Course of recovery of respiratory muscle strength and its associations with exercise capacity and handgrip strength: A prospective cohort study among survivors of critical illness

PLOS ONE · 9 authors, 5 centres

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TL;DR

At baseline (within one week post-discharge), all measures were well below predicted values.

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At baseline (within one week post-discharge), all measures were well below predicted values. Linear mixed model analyses showed significant recovery for all outcomes (MIP, MEP, FEC, HGS) over 6 months. There were significant longitudinal associations between MIP/MEP and the functional outcomes of FEC and HGS in crude models, though an interaction effect for sex was noted. Limitations include a relatively small sample size and potential bias from missing data due to COVID-19 restrictions. The findings suggest RMW is common after critical illness but shows recovery, and its assessment may be important for guiding post-ICU rehabilitation.

STUDY TYPE

cohort

SPECIALTY

critical care

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100% · A

ORIGINAL PAPER

PMC10101425

Course of recovery of respiratory muscle strength and its associations with exercise capacity and handgrip strength: A prospective cohort study among survivors of critical illness

PLOS ONE

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ABSTRACT

Background Mechanical ventilation affects the respiratory muscles, but little is known about long-term recovery of respiratory muscle weakness (RMW) and potential associations with physical functioning in survivors of critical illness. The aim of this study was to investigate the course of recovery of RMW and its association with functional outcomes in patients who received mechanical ventilation. Methods We conducted a prospective cohort study with 6-month follow-up among survivors of critical illness who received ≥ 48 hours of invasive mechanical ventilation. Primary outcomes, measured at 3 timepoints, were maximal inspiratory and expiratory pressures (MIP/MEP). Secondary outcomes were functional exercise capacity (FEC) and handgrip strength (HGS). Longitudinal changes in outcomes and potential associations between MIP/MEP, predictor variables, and secondary outcomes were investigated through linear mixed model analysis. Results A total of 59 participants (male: 64%, median age [IQR]: 62 [53–66]) were included in this study with a median (IQR) ICU and hospital length of stay of 11 (8–21) and 35 (21–52) days respectively. While all measures were well below predicted values at hospital discharge (MIP: 68.4%, MEP 76.0%, HGS 73.3% of predicted and FEC 54.8 steps/2m), significant 6-month recovery was seen for all outcomes. Multivariate analyses showed longitudinal associations between older age and decreased MIP and FEC, and longer hospital length of stay and decreased MIP and HGS outcomes. In crude models, significant, longitudinal associations were found between MIP/MEP and FEC and HGS outcomes. While these associations remained in most adjusted models, an interaction effect was observed for sex. Conclusion RMW was observed directly after hospital discharge while 6-month recovery to predicted values was noted for all outcomes. Longitudinal associations were found between MIP and MEP and more commonly used measures for physical functioning, highlighting the need for continued assessment of respiratory muscle strength in deconditioned patients who are discharged from ICU. The potential of targeted training extending beyond ICU and hospital discharge should be further explored.

CITATION EXPORT

Mel Major, Maarten van Egmond, Daniela Dettling-Ihnenfeldt et al.. Course of recovery of respiratory muscle strength and its associations with exercise capacity and handgrip strength: A prospective cohort study among survivors of critical illness. PLOS ONE. (2023). https://doi.org/10.1371/journal.pone.0284097

AUTHORS

9 · 5 CENTRES

Mel Major, Maarten van Egmond, Daniela Dettling-Ihnenfeldt, Stephan Ramaekers, Raoul Engelbert, Marike van der Schaaf, Francesco Alessandri, Marjan Mansourian, Marjan Mansourian

1 European School of Physiotherapy, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
2 Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
3 Amsterdam UMC, location University of Amsterdam, Rehabilitation Medicine, Amsterdam, The Netherlands
4 Amsterdam Movement Sciences, Ageing and Vitality, Amsterdam, The Netherlands
Universitat Politecnica de Catalunya - Barcelona Tech, SPAIN

EDITOR / REVIEWER

Marjan Mansourian