scholarly journals Five-year outcome of respiratory muscle weakness at intensive care unit discharge: secondary analysis of a prospective cohort study

Thorax ◽  
2021 ◽  
pp. thoraxjnl-2020-216720
Author(s):  
Nathalie Van Aerde ◽  
Philippe Meersseman ◽  
Yves Debaveye ◽  
Alexander Wilmer ◽  
Jan Gunst ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Muscle Strength ◽  
Physical Function ◽  
Respiratory Muscle ◽  
Secondary Analysis ◽  
Respiratory Muscle Weakness ◽  
Absolute Value ◽  
Peripheral Muscle ◽  
Sf 36 ◽  
Icu Discharge

PurposeTo assess the association between respiratory muscle weakness (RMW) at intensive care unit (ICU) discharge and 5-year mortality and morbidity, independent from confounders including peripheral muscle strength.MethodsSecondary analysis of the prospective 5-year follow-up of the EPaNIC cohort (ClinicalTrials.gov: NCT00512122), limited to 366 patients screened for respiratory and peripheral muscle strength in the ICU with maximal inspiratory pressure (MIP) after removal of the artificial airway, and the Medical Research Council sum score. RMW was defined as an absolute value of MIP <30 cmH2O. Associations between RMW at (or closest to) ICU discharge and all-cause 5-year mortality, and key measures of 5-year physical function, comprising respiratory muscle strength (MIP), hand-grip strength (HGF), 6 min walk distance (6MWD) and physical function of the SF-36 quality-of-life questionnaire (PF-SF-36), were assessed with Cox proportional hazards and linear regression models, adjusted for confounders including peripheral muscle strength.ResultsRMW was present in 136/366 (37.2%) patients at ICU discharge. RMW was not independently associated with 5-year mortality (HR with 95% CI 1.273 (0.751 to 1.943), p=0.352). Among 156five-year survivors, those with, as compared with those without RMW demonstrated worse physical function (MIP (absolute value, cmH2O): 62(42–77) vs 94(78–109), p<0.001; HGF (%pred): 67(44–87) vs 96(68–110), p<0.001; 6MWD (%pred): 87(74–102) vs 99 (80–111), p=0.009; PF-SF-36 (score): 55 (30–80) vs 80 (55–95), p<0.001). Associations between RMW and morbidity endpoints remained significant after adjustment for confounders (effect size with 95% CI: MIP: −23.858 (−32.097 to −15.027), p=0.001; HGF: −18.591 (−30.941 to −5.744), p=0.001; 6MWD (transformed): −1587.007 (−3073.763 to −179.253), p=0.034; PF-SF-36 (transformed): 1.176 (0.144–2.270), p=0.036).ConclusionsRMW at ICU discharge is independently associated with 5-year morbidity but not 5-year mortality.

Alterations in Respiratory and Limb Muscle Strength and Size in Patients With Sepsis Who Are Mechanically Ventilated

2014 ◽  
Vol 94 (1) ◽  
pp. 68-82 ◽  
Author(s):  
Claire E. Baldwin ◽  
Andrew D. Bersten
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Muscle Strength ◽  
Respiratory Muscle ◽  
Thigh Muscle ◽  
Control Group ◽  
Respiratory Muscle Weakness ◽  
Peripheral Muscle ◽  
Muscle Groups

Background Skeletal muscle wasting and weakness are common in patients with sepsis in the intensive care unit, although less is known about deficits in diaphragm and limb muscles when mechanical ventilation also is required. Objective The objective of this study was to concurrently investigate relative differences in both thickness and strength of respiratory and peripheral muscles during routine care. Design A prospective, cross-sectional study of 16 alert patients with sepsis and 16 people who were healthy (control group) was used. Methods Assessment was made of the diaphragm, upper arm, forearm, and thigh muscle thicknesses with the use of ultrasound; respiratory muscle strength by means of maximal inspiratory pressure; and isometric handgrip, elbow flexion, and knee extension forces with the use of portable dynamometry. To describe relative changes, data also were normalized to fat-free body mass (FFM) measured by bioelectrical impedance spectroscopy. Results Patients (9 men, 7 women; mean age=62 years, SD=17) were assessed after a median of 16 days (interquartile range=11–29) of intensive care unit admission. Patients' diaphragm thickness did not differ from that of the control group, even for a given FFM. When normalized to FFM, only the difference in patients' mid-thigh muscle size significantly deviated from that of the control group. Within the patient sample, all peripheral muscle groups were thinner compared with the diaphragm. Patients were significantly weaker than were the control group participants in all muscle groups, including for a given FFM. Within the critically ill group, limb weakness was greater than the already-significant respiratory muscle weakness. Limitations Volitional strength tests were applied such that successive measurements from earlier in the course of illness could not be reliably obtained. Conclusions When measured at bedside, survivors of sepsis and a period of mechanical ventilation may have respiratory muscle weakness without remarkable diaphragm wasting. Furthermore, deficits in peripheral muscle strength and size may exceed those in the diaphragm.

scholarly journals Muscle weakness, functional capacities and recovery for COVID-19 ICU survivors

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Clément Medrinal ◽  
Guillaume Prieur ◽  
Tristan Bonnevie ◽  
Francis-Edouard Gravier ◽  
Denys Mayard ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Muscle Weakness ◽  
Respiratory Muscle ◽  
Tertiary Hospital ◽  
Limb Muscle ◽  
Respiratory Muscle Weakness ◽  
Limb Weakness ◽  
Cross Sectional ◽  
Icu Discharge ◽  
Walking Capacity

Abstract Background Few studies have evaluated muscle strength in COVID-19 ICU survivors. We aimed to report the incidence of limb and respiratory muscle weakness in COVID-19 ICU survivors. Method We performed a cross sectional study in two ICU tertiary Hospital Settings. COVID-19 ICU survivors were screened and respiratory and limb muscle strength were measured at the time of extubation. An ICU mobility scale was performed at ICU discharge and walking capacity was self-evaluated by patients 30 days after weaning from mechanical ventilation. Results Twenty-three patients were included. Sixteen (69%) had limb muscle weakness and 6 (26%) had overlap limb and respiratory muscle weakness. Amount of physiotherapy was not associated with muscle strength. 44% of patients with limb weakness were unable to walk 100 m 30 days after weaning. Conclusion The large majority of COVID-19 ICU survivors developed ICU acquired limb muscle weakness. 44% of patients with limb weakness still had severely limited function one-month post weaning.

scholarly journals Muscle function and quality of life in the Crohn’s disease

2017 ◽  
Vol 30 (2) ◽  
pp. 337-345 ◽  
Author(s):  
Andrea Lemos Cabalzar ◽  
Diana Junqueira Fonseca Oliveira ◽  
Maycon de Moura Reboredo ◽  
Fernando Azevedo Lucca ◽  
Júlio Maria Fonseca Chebli ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Muscle Strength ◽  
Muscle Function ◽  
Respiratory Muscle ◽  
Control Group ◽  
Respiratory Muscle Strength ◽  
Peripheral Muscle ◽  
Sf 36 ◽  
Inflammatory Bowel

Abstract Introduction: Crohn’s disease (CD) is an inflammatory bowel disease, marked by exacerbations and remissions periods. Peripheral manifestations in CD may be present with the syndrome of skeletal muscle dysfunction (SMD), which is characterized by loss of muscle strength, fatigue complain, limited exercise capacity and impaired quality of life of these patients. Objective: Evaluate muscle strength, physical capacity and quality of life of patients with CD and compare them with healthy controls. Methods: 18 patients CD and 12 healthy controls matched for age and sex were involved. Peripheral muscle strength evaluated by handgrip strength of the dominant hand and respiratory muscle strength by measures of respiratory muscle strength (maximal inspiratory/expiratory pressure - MIP and MEP). Exercise capacity evaluated by Shuttle test (ST) and the quality of life by the Short-form 36 (SF-36) and by the Inflammatory Bowel Disease Questionnaire (IBDQ). Results: Patients with CD presented a lower respiratory muscle strength (MIP = -68.93 ± 26.61 vs 29.63 ± -100 cmH2O, p = 0.0013 and MEP = 81.07 ± 30.26 vs 108 ± 25.30 cmH2O, p = 0.032) and a tendency the lower peripheral muscle strength (31.72 ± 8.55 vs 39.00 ± 13.37 kgf, p = 0.09). In addition, CD patients presented worse physical capacity on the ST compared to the control group (513.7 ± 237m vs 983.0 ± 263m, p < 0.05) and worse quality of life in 7 of 8 domains of the SF-36 and in all dimensions of the IBDQ. Conclusion: Patients with CD showed muscle functional impairment and poorer quality of life compared to healthy control group. These findings suggest that the assessment and maybe interventions in the muscle function must be used in clinical practice.

scholarly journals Respiratory Muscle Weakness as a Risk Factor for Pneumonia in Older People

Gerontology ◽  
2021 ◽  
pp. 1-10
Author(s):  
Tatsuma Okazaki ◽  
Yoshimi Suzukamo ◽  
Midori Miyatake ◽  
Riyo Komatsu ◽  
Masahiro Yaekashiwa ◽  
...  
Keyword(s):  
Risk Factor ◽  
Muscle Strength ◽  
Older People ◽  
Serum Albumin ◽  
Muscle Mass ◽  
Muscle Weakness ◽  
Fat Mass ◽  
Respiratory Muscle ◽  
Respiratory Muscle Strength ◽  
Respiratory Muscle Weakness

Introduction: The respiratory muscle strength regulates the effectiveness of coughing, which clears the airways and protects people from pneumonia. Sarcopenia is an aging-related loss of muscle mass and function, the worsening of which is associated with malnutrition. The loss of respiratory and swallowing muscle strength occurs with aging, but its effect on pneumonia is unclear. This study aimed to determine the risks of respiratory muscle weakness on the onset and relapse of pneumonia in older people in conjunction with other muscle-related factors such as malnutrition. Methods: We conducted a longitudinal study with 47 pneumonia inpatients and 35 non-pneumonia controls aged 70 years and older. We evaluated the strength of respiratory and swallowing muscles, muscle mass, and malnutrition (assessed by serum albumin levels and somatic fat) during admission and confirmed pneumonia relapse within 6 months. The maximal inspiratory and expiratory pressures determined the respiratory muscle strength. Swallowing muscle strength was evaluated by tongue pressure. Bioelectrical impedance analysis was used to evaluate the muscle and fat mass. Results: The respiratory muscle strength, body trunk muscle mass, serum albumin level, somatic fat mass, and tongue pressure were significantly lower in pneumonia patients than in controls. Risk factors for the onset of pneumonia were low inspiratory respiratory muscle strength (odds ratio [OR], 6.85; 95% confidence interval [CI], 1.56–30.11), low body trunk muscle mass divided by height2 (OR, 6.86; 95% CI, 1.49–31.65), and low serum albumin level (OR, 5.46; 95% CI, 1.51–19.79). For the relapse of pneumonia, low somatic fat mass divided by height2 was a risk factor (OR, 20.10; 95% CI, 2.10–192.42). Discussion/Conclusions: Respiratory muscle weakness, lower body trunk muscle mass, and malnutrition were risk factors for the onset of pneumonia in older people. For the relapse of pneumonia, malnutrition was a risk factor.

scholarly journals Relationship of respiratory muscle strength, pulmonary function, and functional capacity with quality of life in patients with atrial fibrillation

2017 ◽  
Vol 46 (1) ◽  
pp. 195-203 ◽  
Author(s):  
Rengin Demir ◽  
Melih Zeren ◽  
Hulya Nilgun Gurses ◽  
Zerrin Yigit
Keyword(s):  
Muscle Strength ◽  
Functional Capacity ◽  
Respiratory Muscle ◽  
Respiratory Muscle Strength ◽  
Fatigue Score ◽  
6Mwt Distance ◽  
Sf 36 ◽  
Maximum Expiratory Pressure ◽  
Dyspnea Score ◽  
Relationship Of

Objective To examine the relationship of pulmonary parameters and functional capacity with quality of life (QoL) in patients with atrial fibrillation (AF). Methods Thirty-six patients with chronic AF were included in this cross-sectional study. QoL was assessed with the Medical Outcomes Survey 36-item Short Form (SF-36) and Minnesota Living with Heart Failure Questionnaire (MLHFQ). Respiratory muscle strength and pulmonary function were also measured. Functional capacity was assessed with the 6-min walk test (6MWT). The Borg CR10 Scale was used to determine the resting dyspnea and fatigue levels. Results The SF-36 physical component summary score was correlated with the maximum inspiratory pressure (r = 0.517), maximum expiratory pressure (r = 0.391), 6MWT distance (r = 0.542), resting Borg dyspnea score (r = −0.692), and resting Borg fatigue score (r = −0.727). The MLHFQ total score was correlated with the maximum inspiratory pressure (r = −0.542), maximum expiratory pressure (r = −0.384), 6MWT distance (r = −0.535), resting Borg dyspnea score (r = 0.641), and resting Borg fatigue score (r = 0.703). The resting Borg fatigue score was the significant independent predictor of the SF-36 physical component score and the MLHFQ total score. Conclusion Respiratory muscle strength, functional capacity measured with the 6MWT, and resting symptoms including dyspnea and fatigue may have an impact on QoL in patients with AF.

scholarly journals Effect of Delirium on Physical Function in Noncardiac Thoracic Surgery Patients

2020 ◽  
Vol 29 (2) ◽  
pp. e39-e43
Author(s):  
Sikandar H. Khan ◽  
Chenjia Xu ◽  
Sophia Wang ◽  
Sujuan Gao ◽  
Sue Lasiter ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Thoracic Surgery ◽  
Physical Function ◽  
Secondary Analysis ◽  
Functional Independence ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Fisher Exact Test ◽  
Exact Test ◽  
History Of

Background The effect of delirium on physical function in patients undergoing noncardiac thoracic surgery has not been well described and may differ from that in other surgical populations. Objective To determine the effects of delirium on muscle strength and functional independence. The primary end point was change in Medical Research Council sum score (MRC-SS) by delirium status. Methods A secondary analysis of data from a clinical trial involving English-speaking adults aged 18 years or older who were undergoing major noncardiac thoracic surgery. Exclusion criteria were history of schizophrenia, Parkinson disease, dementia, alcohol abuse, or neuroleptic malignant syndrome; haloperidol allergy; being pregnant or nursing; QT prolongation; and taking levodopa or cholinesterase inhibitors. Delirium was assessed twice daily using the Confusion Assessment Method for the Intensive Care Unit. Preoperatively and postoperatively, muscle strength was assessed using the modified MRC-SS and functional independence was assessed using the Katz scale of activities of daily living. Changes in MRC-SS and Katz score by delirium status were analyzed using the Fisher exact test. Results Seventy-three patients were included in the analysis. Median (interquartile range) MRC-SS and Katz score before surgery did not differ significantly between patients without and with delirium (MRC-SS: 30 [30-30] vs 30 [30-30], P &gt; .99; Katz score: 6 [6-6] vs 6 [6-6], P = .63). The percentage of patients with a change in MRC-SS was similar in patients without and with delirium (17% vs 13%, respectively; P &gt; .99). More patients in the delirium group had a change in Katz score (13% vs 0%, P = .04). Conclusions Postoperative delirium was not associated with change in muscle strength. Follow-up studies using other muscle measures may be needed.

scholarly journals Pacemaker implications in the functional capacity and quality of life of cardiopathic patients

2019 ◽  
Vol 32 ◽  
Author(s):  
Tainá Samile Pesente ◽  
Tiago Luan Labres de Freitas ◽  
Jaqueline Piccoli Korb ◽  
Juliana Nunes Ferreira ◽  
Alexandre Simões Dias ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Physical Activity ◽  
Muscle Strength ◽  
Cardiorespiratory Fitness ◽  
Respiratory Muscle ◽  
Respiratory Muscle Strength ◽  
Large Hospital ◽  
The North ◽  
Peripheral Muscle

Abstract Introduction: Cardiovascular diseases are among the main causes of death, and in recent years there has been an increase in pacemaker implants (PM), which is intended not only to increase survival, but also to improve quality of life. Objective: To evaluate the quality of life, cardiorespiratory fitness and level of physical activity of patients before and after permanent PM implant in a large hospital in the north of the state of Rio Grande do Sul. Method: The study comprised 19 patients submitted to PM surgery who had their electronic health record and quality of life (AQUAREL) evaluated as well as their cardiorespiratory fitness and the limit of daily physical activity (VSAQ), peripheral muscle strength (PMS), respiratory muscle strength (manovacuometry), their degree of dyspnea (modified PMS) and the hemodynamic parameters, all of which were assessed in the preoperative period and after 30 days. Results: A mean age of 71.79 years was observed and in 63.1% of the cases Total Atrioventricular Block was the pathology, while 89.5% of the participants presented systemic arterial hypertension and 31.6% also presented Diabetes Melittus. Statistically significant improvement was observed in all the values under evaluation, namely: dyspnea (p = 0.0001), peripheral muscle strength (p = 0.0001) and respiratory muscle strength (PIMAX p = 0.0001 and PEMAX p = 0.0001), Quality of Life (p = 0.0001) and Cardiorespiratory Fitness and level of physical activity p=0.0001). Conclusion: Improvement was verified in all parameters analyzed, thus suggesting that the PM positively influences the quality of life and the functionality of the patients.

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