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VOLUME 27 , ISSUE 1 ( January, 2023 ) > List of Articles

Original Article

Risk Factors of Decreased Abdominal Expiratory Muscle Thickness in Mechanically Ventilated Critically Ill Patients—The mNUTRIC Score is an Independent Predictor

P Vishwas, Vedaghosh Amara, Sagar Shanmukhappa Maddani, Souvik Chaudhuri, Suvajit Podder

Keywords : Abdominal expiratory muscle thickness, Internal oblique muscle, mNUTRIC score

Citation Information : Vishwas P, Amara V, Maddani SS, Chaudhuri S, Podder S. Risk Factors of Decreased Abdominal Expiratory Muscle Thickness in Mechanically Ventilated Critically Ill Patients—The mNUTRIC Score is an Independent Predictor. Indian J Crit Care Med 2023; 27 (1):8-15.

DOI: 10.5005/jp-journals-10071-24375

License: CC BY-NC 4.0

Published Online: 31-12-2022

Copyright Statement:  Copyright © 2023; The Author(s).


Abstract

Background: The expiratory abdominal skeletal muscles are an important component of the respiratory muscle pump, and their reduced thickness has been associated with difficult weaning. There is no objective score that may help clinicians to predict expiratory abdominal muscle thinning. Patients and methods: This was a single-center retrospective study on 81 patients undergoing weaning from mechanical ventilation. The thickness of the four abdominal expiratory muscles—rectus abdominis (RA), internal oblique (IO), external oblique (EO), and transversus abdominis (TA) on the day of the first spontaneous breathing trial (SBT), was obtained. The various parameters of the patients with thinner RA, IO, EO, and TA below the determined thickness cut-off values, predicting difficult weaning was analyzed. Results: Modified nutritional risk in critically ill (mNUTRIC) score was found to be an independent predictor of thinner IO muscle after logistic regression analysis [p = 0.001, adjusted OR 2.33, 95% CI (1.394–3.892)]. The mNUTRIC score was also an independent predictor of thinner EO (p = 0.014, adjusted OR 1.57) and RA muscle (p = 0.002, adjusted OR 1.69). The mNUTRIC cutoff score ≥4 predicted thinner IO (AUC 0.813, p < 0.001 sensitivity 71%, specificity 77%) and thinner EO (AUC 0.738, p < 0.001, 71% sensitivity, 67% specificity). The mNUTRIC score ≥3 predicted that at least one out of the four abdominal expiratory muscles will be thin (AUC 0.849, p < 0.001, 95% CI [0.763–0.935], sensitivity 87.5%, specificity 59%). Conclusion: The mNUTRIC score is an independent predictor of thinner abdominal expiratory muscles in mechanically ventilated critically ill patients.


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  1. Amara V, Vishwas P, Maddani SS, Natarajan S, Chaudhuri S. Evaluation of abdominal expiratory muscle thickness pattern, diaphragmatic excursion, and lung ultrasound score in critically ill patients and their association with weaning patterns: A prospective observational study. Indian J Crit Care Med 2022;26(3):307–313. DOI: 10.5005/jp-journals-10071-24125.
  2. Shi ZH, Jonkman A, de Vries H, Jansen D, Ottenheijm C, Girbes A, et al. Expiratory muscle dysfunction in critically ill patients: Towards improved understanding. Intensive Care Med 2019;45(8):1061–1071. DOI: 10.1007/s00134-019-05664-4.
  3. Peñuelas O, Keough E, López-Rodríguez L, Carriedo D, Gonçalves G, Barreiro E, et al. Ventilator-induced diaphragm dysfunction: Translational mechanisms lead to therapeutical alternatives in the critically ill. Intensive Care Med Exp 2019;7(Suppl 1):48. DOI: 10.1186/s40635-019-0259-9.
  4. Demoule A, Jung B, Prodanovic H, Molinari N, Chanques G, Coirault C, et al. Diaphragm dysfunction on admission to the intensive care unit. Prevalence, risk factors, and prognostic impact-a prospective study. Am J Respir Crit Care Med 2013;188(2):213–219. DOI: 10.1164/rccm.201209-1668OC.
  5. McMeeken JM, Beith ID, Newham DJ, Milligan P, Critchley DJ. The relationship between EMG and change in thickness of transversus abdominis. Clin Biomech (Bristol, Avon) 2004;19(4):337–342. DOI: 10.1016/j.clinbiomech.2004.01.007.
  6. Dot I, Pérez-Teran P, Samper MA, Masclans JR. Diaphragm dysfunction in mechanically ventilated patients. Arch Bronconeumol 2017;53(3):150–156. DOI: 10.1016/j.arbres.2016.07.008.
  7. van Gassel RJJ, Baggerman MR, van de Poll MCG. Metabolic aspects of muscle wasting during critical illness. Curr Opin Clin Nutr Metab Care 2020;23(2):96–101. DOI: 10.1097/MCO.0000000000000628.
  8. Levine M, Ensom MH. Post hoc power analysis: An idea whose time has passed? Pharmacotherapy 2001;21(4):405–409. DOI: 10.1592/phco.21.5.405.34503.
  9. Puthucheary ZA, Rawal J, McPhail M, Connolly B, Ratnayake G, Chan P, et al. Acute skeletal muscle wasting in critical illness. JAMA 2013;310(15):1591–600. DOI: 10.1001/jama.2013.278481. [Erratum in: JAMA 2014;311(6):625. Padhke, Rahul [corrected to Phadke, Rahul].
  10. Wandrag L, Brett SJ, Frost GS, Bountziouka V, Hickson M. Exploration of muscle loss and metabolic state during prolonged critical illness: Implications for intervention? PLoS One 2019;14(11):e0224565. DOI: 10.1371/journal.pone.0224565.
  11. Ferrie S, Allman-Farinelli M, Daley M, Smith K. Protein requirements in the critically ill: A randomized controlled trial using parenteral nutrition. JPEN J Parenter Enteral Nutr 2016;40(6):795–805. DOI: 10.1177/0148607115618449.
  12. McKendry J, Thomas ACQ, Phillips SM. Muscle mass loss in the older critically ill population: Potential therapeutic strategies. Nutr Clin Pract 2020;35(4):607–616. DOI: 10.1002/ncp.10540.
  13. Heyland DK, Dhaliwal R, Jiang X, Day AG. Identifying critically ill patients who benefit the most from nutrition therapy: The development and initial validation of a novel risk assessment tool. Crit Care 2011;15(6): R268. DOI: 10.1186/cc10546.
  14. Haines RW, Zolfaghari P, Wan Y, Pearse RM, Puthucheary Z, Prowle JR. Elevated urea-to-creatinine ratio provides a biochemical signature of muscle catabolism and persistent critical illness after major trauma. Intensive Care Med 2019;45(12):1718–1731. DOI: 10.1007/s00134-019-05760-5.
  15. Saccheri C, Morawiec E, Delemazure J, Mayaux J, Dubé BP, Similowski T, et al. ICU-acquired weakness, diaphragm dysfunction and long-term outcomes of critically ill patients. Ann Intensive Care 2020;10(1):1. DOI: 10.1186/s13613-019-0618-4.
  16. Dres M, Goligher EC, Heunks LMA, Brochard LJ. Critical illness-associated diaphragm weakness. Intensive Care Med 2017;43(10):1441–1452. DOI: 10.1007/s00134-017-4928-4.
  17. Ju S, Choi SM, Park YS, Lee CH, Lee SM, Yoo CG, et al. Rapid muscle loss negatively impacts survival in critically ill patients with cirrhosis. J Intensive Care Med 2020;35(7):663–671. DOI: 10.1177/0885066618775706.
  18. Moisey LL, Mourtzakis M, Cotton BA, Premji T, Heyland DK, Wade CE, et al. Nutrition and Rehabilitation Investigators Consortium (NUTRIC). Skeletal muscle predicts ventilator-free days, ICU-free days, and mortality in elderly ICU patients. Crit Care 2013;17(5):R206. DOI: 10.1186/cc12901.
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