Handgrip strength to predict extubation outcome: a prospective multicenter trial

Area of Science:

• Critical Care Medicine
• Pulmonology
• Neuromuscular Physiology

Background:

• ICU-acquired weakness (ICUAW) is linked to prolonged mechanical ventilation and extubation failure.
• Medical Research Council (MRC) score is a common but time-consuming assessment for ICUAW.
• Handgrip strength (HG) offers a simple, reliable bedside measure of global muscle strength in critical care.

Purpose of the Study:

• To evaluate the association between handgrip strength and extubation outcomes in mechanically ventilated adults.
• To determine if bedside handgrip strength can predict extubation success or failure.

Main Methods:

• Prospective multicenter trial involving 233 adults on mechanical ventilation for at least 48 hours.
• Handgrip strength (HG), Maximal Inspiratory Pressure (MIP), Peak Cough Expiratory Flow (PCEF), and MRC score were measured before weaning.
• Extubation failure was defined as unscheduled reintubation, non-invasive ventilation, or high-flow nasal oxygen due to respiratory failure within 7 days post-extubation.

Main Results:

• No significant association was found between handgrip strength and extubation outcome (p=0.85).
• MRC score, MIP, and PCEF also showed no association with extubation success or failure.
• Handgrip strength demonstrated a strong correlation with MRC score (r=0.718, p<0.0001).
• Patients with muscular weakness (low HG) had significantly longer ICU and hospital stays.

Conclusions:

• Handgrip strength was not associated with extubation outcomes in this cohort.
• Further research is needed to determine if HG is an appropriate tool for this setting or if ICUAW's impact on extubation needs re-evaluation.