Combret Yann, Prieur Guillaume, Hilfiker Roger, Gravier Francis-Edouard, Smondack Pauline, Contal Olivier, Lamia Bouchra, Bonnevie Tristan, Medrinal Clément
Intensive Care Unit, Le Havre Hospital, 76600, Le Havre, France.
Research and Clinical Experimentation Institute (IREC), Pulmonology, ORL and Dermatology, Louvain Catholic University, 1200, Brussels, Belgium.
Ann Intensive Care. 2021 Jan 13;11(1):8. doi: 10.1186/s13613-020-00791-4.
Little interest has been paid to expiratory muscle strength, and the impact of expiratory muscle weakness on critical outcomes is not known. Very few studies assessed the relationship between maximal expiratory pressure (MEP) and critical outcomes. The aim of this study was to investigate the relationship between MEP and critical outcomes.
This work was a secondary analysis of a prospective, observational study of adult patients who required mechanical ventilation for ≥ 24 h in an 18-bed ICU. MEP was assessed before extubation after a successful, spontaneous breathing trial. The relationships between MEP and extubation failure, and short-term (30 days) mortality, were investigated. Univariate logistic regressions were computed to investigate the relationship between MEP values and critical outcomes. Two multivariate analyses, with and without maximal inspiratory pressure (MIP), both adjusted using principal component analysis, were undertaken. Unadjusted and adjusted ROC curves were computed to compare the respective ability of MEP, MIP and the combination of both measures to discriminate patients with and without extubation failure or premature death.
One hundred and twenty-four patients were included. Median age was 66 years (IQR 18) and median mechanical ventilation duration was 7 days (IQR 6). Extubation failure rate was 15% (18/124 patients) and the rate for 30-day mortality was 11% (14/124 patient). Higher MEP values were significantly associated with a lower risk of extubation failure in the univariate analysis [OR 0.96 95% CI (0.93-0.98)], but not with short-term mortality. MEP was independently linked with extubation failure when MIP was not included in the multivariate model, but not when it was included, despite limited collinearity between these variables. This study was not able to differentiate the respective abilities of MEP, MIP, and their combination to discriminate patients with extubation failure or premature death (adjusted AUC for the combination of MEP and MIP: 0.825 and 0.650 for extubation failure and premature death, respectively).
MEP is related to extubation failure. But, the results did not support its use as a substitute for MIP, since the relationship between MEP and critical outcomes was no longer significant when MIP was included. The use of MIP and MEP measurements combined did not reach higher discriminative capacities for critical outcomes that MEP or MIP alone. Trial Registration This study was retrospectively registered at https://clinicaltrials.gov/ct2/show/NCT02363231?cond=NCT02363231&draw=2&rank=1 (NCT02363231) in 13 February 2015.
呼气肌力量很少受到关注，呼气肌无力对关键结局的影响尚不清楚。极少有研究评估最大呼气压（MEP）与关键结局之间的关系。本研究的目的是调查MEP与关键结局之间的关系。
本研究是对一家拥有18张床位的重症监护病房（ICU）中需要机械通气≥24小时的成年患者进行的一项前瞻性观察性研究的二次分析。在成功进行自主呼吸试验后拔管前评估MEP。研究了MEP与拔管失败以及短期（30天）死亡率之间的关系。计算单因素逻辑回归以研究MEP值与关键结局之间的关系。进行了两项多因素分析，一项包含最大吸气压（MIP），另一项不包含MIP，均使用主成分分析进行调整。计算未调整和调整后的ROC曲线，以比较MEP、MIP以及两者组合区分有或无拔管失败或过早死亡患者的各自能力。
纳入了124例患者。中位年龄为66岁（四分位间距18），中位机械通气时间为7天（四分位间距6）。拔管失败率为15%（18/124例患者），30天死亡率为11%（14/124例患者）。在单因素分析中，较高的MEP值与较低的拔管失败风险显著相关[比值比0.96，95%置信区间（0.93 - 0.98）]，但与短期死亡率无关。当多因素模型中不包含MIP时，MEP与拔管失败独立相关，但包含MIP时则不然，尽管这些变量之间的共线性有限。本研究无法区分MEP、MIP及其组合区分有拔管失败或过早死亡患者的各自能力（MEP和MIP组合的调整后AUC：拔管失败为0.825，过早死亡为0.650）。
MEP与拔管失败有关。但是，结果不支持将其用作MIP的替代指标，因为当包含MIP时，MEP与关键结局之间的关系不再显著。联合使用MIP和MEP测量对关键结局的判别能力并未高于单独使用MEP或MIP。试验注册本研究于2015年2月13日在https://clinicaltrials.gov/ct2/show/NCT02363231?cond=NCT02363231&draw=2&rank=1（NCT02363231）进行回顾性注册。
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