Machefert Margaux, Prieur Guillaume, Aubry Solène, Combret Yann, Medrinal Clément
Physiotherapy Department, Le Havre Hospital, Le Havre, F-76600, France.
Paris-Saclay University, UVSQ, ERPHAN UR 20201, Versailles, F-78000, France.
BMC Anesthesiol. 2025 Mar 20;25(1):134. doi: 10.1186/s12871-025-03008-y.
Intensive care unit-acquired weakness (ICU-Aw) is a prevalent complication in critically ill patients, affecting both limb and respiratory muscles, individually or concurrently. The precise mechanisms by which muscle weakness influences the distinct functional roles of each muscle group remain to be fully elucidated. The objective of this study was to compare the time course evolution of inspiratory and quadriceps muscles strength during repeated maximal isometric contractions in patients with limb muscles and inspiratory muscles weakness.
A single-center, observational study was conducted in critically ill patients after extubation, presenting with both inspiratory and limb muscle weakness (defined as maximal inspiratory pressure (Pi) < 30 cmHO and an MRC score < 48). The patients' ability to sustain maximal voluntary effort was measured using electronic manometers and dynamometers, with repeated efforts performed 10 times. Following each measurement, a 10-second rest period was observed, and strength measurements were repeated to evaluate recovery.
A total of 20 patients (90% male, mean age 61 ± 10 years, SAPS II score 28 ± 17) were included. The mean first maximal inspiratory pressure was 32.6 ± 17 cmHO, and the mean first quadriceps maximal force was 135 ± 90 Newtons (N). Investigation revealed a decline in quadriceps muscle force of -15.45 ± 28.61 N (95% CI: -28.84 to -2.05) while inspiratory muscles demonstrated stability (mean difference: 1.75 ± 7.57 cmHO (95% CI: -1.80 to 5.30)). A statistically significant interaction between time and muscle group was identified (p = 0.0017), suggesting a different time course evolution of maximal voluntary strength between muscle groups. After a one-minute recovery, significant improvement in quadriceps strength was observed (p = 0.009), while no statistically significant change was detected in inspiratory muscle strength (p = 0.16).
The results of this study indicate potential disparities in the maximum force maintenance capacity between the quadriceps muscles and inspiratory muscles in patients with ICU-acquired weakness.
Registered on ClinicalTrials.gov Identifier NCT05396066.
重症监护病房获得性肌无力（ICU-Aw）是危重症患者中普遍存在的并发症，可单独或同时影响肢体和呼吸肌。肌无力影响每个肌肉群不同功能作用的确切机制仍有待充分阐明。本研究的目的是比较肢体肌肉和吸气肌无力患者在重复最大等长收缩过程中吸气肌和股四头肌力量的时间进程演变。
对拔管后的危重症患者进行了一项单中心观察性研究，这些患者同时存在吸气肌和肢体肌无力（定义为最大吸气压力（Pi）<30 cmH₂O且医学研究委员会（MRC）评分<48）。使用电子压力计和测力计测量患者维持最大自主用力的能力，重复用力10次。每次测量后，观察10秒的休息期，并重复力量测量以评估恢复情况。
共纳入20例患者（90%为男性，平均年龄61±10岁，简化急性生理学评分II（SAPS II）为28±17）。平均首次最大吸气压力为32.6±17 cmH₂O，平均首次股四头肌最大力量为135±90牛顿（N）。研究发现股四头肌力量下降了-15.45±28.61 N（95%置信区间：-28.84至-2.05），而吸气肌表现出稳定性（平均差异：1.75±7.57 cmH₂O（95%置信区间：-1.80至5.30））。确定了时间和肌肉群之间存在统计学显著的交互作用（p = 0.0017），表明不同肌肉群之间最大自主力量的时间进程演变不同。经过一分钟的恢复后，观察到股四头肌力量有显著改善（p = 0.009），而吸气肌力量未检测到统计学显著变化（p = 0.16）。
本研究结果表明，ICU获得性肌无力患者的股四头肌和吸气肌在最大力量维持能力方面可能存在差异。
在ClinicalTrials.gov上注册，标识符为NCT05396066。
