Background: Intensive care unit (ICU)-acquired weakness (ICU-AW) and ICU-acquired diaphragm dysfunction\n(ICU-DD) occur frequently in mechanically ventilated (MV) patients. It is unknown whether they have different\nrisk factors and different impacts on outcome. This study was designed to (1) describe the respective risk\nfactors associated with ICU-AW and severe ICU-DD and (2) evaluate the respective impact of ICU-AW and\nsevere ICU-DD on outcome.\nMethods: Post hoc analysis of two prospective cohort studies conducted in two ICUs. In patients mechanically\nventilated for at least 24 h undergoing a first spontaneous breathing trial, severe ICU-DD was defined as diaphragm\ntwitch pressure < 7 cmH2O and ICU-AW was defined as Medical Research Council Score < 48.\nResults: One hundred sixteen patients were assessed. Factors independently associated with severe ICU-DD were age,\nlonger duration of MV, and exposure to sufentanil, and those factors associated with ICU-AW were longer duration of\nMV and exposure to norepinephrine. Severe ICU-DD (OR 3.56, p = 0.008), but not ICU-AW, was independently associated\nwith weaning failure (59%). ICU-AW (OR 4.30, p = 0.033), but not severe ICU-DD, was associated with ICU\nmortality. Weaning failure and mortality rate were higher in patients with both severe ICU-DD and ICU-AW\n(86% and 39%, respectively) than in patients with either severe ICU-DD (64% and 0%) or ICU-AW (63% and 13%).\nConclusion: Severe ICU-DD and ICU-AW have different risk factors and different impacts on weaning failure and\nmortality. The impact of the combination of ICU-DD and ICU-AW is more pronounced than their individual impact.
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