Handgrip strength to predict extubation outcome: a prospective multicenter trial

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Abstract

Background

ICU-acquired weakness (ICUAW) has been shown to be associated with prolonged duration of mechanical ventilation and extubation failure. It is usually assessed through Medical Research Council (MRC) score, a time-consuming score performed by physiotherapists. Handgrip strength (HG) can be monitored very easily at the bedside. It has been shown to be a reproducible and reliable marker of global muscular strength in critical care patients. We sought to test if muscular weakness, as assessed by handgrip strength, was associated with extubation outcome.

Methods

Prospective multicenter trial over an 18 months period in six mixed ICUs. Adults receiving mechanical ventilation for at least 48 h were eligible. Just before weaning trial, HG, Maximal Inspiratory Pressure (MIP), Peak Cough Expiratory Flow (PCEF) and Medical Research Council (MRC) score were registered. The attending physicians were unaware of the tests results and weaning procedures were conducted according to guidelines. Occurrence of unscheduled reintubation, non-invasive ventilation (NIV) or high-flow nasal continuous oxygen (HFNC) because of respiratory failure within 7 days after extubation defined extubation failure. The main outcome was the link between HG and extubation outcome.

Results

233 patients were included. Extubation failure occurred in 51 (22.5%) patients, 39 (17.2%) required reintubation. Handgrip strength was 12 [6–20] kg and 12 [8–20] kg, respectively, in extubation success and failure ( p = 0.85). There was no association between extubation outcome and MRC score, MIP or PCEF. Handgrip strength was well correlated with MRC score ( r = 0.718, p < 0.0001). ICU and hospital length of stay were significantly higher in the subset of patients harboring muscular weakness as defined by handgrip performed at the first weaning trial (respectively, 15 [10–25] days vs. 11 [7–17] days, p = 0.001 and 34 [19–66] days vs. 22 [15–43] days, p = 0.002).

Conclusion

No association was found between handgrip strength and extubation outcome. Whether this was explained by the appropriateness of the tool in this specific setting, or by the precise impact of ICUAW on extubation outcome deserves to be further evaluated.

Trial registration Clinical Trials; NCT02946502, 10/27/2016, URL: https://clinicaltrials.gov/ct2/results?cond=&term=gripwean&cntry=&state=&city=&dist=

Supplementary Information

The online version contains supplementary material available at 10.1186/s13613-021-00932-3.

Related collections

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Author and article information

Contributors

Benjamin Sztrymf:

ORCID: http://orcid.org/0000-0003-4624-2577

benjamin.sztrymf@aphp.fr

Journal

Journal ID (nlm-ta): Ann Intensive Care

Journal ID (iso-abbrev): Ann Intensive Care

Title: Annals of Intensive Care

Publisher: Springer International Publishing (Cham )

ISSN (Electronic): 2110-5820

Publication date (Electronic): 2 October 2021

Publication date PMC-release: 2 October 2021

Publication date Collection: 2021

Volume: 11

Electronic Location Identifier: 144

Affiliations

[1 ]GRID grid.413738.a, ISNI 0000 0000 9454 4367, AP-HP, Service de Rééducation Fonctionnelle et Kinésithérapie, , Hôpital Antoine Béclère, ; 92140 Clamart, France

[2 ]GRID grid.508487.6, ISNI 0000 0004 7885 7602, AP-HP, Hôpital Louis Mourier, DMU ESPRIT, Service de Médecine Intensive Réanimation, , Université de Paris, ; 92700 Colombes, France

[3 ]GRID grid.508487.6, ISNI 0000 0004 7885 7602, PHERE UMRS 1152, , Université de Paris, ; 75018 Paris, France

[4 ]GRID grid.508487.6, ISNI 0000 0004 7885 7602, Réanimation Médicale et Toxicologique, Fédération de toxicologie, Hôpital Lariboisière, , Université Paris-Diderot, Inserm UMRS 1144, ; 2, rue Ambroise-Paré, 75010 Paris, France

[5 ]GRID grid.413784.d, ISNI 0000 0001 2181 7253, AP-HP, Hôpitaux Universitaires Paris-Sud, , Hôpital de Bicêtre, Service de Réanimation Médicale, ; 78, Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France

[6 ]GRID grid.5842.b, ISNI 0000 0001 2171 2558, Faculté de Médecine Paris-Sud, , Univ Paris-Sud, ; Inserm UMR_S 999, 94270 Le Kremlin-Bicêtre, France

[7 ]GRID grid.413961.8, ISNI 0000 0004 0443 544X, Réanimation Polyvalente, , Hôpital Delafontaine, ; 93200 Saint-Denis, France

[8 ]GRID grid.414145.1, ISNI 0000 0004 1765 2136, Réanimation Polyvalente, , Hôpital Intercommunal de Montfermeil, ; 93370 Montfermeil, France

[9 ]GRID grid.413738.a, ISNI 0000 0000 9454 4367, AP-HP, Service de réanimation polyvalente et surveillance continue, , Hôpital Antoine Béclère, ; 157 rue de la porte de Triveaux, 92140 Clamart, France

Author information

Benjamin Sztrymf http://orcid.org/0000-0003-4624-2577

Article

Publisher ID: 932

DOI: 10.1186/s13613-021-00932-3

PMC ID: 8487340

PubMed ID: 34601639

SO-VID: ede6a267-8898-42f7-a626-189f492fe95b

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 28 June 2021

Date accepted : 23 September 2021

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100004409, ministère de l’enseignement supérieur, de la recherche scientifique et des technologies de l'information et de la communication;

Award ID: PHRIP P150948

Award Recipient : Guillaume Cottereau