Handgrip Strength Value in Predicting Mechanical Ventilation Weaning

Study Overview
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Brief Summary
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The purpose of this study is to test the association between ICU acquired weakness as evaluated by dominant handheld dynamometry (handgrip) and the mechanical ventilation weaning outcome

Detailed Description
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Previous studies have evidenced that Intensive Care Unit acquired peripheral muscle weakness may lead to delayed mechanical ventilation weaning (i.e difficult or prolonged weaning according to guidelines). Nevertheless, no study has ever tested the association between handgrip strength and extubation outcome. The investigators have generated the hypothesis that ICU acquired weakness, as tested by handgrip strength might be associated with extubation outcome. The investigators have planned to include 240 patients. Handgrip strength will be monitored, along with a full muscular assessment through Medical Research Council score by the attending physiotherapist. Physicians in charge of the patients will be blinded to these values and the weaning protocol will continue according to guidelines.

Official Title
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Prognostic Value of Dominant Hand Held Dynamometry in Mechanical Ventilation Weaning: a Prospective, Multicenter Study

Conditions
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Ventilator Weaning, Hand Strength, Respiration

Intervention / Treatment
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* Procedure: Handheld dynamometry (handgrip strength)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: adult patients under mechanical ventilation for at least 48 hours meeting readiness to wean criteria according to international guidelines with social security informed consent given by the patient or a proxy Exclusion Criteria: baseline pre existing rheumatologic or neurologic condition preventing the patient to use the tested device confusion (as assessed by Confusion Assessment Method for the Intensive Care Unit ) Patients whose extubation is a terminal extubation, or with prior decision not to resort a reintubation in case of post-extubation respiratory distress. known pregnancy Inability to deliver clear patient information (language barrier without an interpreter, for example) Participation in another intervention research

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Handheld dynamometry (handgrip strength)<br>All included patients will have a blinded evaluation of handgrip strength before weaning process. | Procedure: Handheld dynamometry (handgrip strength)<br>* Patients will perform handgrip strength dynamometry through holding the device in their dominant hand with the maximum strength, with standardized arm and body positions, as well as incentives<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| extubation outcome according to handgrip strength value | Each mechanical ventilation weaning trial | 7 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Association between handgrip strength and difficulty of weaning according to guidelines | Each mechanical ventilation weaning trial | 7 days | 
| Association between handgrip strength and cough strength as assessed through peak expiratory flow evaluated with a portable spirometer | Each mechanical ventilation weaning trial | 7 days | 
| Association between handgrip strength and maximal inspiratory strength during a brief inspiratory valve occlusion on the ventilator | Each mechanical ventilation weaning trial | 7 days | 
| Association between handgrip strength and peripheral muscular strength evaluated by the Medical Research Council score | Each mechanical ventilation weaning trial | 7 days | 
| Association between handgrip strength and the peripheral muscular strength evaluated by the Medical Research Council score. (Global score and its components) | Each mechanical ventilation weaning trial | 7 days | 
| Association between handgrip strength defined Intensive Care Unit acquired weakness and Intensive Care Unit and hospital length of stay |  | 18 months | 
| Association between handgrip strength defined Intensive Care Unit acquired weakness and Intensive Care Unit and hospital survival |  | 18 months |