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De Beer C.R.1,2, Van Rooijen A.J.1, Pretorius J.P.3, Rheeder P.4, Paruk F.3
1University of Pretoria, Physiotherapy Department, Pretoria, South Africa, 2Steve Biko Academic Hospital, Department of Physiotherapy and Critical Care, Pretoria, South Africa, 3University of Pretoria, Department of Critical Care Steve Biko Academic Hospital, Pretoria, South Africa, 4University of Pretoria, Department of Internal Medicine Steve Biko Academic Hospital, Pretoria, South Africa
Background: Prolonged mechanical ventilation is detrimental to the human body. It increases the risk of critical illness myopathy / polyneuropathy and decreases the patient's functional ability. Delay in the weaning process increases the complication rate of mechanical ventilation. A too aggressive weaning process and early extubation can lead to an increase in re-intubation. Extubation failure is associated with an increased length of ICU stay, financial expenditure and mortality rate. A variety of parameters are used as predictors of extubation readiness. Due to the complexity to determine extubation readiness, no test in isolation can predict the extubation outcome. Previous studies showed an association between peripheral and respiratory muscle weakness. Currently no study has determined the association between muscle strength (Deltoid, Sternocleidomastoid and Trapezius), endurance and extubation readiness.
Purpose: The aim of this study was to determine whether muscle strength and endurance can be used as possible predictors of successful extubation in mechanically ventilated patients.
Methods: The researcher recruited 30 patients during the pilot study. The Richmond Agitation-Sedation Scale (RASS), Confusion Assessment Method for ICU (CAM-ICU) and the Five Point Questionnaire were used to determine the patients level of cooperation and cognition before muscle strength and endurance testing were commenced. The Deltoid, Sternocleidomastoid and Trapezius muscle strength were tested with the Oxford grading scale and the respiratory muscle strength were tested with the maximum inspiratory and expiratory pressures. Muscle endurance was determined by riding the MOTOmed® letto2 cycle ergometer for five minutes with the upper limbs.
Results: Exploratory data analysis was used to determine the differences in parameters between the patients who failed extubation and the patients who were successfully extubated. The results demonstrated that muscle strength (Deltoid and Sternocleidomastoid muscles) and muscle endurance were associated with successful extubation. Patients ventilated for more than three days with a grade three muscle strength of Deltoid and Sternocleidomastoid muscles respectively had a 100% chance of successful extubation
(P = 0.038). The results of the Trapezius muscle strength testing were not associated with successful extubation (P = 0.366). Patients not riding the MOTOmed® letto2 cycle ergometer actively with the upper limbs for 4.5 min and covering a distance of 0.5 km demonstrated a linear trend (P = 0.006) to fail extubation. The results also showed that the number of days a patient was admitted to ICU was associated with successful extubation. The number of days a patient was ventilated did not show significant results for an association between ventilated days and successful extubation.
Conclusion(s): Developing possible predictors of successful extubation is essential to improve the management of extubation. Indicators such as muscle strength and endurance will assist the treating physician to assess the patients readiness for extubation. Extubation predictors will assist the physiotherapist in giving an indication of the rehabilitation program needed for optimal functional recovery and prevention of re-intubation.
Implications: Successful safe extubation may decrease the ICU length of stay, hospital length of stay, total cost involved and it will increase the patients functional ability and quality of life post hospital discharge.
Funding acknowledgements: The principle researcher was responsible for the funding. No additional funding was received.
Topic: Critical care
Ethics approval: Approval was obtained from Research Ethics committee, Faculty of Health Sciences, University of Pretoria (309/2015). Patients included gave informed consent.
All authors, affiliations and abstracts have been published as submitted.
