The present study was designed to investigate the evolution and the impact of respiratory muscles function and limb muscles strength on weaning success in prolonged weaning of tracheotomized patients. The primary objective was to determine whether the change in respiratory muscles function and limb muscles strength over the time is or is not associated with weaning success. Tracheotomized patients who were ventilator dependent upon admission at a weaning center were eligible. Diaphragm function was assessed with the phrenic nerve stimulation technique and with ultrasound to measure the diaphragm thickening fraction (TFdi) and diaphragm excursion (EXdi). Global respiratory muscle function was assessed with the maximal inspiratory pressure (MIP) and the forced vital capacity (FVC). Limb muscle strength was measured with the Medical Research Council Score (MRC). Measurements were made on a weekly basis. Patients were compared according to their outcome at discharge: complete weaning, partial weaning or death. Among the 60 patients who were enrolled, 30 patients finally achieved complete weaning, 20 had partial weaning and 10 died. At 6 months, 6 patients were lost of follow-up, 33 achieved complete weaning, 10 had partial weaning and 11 died. In median, 2 (1–9) assessments were performed per patient. Diaphragm dysfunction was present in all patients with a median Ptr,stim of 5.5 cmH2O (3.0–7.5). Ptr,stim, MIP, TFdi and EXdi at admission were not different between patients who achieved complete weaning and their counterparts. At discharge of the weaning center, MIP, Ptr,stim and EXdi significantly increased in patients who achieved complete weaning. The MRC score significantly increased only in patients with complete weaning. At discharge, diaphragm dysfunction was highly prevalent even in patients with complete weaning (Ptr,stim < 11 cmH2O in n = 11 (37%)). Respiratory muscle function and limb muscles strength are severely impaired in patients with prolonged weaning from mechanical ventilation. Significant improvement of diaphragm ultrasound indices was associated with successful weaning from mechanical ventilation and ICU-acquired weakness upon admission was significantly associated with good outcome suggesting that it was an amendable determinant of weaning failure in this population.

中文翻译：

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呼吸肌功能对呼吸机依赖患者脱机结局的贡献和进化


本研究旨在探讨呼吸肌功能和肢体肌肉力量对气管切开患者长时间脱机成功率的演变和影响。主要目的是确定呼吸肌功能和肢体肌肉力量随时间的变化是否与脱机成功相关。在脱机中心入院时依赖呼吸机的气管切开患者符合条件。使用膈神经刺激技术和超声评估膈肌功能，以测量膈肌增厚分数 （TFdi） 和膈肌偏移 （EXdi）。使用最大吸气压 （MIP） 和用力肺活量 （FVC） 评估整体呼吸肌功能。肢体肌肉力量用医学研究委员会评分 （MRC） 测量。每周进行一次测量。根据患者出院时的结局进行比较：完全脱机、部分脱机或死亡。在入组的 60 例患者中，30 例患者最终完全脱机，20 例部分脱机，10 例死亡。6 个月时，6 例患者失访，33 例实现完全脱机，10 例部分脱机，11 例死亡。在中位数，每位患者进行了 2 （1-9） 次评估。所有中位 Ptr，刺激为 5.5 cmH2O （3.0-7.5） 的患者都存在膈肌功能障碍。入院时 Ptr、stim、MIP、TFdi 和 EXdi 在完全脱机患者与患者之间没有差异。脱机中心出院时，完全脱机患者的 MIP 、 Ptr 、 stim 和 EXdi 显著增加。MRC 评分仅在完全脱机患者中显著升高。 出院时，即使在完全脱机的患者中，膈肌功能障碍也非常普遍 （Ptr，stim < 11 cmH2O in n = 11 （37%））。长时间脱离机械通气的患者呼吸肌功能和肢体肌肉力量严重受损。膈肌超声指标的显著改善与机械通气成功脱机相关，入院时 ICU 获得性虚弱与良好结局显著相关，表明这是该人群脱机失败的可修正决定因素。