The relationship between maximal expiratory pressure values and critical outcomes in mechanically ventilated patients: a post hoc analysis of an observational study
Abstract Background Little interest has been paid to expiratory muscle strength, and the impact of expiratory muscle weakness on critical outcomes is not known. Very few studies assessed the relationship between maximal expiratory pressure (MEP) and critical outcomes. The aim of this study was to in...
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| Format: | Article |
| Language: | English |
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SpringerOpen
2021-01-01
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| Series: | Annals of Intensive Care |
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| Online Access: | https://doi.org/10.1186/s13613-020-00791-4 |
| _version_ | 1818430692608966656 |
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| author | Yann Combret Guillaume Prieur Roger Hilfiker Francis-Edouard Gravier Pauline Smondack Olivier Contal Bouchra Lamia Tristan Bonnevie Clément Medrinal |
| author_facet | Yann Combret Guillaume Prieur Roger Hilfiker Francis-Edouard Gravier Pauline Smondack Olivier Contal Bouchra Lamia Tristan Bonnevie Clément Medrinal |
| author_sort | Yann Combret |
| collection | DOAJ |
| description | Abstract Background Little interest has been paid to expiratory muscle strength, and the impact of expiratory muscle weakness on critical outcomes is not known. Very few studies assessed the relationship between maximal expiratory pressure (MEP) and critical outcomes. The aim of this study was to investigate the relationship between MEP and critical outcomes. Methods This work was a secondary analysis of a prospective, observational study of adult patients who required mechanical ventilation for ≥ 24 h in an 18-bed ICU. MEP was assessed before extubation after a successful, spontaneous breathing trial. The relationships between MEP and extubation failure, and short-term (30 days) mortality, were investigated. Univariate logistic regressions were computed to investigate the relationship between MEP values and critical outcomes. Two multivariate analyses, with and without maximal inspiratory pressure (MIP), both adjusted using principal component analysis, were undertaken. Unadjusted and adjusted ROC curves were computed to compare the respective ability of MEP, MIP and the combination of both measures to discriminate patients with and without extubation failure or premature death. Results One hundred and twenty-four patients were included. Median age was 66 years (IQR 18) and median mechanical ventilation duration was 7 days (IQR 6). Extubation failure rate was 15% (18/124 patients) and the rate for 30-day mortality was 11% (14/124 patient). Higher MEP values were significantly associated with a lower risk of extubation failure in the univariate analysis [OR 0.96 95% CI (0.93–0.98)], but not with short-term mortality. MEP was independently linked with extubation failure when MIP was not included in the multivariate model, but not when it was included, despite limited collinearity between these variables. This study was not able to differentiate the respective abilities of MEP, MIP, and their combination to discriminate patients with extubation failure or premature death (adjusted AUC for the combination of MEP and MIP: 0.825 and 0.650 for extubation failure and premature death, respectively). Conclusions MEP is related to extubation failure. But, the results did not support its use as a substitute for MIP, since the relationship between MEP and critical outcomes was no longer significant when MIP was included. The use of MIP and MEP measurements combined did not reach higher discriminative capacities for critical outcomes that MEP or MIP alone. Trial Registration This study was retrospectively registered at https://clinicaltrials.gov/ct2/show/NCT02363231?cond=NCT02363231&draw=2&rank=1 (NCT02363231) in 13 February 2015 |
| first_indexed | 2024-12-14T15:37:27Z |
| format | Article |
| id | doaj.art-189f1a7d6ace45248fe858b49e0d66fd |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-12-14T15:37:27Z |
| publishDate | 2021-01-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-189f1a7d6ace45248fe858b49e0d66fd2022-12-21T22:55:41ZengSpringerOpenAnnals of Intensive Care2110-58202021-01-011111810.1186/s13613-020-00791-4The relationship between maximal expiratory pressure values and critical outcomes in mechanically ventilated patients: a post hoc analysis of an observational studyYann Combret0Guillaume Prieur1Roger Hilfiker2Francis-Edouard Gravier3Pauline Smondack4Olivier Contal5Bouchra Lamia6Tristan Bonnevie7Clément Medrinal8Intensive Care Unit, Le Havre HospitalIntensive Care Unit, Le Havre HospitalSchool of Health Sciences, University of Applied Sciences and Arts Western Switzerland Valais (HES-SO Valais-Wallis)Institute for Research and Innovation in Biomedicine (IRIB), Normandie University, UNIROUEN, UPRES EA3830-GRHVADIR Association, Rouen University HospitalUniversity of Applied Sciences and Arts, Western Switzerland (HES-SO)Institute for Research and Innovation in Biomedicine (IRIB), Normandie University, UNIROUEN, UPRES EA3830-GRHVInstitute for Research and Innovation in Biomedicine (IRIB), Normandie University, UNIROUEN, UPRES EA3830-GRHVIntensive Care Unit, Le Havre HospitalAbstract Background Little interest has been paid to expiratory muscle strength, and the impact of expiratory muscle weakness on critical outcomes is not known. Very few studies assessed the relationship between maximal expiratory pressure (MEP) and critical outcomes. The aim of this study was to investigate the relationship between MEP and critical outcomes. Methods This work was a secondary analysis of a prospective, observational study of adult patients who required mechanical ventilation for ≥ 24 h in an 18-bed ICU. MEP was assessed before extubation after a successful, spontaneous breathing trial. The relationships between MEP and extubation failure, and short-term (30 days) mortality, were investigated. Univariate logistic regressions were computed to investigate the relationship between MEP values and critical outcomes. Two multivariate analyses, with and without maximal inspiratory pressure (MIP), both adjusted using principal component analysis, were undertaken. Unadjusted and adjusted ROC curves were computed to compare the respective ability of MEP, MIP and the combination of both measures to discriminate patients with and without extubation failure or premature death. Results One hundred and twenty-four patients were included. Median age was 66 years (IQR 18) and median mechanical ventilation duration was 7 days (IQR 6). Extubation failure rate was 15% (18/124 patients) and the rate for 30-day mortality was 11% (14/124 patient). Higher MEP values were significantly associated with a lower risk of extubation failure in the univariate analysis [OR 0.96 95% CI (0.93–0.98)], but not with short-term mortality. MEP was independently linked with extubation failure when MIP was not included in the multivariate model, but not when it was included, despite limited collinearity between these variables. This study was not able to differentiate the respective abilities of MEP, MIP, and their combination to discriminate patients with extubation failure or premature death (adjusted AUC for the combination of MEP and MIP: 0.825 and 0.650 for extubation failure and premature death, respectively). Conclusions MEP is related to extubation failure. But, the results did not support its use as a substitute for MIP, since the relationship between MEP and critical outcomes was no longer significant when MIP was included. The use of MIP and MEP measurements combined did not reach higher discriminative capacities for critical outcomes that MEP or MIP alone. Trial Registration This study was retrospectively registered at https://clinicaltrials.gov/ct2/show/NCT02363231?cond=NCT02363231&draw=2&rank=1 (NCT02363231) in 13 February 2015https://doi.org/10.1186/s13613-020-00791-4Maximal expiratory pressureExtubation failureMechanical ventilationIntensive care unit |
| spellingShingle | Yann Combret Guillaume Prieur Roger Hilfiker Francis-Edouard Gravier Pauline Smondack Olivier Contal Bouchra Lamia Tristan Bonnevie Clément Medrinal The relationship between maximal expiratory pressure values and critical outcomes in mechanically ventilated patients: a post hoc analysis of an observational study Annals of Intensive Care Maximal expiratory pressure Extubation failure Mechanical ventilation Intensive care unit |
| title | The relationship between maximal expiratory pressure values and critical outcomes in mechanically ventilated patients: a post hoc analysis of an observational study |
| title_full | The relationship between maximal expiratory pressure values and critical outcomes in mechanically ventilated patients: a post hoc analysis of an observational study |
| title_fullStr | The relationship between maximal expiratory pressure values and critical outcomes in mechanically ventilated patients: a post hoc analysis of an observational study |
| title_full_unstemmed | The relationship between maximal expiratory pressure values and critical outcomes in mechanically ventilated patients: a post hoc analysis of an observational study |
| title_short | The relationship between maximal expiratory pressure values and critical outcomes in mechanically ventilated patients: a post hoc analysis of an observational study |
| title_sort | relationship between maximal expiratory pressure values and critical outcomes in mechanically ventilated patients a post hoc analysis of an observational study |
| topic | Maximal expiratory pressure Extubation failure Mechanical ventilation Intensive care unit |
| url | https://doi.org/10.1186/s13613-020-00791-4 |
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