Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Thammasat University, 99/209 Paholyotin Road, Klong Luang, 12120, Pathum Thani, Thailand.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Thammasat University, 99/209 Paholyotin Road, Klong Luang, 12120, Pathum Thani, Thailand.
Heart Lung. 2020 Sep-Oct;49(5):637-640. doi: 10.1016/j.hrtlng.2020.03.019. Epub 2020 May 6.
Weaning from mechanical ventilation is a crucial process for critically ill patients. Hand grip strength (HGS) is an assessment tool for respiratory muscle function to assist guidance of extubation.
To evaluate HGS as a predictor for in-hospital clinical outcomes in mechanically ventilated patients.
A prospective study was conducted. Patients requiring mechanical ventilation with tracheal intubation in medical wards and intensive care units were recruited. HGS, reintubation, number of ventilator-free days and mortality were recorded.
A total of 34 patients (52.9% men) were included. When compared to the non re-intubation group, the re-intubation group had significantly lower HGS at 10 min and 30 min after starting spontaneous breathing trial (7.6 ± 4.8 kg Vs 13.4 ± 6.5 kg, P = 0.045, and 8 ± 5.1 kg Vs 13.2 ± 5.7 kg, P = 0.047). Moreover, at 1 h and 48 h of post extubation, the re-intubation group had lower HGS than the non re-intubation group. HGS at 1 h of post extubation was positively correlated with ventilator-free day at 28 days (r = 0.34, P = 0.05). HGS did not differ between survival group and death group in hospital over time.
Hand grip strength may be a predictive tool for extubation failure in mechanically ventilated patients. Low strength corresponded to significantly increased re-intubation rate. Furthermore, this measurement could not predict in-hospital mortality.
机械通气撤机是危重症患者的一个关键过程。握力（HGS）是一种评估呼吸肌功能的工具，可辅助指导拔管。
评估 HGS 作为机械通气患者院内临床结局的预测指标。
进行了一项前瞻性研究。纳入需要机械通气并气管插管的内科病房和重症监护病房患者。记录 HGS、再次插管、无呼吸机天数和死亡率。
共纳入 34 名患者（52.9%为男性）。与未再插管组相比，再插管组在开始自主呼吸试验后 10 分钟和 30 分钟时的 HGS 明显更低（7.6±4.8kg 比 13.4±6.5kg，P=0.045，8±5.1kg 比 13.2±5.7kg，P=0.047）。此外，在拔管后 1 小时和 48 小时，再插管组的 HGS 低于未再插管组。拔管后 1 小时的 HGS 与 28 天无呼吸机天数呈正相关（r=0.34，P=0.05）。HGS 在不同时间点在存活组和死亡组之间无差异。
握力可能是机械通气患者拔管失败的预测工具。握力低与再插管率显著增加相关。此外，该测量无法预测院内死亡率。
