First Critical Care Department, Evangelismos Hospital, National and Kapodestrian University of Athens, Athens, Greece.
BMC Anesthesiol. 2011 Jun 26;11:14. doi: 10.1186/1471-2253-11-14.
Physical examination has been advocated as a primary determinant of ICU-acquired weakness (ICU-AW). The purpose of the study is to investigate ICU-AW development by using Maximum Inspiratory Pressure (MIP) as a surrogate parameter of the standardized method to evaluate patients' peripheral muscle strength.
Seventy-four patients were recruited in the study and prospectively evaluated in a multidisciplinary university ICU towards the appearance of ICU-AW. APACHE II admission score was 16 ± 6 and ICU stay 26 ± 18 days. ICU-AW was diagnosed with the Medical Research Council (MRC) scale for the clinical evaluation of muscle strength. MIP was measured using the unidirectional valve method, independently of the patients' ability to cooperate.
A significant correlation was found between MIP and MRC (r = 0.68, p < 0.001). Patients that developed ICU-AW (MRC<48) had a longer weaning period compared to non ICU-AW patients (12 ± 14 versus 2 ± 3 days, p < 0.01). A cut-off point of 36 cmH2O for MIP was defined by ROC curve analysis for ICU-AW diagnosis (88% sensitivity,76% specificity). Patients with MIP below the cut-off point of 36 cmH2O had a significant greater weaning period (10 ± 14 versus 3 ± 3 days, p = 0.004) also shown by Kaplan-Meier analysis (log-rank:8.2;p = 0.004).
MIP estimated using the unidirectional valve method may be a potential surrogate parameter for the assessment of muscle strength compromise, useful for the early detection of ICU-AW.
体格检查被认为是 ICU 获得性肌无力（ICU-AW）的主要决定因素。本研究旨在通过使用最大吸气压力（MIP）作为评估患者周围肌肉力量的标准化方法的替代参数来研究 ICU-AW 的发展。
本研究共纳入 74 例患者，在多学科大学 ICU 前瞻性评估 ICU-AW 的发生情况。APACHE II 入院评分为 16±6，ICU 入住时间为 26±18 天。ICU-AW 采用医疗研究委员会（MRC）量表进行临床肌肉力量评估。使用单向阀法测量 MIP，独立于患者的合作能力。
MIP 与 MRC 之间存在显著相关性（r=0.68，p<0.001）。发生 ICU-AW（MRC<48）的患者与非 ICU-AW 患者相比，脱机时间更长（12±14 与 2±3 天，p<0.01）。通过 ROC 曲线分析，MIP 的截断值为 36cmH2O 用于 ICU-AW 诊断（88%的敏感性，76%的特异性）。MIP 低于 36cmH2O 截断值的患者脱机时间明显更长（10±14 与 3±3 天，p=0.004），也通过 Kaplan-Meier 分析显示（对数秩检验：8.2；p=0.004）。
使用单向阀法估计的 MIP 可能是评估肌肉力量受损的潜在替代参数，有助于早期发现 ICU-AW。
