Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
Department of Radiology, Nippon Medical School Musashi Kosugi Hospital, 1-396, Kosugi-cho, Nakahara-ku, Kawasaki, Kanagawa, 211-8533, Japan.
Sci Rep. 2024 Nov 29;14(1):29729. doi: 10.1038/s41598-024-81372-4.
The relationship between mechanical ventilation-induced brain volume changes and ICU-acquired weakness (ICU-AW) is not clear. We assessed brain volume change in ventilated patients and identified associations with changes in extremity muscle strength. Patients admitted to the ICU due to the need for ventilation, and who underwent at least two head CT scans during hospitalization, were included. We employed an automated segmentation method to measure brain volume, recording changes in volume from baseline. Cases with brain volume reduction > 0% were assigned to the "brain atrophy group" and those with ≤ 0% reduction to the "preserved brain volume group." Medical Research Council (MRC) scores as an indicator of ICU-AW at discharge were compared between groups. There were 84 eligible patients, 71 in the brain atrophy group and 13 in the preserved brain volume group. Analysis of the brain atrophy group showed a significant brain volume reduction of - 3.3% over a median of 30 days. The median MRC scores were significantly lower in the brain atrophy group than in the preserved brain volume group (36 vs. 48, difference [95% CI]: - 12 [- 19.5- - 7.1]). Many ICU patients on mechanical ventilation showed rapidly progressive brain atrophy, and most of these patients developed ICU-AW.
机械通气引起的脑容量变化与 ICU 获得性肌无力（ICU-AW）之间的关系尚不清楚。我们评估了通气患者的脑容量变化，并确定了与四肢肌肉力量变化的关联。纳入因通气需要而入住 ICU 且在住院期间至少接受两次头部 CT 扫描的患者。我们采用自动分割方法测量脑容量，记录从基线开始的体积变化。脑容量减少>0%的病例被分配到“脑萎缩组”，而脑容量减少≤0%的病例被分配到“脑容量保留组”。比较两组出院时 ICU-AW 的医学研究委员会（MRC）评分。共有 84 名符合条件的患者，脑萎缩组 71 例，脑容量保留组 13 例。对脑萎缩组进行分析显示，中位数为 30 天的时间内脑容量显著减少了-3.3%。脑萎缩组的中位数 MRC 评分明显低于脑容量保留组（36 对 48，差异[95%CI]：-12[-19.5 至-7.1]）。许多接受机械通气的 ICU 患者出现快速进行性脑萎缩，其中大多数患者出现 ICU-AW。
