Magnetic twitch assessment of diaphragm and quadriceps weakness in critically ill mechanically ventilated patients

Gerald S. Supinski; Paul F. Netzel; Philip M. Westgate; Elizabeth A. Schroder; Lin Wang; Leigh Ann Callahan

doi:10.1016/j.resp.2021.103789

Magnetic twitch assessment of diaphragm and quadriceps weakness in critically ill mechanically ventilated patients

Gerald S. Supinski
, Paul F. Netzel
, Philip M. Westgate
, Elizabeth A. Schroder
, Lin Wang
, Leigh Ann Callahan

Research output: Contribution to journal › Article › peer-review

5 Scopus citations

Abstract

Critically ill mechanically ventilated (MV) patients develop significant muscle weakness, which has major clinical consequences. There remains uncertainty, however, regarding the severity of leg weakness, the precise relationship between muscle strength and thickness, and the risk factors for weakness in MV patients. We therefore measured both diaphragm (PdiTw) and quadriceps (QuadTw) strength in MV patients using magnetic stimulation and compared strength to muscle thickness. Both PdiTw and QuadTw were profoundly reduced for MV patients, with PdiTw 19 % of normal and QuadTw 6% of normal values. There was a poor correlation between strength and thickness for both muscles, with thickness often remaining in the normal range when strength was severely reduced. Regression analysis revealed reductions in PdiTw correlated with presence of infection (p = 0.006) and age (p = 0.007). QuadTw best correlated with duration of MV (p = 0.036). Limb muscles are profoundly weak in critically ill patients, with a severity that mirrors the level of weakness observed in the diaphragm.

Original language	English
Article number	103789
Journal	Respiratory Physiology and Neurobiology
Volume	295
DOIs	https://doi.org/10.1016/j.resp.2021.103789
State	Published - Jan 2022

Bibliographical note

Publisher Copyright:
© 2021 Elsevier B.V.

Funding

This work was supported by the National Institutes of Health R01HL113494 and R01HL141356 and the Department of Veterans Affairs 5I01BX002132 .

Funders	Funder number
National Institutes of Health (NIH)
Department of Veterans Affairs5I01BX002132
U.S. Department of Veterans Affairs	I01BX002132, 5I01BX002132
National Institutes of HealthR01HL113494	R01HL141356
National Heart, Lung, and Blood Institute (NHLBI)	R01HL141356, R01HL113494

Keywords

Diaphragm weakness
Intensive care unit myopathy
Magnetic stimulation
Quadriceps twitch force generation
Quadriceps weakness
Transdiaphragmatic pressure generation

ASJC Scopus subject areas

General Neuroscience
Physiology
Pulmonary and Respiratory Medicine

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10.1016/j.resp.2021.103789

Cite this

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title = "Magnetic twitch assessment of diaphragm and quadriceps weakness in critically ill mechanically ventilated patients",

abstract = "Critically ill mechanically ventilated (MV) patients develop significant muscle weakness, which has major clinical consequences. There remains uncertainty, however, regarding the severity of leg weakness, the precise relationship between muscle strength and thickness, and the risk factors for weakness in MV patients. We therefore measured both diaphragm (PdiTw) and quadriceps (QuadTw) strength in MV patients using magnetic stimulation and compared strength to muscle thickness. Both PdiTw and QuadTw were profoundly reduced for MV patients, with PdiTw 19 \% of normal and QuadTw 6\% of normal values. There was a poor correlation between strength and thickness for both muscles, with thickness often remaining in the normal range when strength was severely reduced. Regression analysis revealed reductions in PdiTw correlated with presence of infection (p = 0.006) and age (p = 0.007). QuadTw best correlated with duration of MV (p = 0.036). Limb muscles are profoundly weak in critically ill patients, with a severity that mirrors the level of weakness observed in the diaphragm.",

keywords = "Diaphragm weakness, Intensive care unit myopathy, Magnetic stimulation, Quadriceps twitch force generation, Quadriceps weakness, Transdiaphragmatic pressure generation",

author = "Supinski, \{Gerald S.\} and Netzel, \{Paul F.\} and Westgate, \{Philip M.\} and Schroder, \{Elizabeth A.\} and Lin Wang and Callahan, \{Leigh Ann\}",

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doi = "10.1016/j.resp.2021.103789",

language = "English",

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AU - Supinski, Gerald S.

AU - Netzel, Paul F.

AU - Westgate, Philip M.

AU - Schroder, Elizabeth A.

AU - Wang, Lin

AU - Callahan, Leigh Ann

PY - 2022/1

Y1 - 2022/1

N2 - Critically ill mechanically ventilated (MV) patients develop significant muscle weakness, which has major clinical consequences. There remains uncertainty, however, regarding the severity of leg weakness, the precise relationship between muscle strength and thickness, and the risk factors for weakness in MV patients. We therefore measured both diaphragm (PdiTw) and quadriceps (QuadTw) strength in MV patients using magnetic stimulation and compared strength to muscle thickness. Both PdiTw and QuadTw were profoundly reduced for MV patients, with PdiTw 19 % of normal and QuadTw 6% of normal values. There was a poor correlation between strength and thickness for both muscles, with thickness often remaining in the normal range when strength was severely reduced. Regression analysis revealed reductions in PdiTw correlated with presence of infection (p = 0.006) and age (p = 0.007). QuadTw best correlated with duration of MV (p = 0.036). Limb muscles are profoundly weak in critically ill patients, with a severity that mirrors the level of weakness observed in the diaphragm.

AB - Critically ill mechanically ventilated (MV) patients develop significant muscle weakness, which has major clinical consequences. There remains uncertainty, however, regarding the severity of leg weakness, the precise relationship between muscle strength and thickness, and the risk factors for weakness in MV patients. We therefore measured both diaphragm (PdiTw) and quadriceps (QuadTw) strength in MV patients using magnetic stimulation and compared strength to muscle thickness. Both PdiTw and QuadTw were profoundly reduced for MV patients, with PdiTw 19 % of normal and QuadTw 6% of normal values. There was a poor correlation between strength and thickness for both muscles, with thickness often remaining in the normal range when strength was severely reduced. Regression analysis revealed reductions in PdiTw correlated with presence of infection (p = 0.006) and age (p = 0.007). QuadTw best correlated with duration of MV (p = 0.036). Limb muscles are profoundly weak in critically ill patients, with a severity that mirrors the level of weakness observed in the diaphragm.

KW - Diaphragm weakness

KW - Intensive care unit myopathy

KW - Magnetic stimulation

KW - Quadriceps twitch force generation

KW - Quadriceps weakness

KW - Transdiaphragmatic pressure generation

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Magnetic twitch assessment of diaphragm and quadriceps weakness in critically ill mechanically ventilated patients

Abstract

Bibliographical note

Funding

Keywords

ASJC Scopus subject areas

Access to Document

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