Neuromuscular dysfunction associated with delayed weaning from mechanical ventilation in patients with respiratory failure

Khalil, Yehia; Mustafa, Emad El Din; Youssef, Ahmed; Imam, Mohamed Hassan; Behiry, Amni Fathy El

doi:10.1016/j.ajme.2012.02.004

Cited by 8 publications

(7 citation statements)

References 62 publications

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“…In particular, Khalil et al did not find a difference in the maximal inspiratory pressure in those with neuromuscular failure and those with other underlying etiology for inability to wean from the ventilator. 5 Critical illness myopathy, CIP, and CIPNM not only affect respiration but also most other skeletal muscles.…”

Section: Introductionmentioning

confidence: 99%

Review of Critical Illness Myopathy and Neuropathy

Shepherd

Batra

Lerner

2016

The Neurohospitalist

134

141

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Critical illness myopathy (CIM) and neuropathy are underdiagnosed conditions within the intensive care setting and contribute to prolonged mechanical ventilation and ventilator wean failure and ultimately lead to significant morbidity and mortality. These conditions are often further subdivided into CIM, critical illness polyneuropathy (CIP), or the combination-critical illness polyneuromyopathy (CIPNM). In this review, we discuss the epidemiology and pathophysiology of CIM, CIP, and CIPNM, along with diagnostic considerations such as detailed clinical examination, electrophysiological studies, and histopathological review of muscle biopsy specimens. We also review current available treatments and prognosis. Increased awareness and early recognition of CIM, CIP, and CIPNM in the intensive care unit setting may lead to earlier treatments and rehabilitation, improving patient outcomes.

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Section: Introductionmentioning

confidence: 99%

Review of Critical Illness Myopathy and Neuropathy

Shepherd

Batra

Lerner

2016

The Neurohospitalist

134

141

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“…Major risk factors for ICU related sarcopenia include primary disease severity, and length of MV and ICU stay. Some studies found that older age, female gender, administration of corticosteroids and neuromuscular blockers, need for red blood cell transfusion, hypoalbuminemia, and hyperglycemia are also possible risk factors [ 10 , 26 , 27 , 28 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…Information on patient demographics, body mass index (BMI), admission Acute Physiology and Chronic Health Evaluation II (APACHE-II) score, comorbidities, indication for mechanical ventilation, duration of mechanical ventilation prior to extubation trial, laboratory values, fraction of inspired oxygen (FiO 2 ), and vital signs, before extubation, and minimal ALT and creatine phosphokinase values over the preceding 10 days were collected. As some studies found an association between exposure to corticosteroids, vasopressors, muscle relaxants, hypoalbuminemia, and hyperglycemia to neuromuscular dysfunction in ICU patients, these data were also collected [ 26 , 27 , 28 , 29 ]. Time (hours) from extubation to re-intubation was recorded up to seven days after extubation.…”

Section: Methodsmentioning

confidence: 99%

Association of Low Alanine Aminotransferase Values with Extubation Failure in Adult Critically Ill Patients: A Retrospective Cohort Study

Weber

Epstein

Miller

et al. 2021

JCM

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Background: Liberation from mechanical ventilation is a cardinal landmark during hospitalization of ventilated patients. Decreased muscle mass and sarcopenia are associated with a high risk of extubation failure. A low level of alanine aminotransferase (ALT) is a known biomarker of sarcopenia. This study aimed to determine whether low levels of ALT are associated with increased risk of extubation failure among critically ill patients. Methods: This was a retrospective single-center cohort study of mechanically ventilated patients undergoing their first extubation. The study’s outcome was extubation failure within 48 h and 7 days. Multivariable logistic and Cox regression were performed to determine whether ALT was an independent predictor of these outcomes. Results: The study included 329 patients with a median age of 62.4 years (IQR 48.1–71.2); 210 (63.8%) patients were at high risk for extubation failure. 66 (20.1%) and 83 (25.2%) failed the extubation attempt after 48 h and 7 days, respectively. Low ALT values were more common among patients requiring reintubation (80.3–61.5% vs. 58.6–58.9%, p < 0.002). Multivariable logistic regression analysis identified ALT as an independent predictor of extubation failure at 48 h and 7 days. ALT ≤ 21 IU/L had an adjusted hazard ratio (HR) of 2.41 (95% CI 1.31–4.42, p < 0.001) for extubation failure at 48 h and ALT ≤ 16 IU/L had adjusted HR of 1.94 (95% CI 1.25–3.02, p < 0.001) for failure after 7 days. Conclusions: Low ALT, an established biomarker of sarcopenia and frailty, is an independent risk factor for extubation failure among hospitalized patients. This simple laboratory parameter can be used as an effective adjunct predictor, along with other weaning parameters, and thereby facilitate the identification of high-risk patients.

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“…As some studies found an association between exposure to corticosteroids, need for red blood cell transfusion, hypoalbuminemia, and hyperglycemia to neuromuscular dysfunction in ICU patients, these data were also collected. (22)(23)(24)(25) Time (hours) from extubation to re-intubation was recorded up to seven days after extubation. Prolonged MV was de ned as MV exceeding seven days.…”

Section: Outcome Measures and Variablesmentioning

confidence: 99%

mentioning

confidence: 99%

Association of low alanine aminotransferase values with extubation failure in adult critically ill patients: A retrospective cohort study

Weber

Epstein

Miller

et al. 2020

Preprint

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Background: Liberation from mechanical ventilation is a cardinal landmark during hospitalization of ventilated patients in intensive care units. Sufficient respiratory muscle strength and function are essential for successful extubation; therefore, decreased muscle mass and sarcopenia are associated with a high risk of failure. A low level of alanine aminotransferase (ALT) is a known biomarker of sarcopenia. This study was aimed to determine whether low levels of ALT are associated with increased risk of extubation failure among critically ill patients.Methods: This was a retrospective single-center cohort study of mechanically ventilated patients hospitalized in a medical intensive care unit and undergoing their first extubation. The primary outcome was extubation failure, which was defined as reintubation within seven days. Multivariable logistic regression was performed to determine whether ALT was an independent predictor of this outcome.Results: The study included 329 patients with a median age of 62.3 years (interquartile range [IQR] 48.13–71.16); 210 (63.83%) patients were at high risk for extubation failure and 83 (25.23%) failed the first extubation attempt. Low ALT values were more common among patients requiring reintubation (61.45% vs. 41.06%, P=0.002). Multivariable logistic regression analysis identified the age of 75 years or older and low ALT values as the only independent predictors of extubation failure, with adjusted odds ratio (OR) of 2.74 (95% confidence interval [CI] 1.23-6.11, p=0.01) and 2.14 (95% CI 1.16-3.96, p=0.02), respectively.Conclusions: Low ALT, an established biomarker of sarcopenia and frailty, is an independent risk factor for extubation failure among adult patients hospitalized in the medical intensive care unit. This simple laboratory parameter can be used as an effective adjunct predictor, along with other weaning parameters, and thereby facilitate the identification of high-risk patients.

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Neuromuscular dysfunction associated with delayed weaning from mechanical ventilation in patients with respiratory failure

Cited by 8 publications

References 62 publications

Review of Critical Illness Myopathy and Neuropathy

Review of Critical Illness Myopathy and Neuropathy

Association of Low Alanine Aminotransferase Values with Extubation Failure in Adult Critically Ill Patients: A Retrospective Cohort Study

Association of low alanine aminotransferase values with extubation failure in adult critically ill patients: A retrospective cohort study

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