CORRELATION OF INTENSIVE CARE UNIT ACQUIRED WEAKNESS WITHDIAPHRAGMATIC EXCURSION MEASURED BY USG.

Intensive care unit (ICU) acquired muscle weakness (ICUAW) is a clinically detected

condition characterized by diffuse, symmetric weakness involving the limbs and respiratory

muscles Patients have different degrees of limb muscle weakness and are dependent on a

ventilator, while the facial muscles are spared. Diagnosis of ICUAW requires that no

plausible etiology other than critical illness be identified, and thus, other causes of acute

muscle weakness is excluded. One major diagnostic criterion is that ICUAW is detected

after the onset of critical illness.

ICUAW is a multifactorial disease the risk factors include female gender duration of

mechanical ventilation, glucocorticoids therapy, persistent hyperglycemia, multiorgan

system failure, sepsis, use of neuromuscular blockers during the ICU stay2,3,1

ICUAW is a clinically relevant complication during the acute stage of disease and after

discharge from the acute-care hospital. In the ICU, severe muscle weakness is independently

associated with prolonged mechanical ventilation, ICU stays, hospital stays, and increased

mortality Patients developing weakness during the ICU stay have reduced quality of life and

increased mortality 1 year after ICU discharge.

A diagnosis of ICUAW is achieved by manually testing the muscle strength using the

Medical Research Council scale. MRC muscle strength is assessed in 12 muscle groups,

(wrist flexion, forearm flexion, shoulder abduction, ankle dorsiflexion, knee extension, and

hip flexion), the total score ranges from 0 (complete paralysis) to 60 (normal muscle strength)

a summed score below 48/60 designates ICUAW or significant weakness, and an MRC score

below 36/48 indicates severe weakness But this requires full patient cooperation and a fully

conscious patient which is not always the case in ICU because of the use of sedation.

Respiratory muscles are often involved in ICUAW. The diaphragm is a major respiratory

muscle accounting for 80% of inspiratory function assessment of diaphragm weakness is a

useful tool in assessing ICUAW.

Bedside ultrasonography, which is already crucial in several aspects of critical illness has

been recently proposed as a simple, non-invasive method of quantification of diaphragmatic

contractile activity. Ultrasound can be used to determine diaphragm excursion using M

mode Ultrasonography of the diaphragm may be useful in identifying patients with

diaphragmatic weakness which may lead to prolonged weaning Diaphragmatic excursion using M mode can be measured in both hemidiaphragm, during

quiet breathing, deep breathing, and voluntary sniff. Normal values of excursion vary with

age and gender position of the patient, In supine position. The lower limit values for the right

hemidiaphragm were close to 1.1 cm for women and 1.2 cm for men during quiet breathing,

1.6 cm for women and 1.8 cm for men during voluntary sniffing, and 3.7 cm for women and

4.7 cm for men during deep breathing7

Not all patients who are weaned in ICU off ventilator have diaphragm weakness, they may

have poor muscle power or MRC score. in this study, we plan to find a correlation

between diaphragmatic excursion using ultrasound with MRC sum score which has not been

done in earlier studies. We hypothesize that the degree of respiratory weakness correlates

with the degree of limb weakness measured using the MRC sum score. And we can use

diaphragmatic excursion to predict the presence of ICUAW.