Role of ICU-acquired weakness on extubation outcome among patients at high risk of reintubation

Thille, Arnaud W.; Boissier, Florence; Müller, Michel; Levrat, Albrice; Bourdin, Gaël; Rosselli, Sylvène; Frat, Jean‐Pierre; Coudroy, Rémi; Vivier, Emmanuel

doi:10.1186/s13054-020-2807-9

Cited by 39 publications

(38 citation statements)

References 42 publications

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“…Greater disease severity, frequent need for suctioning post-extubation and ICU-acquired weakness were identified as predictors of extubation failure in non-COVID patients. 11 , 12 Clinical markers to predict extubation success or failure are currently unknown in the critically ill COVID-19 population. In our cohort, reintubated patients were significantly older (on average by 8 years) compared to those whose extubation was successful; the comorbidity burden and the mortality risk assessed by the SOFA score on intubation day were similar.…”

Section: Discussionmentioning

confidence: 99%

Extubation Failure in Critically Ill COVID-19 Patients: Risk Factors and Impact on In-Hospital Mortality

Ionescu

Zimmer

Petrescu

et al. 2021

J Intensive Care Med

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Purpose: We sought to identify clinical factors that predict extubation failure (reintubation) and its prognostic implications in critically ill COVID-19 patients. Materials and Methods: Retrospective, multi-center cohort study of hospitalized COVID-19 patients. Multivariate competing risk models were employed to explore the rate of reintubation and its determining factors. Results: Two hundred eighty-one extubated patients were included (mean age, 61.0 years [±13.9]; 54.8% male). Reintubation occurred in 93 (33.1%). In multivariate analysis accounting for death, reintubation risk increased with age (hazard ratio [HR] 1.04 per 1-year increase, 95% confidence interval [CI] 1.02 -1.06), vasopressors (HR 1.84, 95% CI 1.04-3.60), renal replacement (HR 2.01, 95% CI 1.22-3.29), maximum PEEP (HR 1.07 per 1-unit increase, 95% CI 1.02 -1.12), paralytics (HR 1.48, 95% CI 1.08-2.25) and requiring more than nasal cannula immediately post-extubation (HR 2.19, 95% CI 1.37-3.50). Reintubation was associated with higher mortality (36.6% vs 2.1%; P < 0.0001) and risk of inpatient death after adjusting for multiple factors (HR 23.2, 95% CI 6.45-83.33). Prone ventilation, corticosteroids, anticoagulation, remdesivir and tocilizumab did not impact the risk of reintubation or death. Conclusions: Up to 1 in 3 critically ill COVID-19 patients required reintubation. Older age, paralytics, high PEEP, need for greater respiratory support following extubation and non-pulmonary organ failure predicted reintubation. Extubation failure strongly predicted adverse outcomes.

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Section: Discussionmentioning

confidence: 99%

Extubation Failure in Critically Ill COVID-19 Patients: Risk Factors and Impact on In-Hospital Mortality

Ionescu

Zimmer

Petrescu

et al. 2021

J Intensive Care Med

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“…Although patients with altered sleep had lower central respiratory drive (as indicated by lower P 0.1 ), their risk of post-extubation respiratory failure or reintubation was not significantly increased as compared to those with normal sleep. Once a trial is successful and the patient able to breathe spontaneously, sleep quality may no longer be a determinant for extubation failure, which may be more likely be due to multiple factors including underlying cardiac or respiratory disease, cough strength, ICU-acquired weakness and respiratory muscle dysfunction [ 17 , 28 , 34 ]. However, we cannot rule out the possibility that the sleep times observed in our study after extubation were so short in the overall population that the potential impact on prognosis of altered sleep cannot be accurately assessed.…”

Section: Discussionmentioning

confidence: 99%

“…We hypothesized that patients with poor sleep quality (with atypical sleep or no REM sleep) may have reintubation rates reaching 40%, i.e., close to the reintubation rates reported in the most severe patients with severe cardiac heart failure, severe limb weakness or ineffective cough [ 17 , 27 , 28 ], versus only 10% in patients with good sleep quality, i.e., as patients at low-risk of reintubation [ 29 ]. Enrollment of 64 patients with adequate polysomnography was determined to provide a power of 80% and to show an absolute difference of 30% in rate of reintubation between patients with poor sleep quality and those with good sleep quality.…”

Section: Methodsmentioning

confidence: 99%

Role of sleep on respiratory failure after extubation in the ICU

Thille

Barrau

Beuvon

et al. 2021

Ann. Intensive Care

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Background Sleep had never been assessed immediately after extubation in patients still in the ICU. However, sleep deprivation may alter respiratory function and may promote respiratory failure. We hypothesized that sleep alterations after extubation could be associated with an increased risk of post-extubation respiratory failure and reintubation. We conducted a prospective observational cohort study performed at the medical ICU of the university hospital of Poitiers in France. Patients at high-risk of extubation failure (> 65 years, with any underlying cardiac or lung disease, or intubated > 7 days) were included. Patients intubated less than 24 h, with central nervous or psychiatric disorders, continuous sedation, neuroleptic medication, or uncooperative were excluded. Sleep was assessed by complete polysomnography just following extubation including the night. The main objective was to compare sleep between patients who developed post-extubation respiratory failure or required reintubation and the others. Results Over a 3-year period, 52 patients had complete polysomnography among whom 12 (23%) developed post-extubation respiratory failure and 8 (15%) required reintubation. Among them, 10 (19%) had atypical sleep, 15 (29%) had no deep sleep, and 33 (63%) had no rapid eye movement (REM) sleep. Total sleep time was 3.2 h in median [interquartile range, 2.0–4.4] in patients who developed post-extubation respiratory failure vs. 2.0 [1.1–3.8] in those who were successfully extubated (p = 0.34). Total sleep time, and durations of deep and REM sleep stages did not differ between patients who required reintubation and the others. Reintubation rates were 21% (7/33) in patients with no REM sleep and 5% (1/19) in patients with REM sleep (difference, − 16% [95% CI − 33% to 6%]; p = 0.23). Conclusions Sleep assessment by polysomnography after extubation showed a dramatically low total, deep and REM sleep time. Sleep did not differ between patients who were successfully extubated and those who developed post-extubation respiratory failure or required reintubation.

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“…With the advancements in modern intensive care medicine, mortality of critical ill patients has decreased, however, at the cost of a growing incidence of ICU-AW [10]. ICU-AW is known to have detrimental effects on both short-term and long-term clinical outcomes, identifying those who at high risk of developing ICU-AW is important [8,11].In our research, we show in a population of critical ill patients that the use of adrenaline and occurrence of infection are closely associated with the development of ICU-AW when discharged. We showed in a population of critical ill patients with ECMO support, there was higher proportion of adrenaline use in ICU-AW group, the use of adrenaline significantly increased the risk of developing ICU-AW.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors of ICU-Acquired Weakness in Critical Ill Patients with ECMO Support: A Retrospective Study

chen

Xiong

et al. 2021

Preprint

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Background Muscle weakness is exceedingly common in critical illness patients and is well described. However, information on the risk factors of muscle weakness in critically ill patients who received extracorporeal membrane oxygenation (ECMO) support are lacking. Our study aims to clarify the risk factors of ICU-acquired weakness (ICU-AW) in ECMO patients to help early recognize potential weakness. Methods We conducted a retrospective study of critical ill patients who used ECMO during their ICU stay. ICU-AW was diagnosed at the time when patients discharged and had a muscle strength sum score < 48 out of a maximal score of 60. Baseline characters and therapy details were collected from the case report form and inspection report. Results 63 patients receiving ECMO support were divided to ICU-AW group and no ICU-AW group according to the Medical Research Council (MRC) score when discharged. A total of 50 of the 63 patients were diagnosed with ICU-AW. On logistic regression analysis, the use of adrenaline apparently increased the odds of developing ICU-AW (OR=6.8,95%CI 1.19-38.92, p=0.032), and it was independent of all other established risk factors for ICU-AW. Meanwhile, the occurrence of infection during ECMO support significantly increased the risks of ICU-AW (OR=7.3,95% CI 1.28-41.24, p=0.025) and was independently associated with the outcome of ICU-AW. Other factors such as mechanical ventilation duration, steroid use and neuromuscular blockade did not differ significantly between the groups in our analysis. Conclusion Infection during ECMO support and use of adrenaline were found independently associated with the development of ICU-AW.

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Role of ICU-acquired weakness on extubation outcome among patients at high risk of reintubation

Cited by 39 publications

References 42 publications

Extubation Failure in Critically Ill COVID-19 Patients: Risk Factors and Impact on In-Hospital Mortality

Extubation Failure in Critically Ill COVID-19 Patients: Risk Factors and Impact on In-Hospital Mortality

Role of sleep on respiratory failure after extubation in the ICU

Risk Factors of ICU-Acquired Weakness in Critical Ill Patients with ECMO Support: A Retrospective Study

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