV, Rouen, France ; Institute for Research and Innovation in Biomedicine (IRIB), Rouen, France ; ADIR Association, Bois-Guillaume, France) ; Bonnevie, Tristan (Normandie Univ, UNIROUEN, EA3830-GRHV, Rouen, France ; Institute for Research and Innovation in Biomedicine (IRIB), Rouen, France ; ADIR Association, Bois-Guillaume, France) ; Contal, Olivier (HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland) ; Lamia, Bouchra (Normandie Univ, UNIROUEN, EA3830-GRHV, Rouen, France ; Institute for Research and Innovation in Biomedicine (IRIB), Rouen, France ; Groupe Hospitalier du Havre, Pulmonology department, Montivilliers, France ; Pulmonology, Respiratory Department, Rouen University Hospital, Rouen, France)

Background The relationship between muscle function in critically ill patients assessed using bedside techniques and clinical outcomes has not been systematically described. We aimed to evaluate the association between muscle weakness assessed by bedside evaluation and mortality or weaning from mechanical ventilation, and the capacity of each evaluation tool to predict outcomes. Methods Five databases (PubMed, EMBASE, CINAHL, Cochrane library, Science Direct) were searched from January 2000 to December 2018. Data were extracted and random effects meta-analyses were performed. Results Sixty studies were analysed, including 4382 patients. ICU-related muscle weakness was associated with an increase in overall mortality with odds ratios ranging from 1.2 [95% CI 0.60 to 2.40] to 4.48 [95% CI 1.49 to 13.42]. Transdiaphragmatic twitch pressure had the highest predictive capacity for overall mortality, with a sensitivity of 0.87 [95%CI 0.76 to 0.93] and a specificity of 0.36 [95%CI 0.27–0.43]. The area under the curve (AUC) was 0.74 [95%CI 0.70 to 0.78]. Muscle weakness was associated with an increase in mechanical ventilation weaning failure rate with an odds ratio ranging from 2.64 [95% CI 0.72 to 9.64] to 19.07 [95% CI 9.35 to 38.9]. Diaphragm thickening fraction had the highest predictive capacity for weaning failure with a sensitivity of 0.76 [95%CI 0.67 to 0.83] and a specificity of 0.86 [95%CI 0.78 to 0.92]. The AUC was 0.86 [95%CI 0.83 to 0.89]. Conclusion ICU-related muscle weakness detected by bedside techniques is a serious issue associated with a high risk of death or prolonged mechanical ventilation. Evaluating diaphragm function should be a clinical priority in the ICU.


Article Type:
scientifique
Faculty:
Santé
School:
HEdS-VS
HESAV
Institute:
Institut Santé
Unité de recherche en santé, HESAV
Date:
2020-10
Pagination:
61 p.
Published in:
European respiratory journal
Numeration (vol. no.):
October 2020, vol. 56, no. 4, Article 1902482
DOI:
ISSN:
0903-1936
Appears in Collection:

Note: The file is under embargo until: 2021-10-02


 Record created 2020-05-27, last modified 2020-10-27

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