Advertisement

Muscle Power is Related to Physical Function in Patients Surviving Acute Respiratory Failure: A Prospective Observational Study

Published:October 02, 2020DOI:https://doi.org/10.1016/j.amjms.2020.09.018

      Abstract

      Background

      Up to 66% of patients admitted to the intensive care unit (ICU) for acute respiratory failure (ARF) develop ICU-acquired weakness, which is diagnosed by muscle strength testing. Muscle power, different from strength, is an important determinant of function that is not a common focus in patients surviving critical illness. Therefore, the purpose of this study is to assess muscle power in survivors of ARF.

      Methods

      A cross-sectional observational study performed with survivors of ARF. Muscle power, strength and physical function were assessed 4–8 weeks post-hospital discharge. Cross sectional area and echogenicity of rectus femoris and tibialis anterior muscles were assessed using ultrasonography. Healthy community-dwelling adults were included for comparison.

      Results

      12 survivors of ARF mean age of 55.6 ± 17.1 (66% male) and 12 healthy adults mean age of 51.6.1 ± 10.3 (66% male) participated in this study. Patients in the post-ARF group had a mean muscle power of 9.9 ± 3.5 W and 63.7 ± 31.6 W for 2-lb and 10% of body-weight loads, respectively. Compared to matched controls, power in ARF group was reduced by 43%. Muscle power in post-ARF group had moderate correlations with 5-times sit-to-stand testing (r = -0.644, P = 0.024), 4-m habitual gait speed (-0.780, P = 0.002), and 6-min walk distance (r = 0.589, P = 0.044).

      Conclusions

      Muscle power is significantly reduced in survivors of critical illness and associated with deficits in physical function. These preliminary findings may support therapeutic interventions aimed at improving muscle power to potentially increase functional benefit.

      Key Indexing Terms

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of the Medical Sciences
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Parry S.M.
        • El-Ansary D.
        • Cartwright M.S.
        • et al.
        Ultrasonography in the intensive care setting can be used to detect changes in the quality and quantity of muscle and is related to muscle strength and function.
        J Crit Care. 2015; 30 (1151.e1159-1114)
        • Puthucheary Z.A.
        • Phadke R.
        • Rawal J.
        • et al.
        Qualitative ultrasound in acute critical illness muscle wasting.
        Crit Care Med. 2015; 43: 1603-1611
        • Hermans G.
        • Van den Berghe G
        Clinical review: intensive care unit acquired weakness.
        Crit Care. 2015; 19: 274
        • Kortebein P.
        • Ferrando A.
        • Lombeida J.
        • Wolfe R.
        • Evans W.J
        Effect of 10 days of bed rest on skeletal muscle in healthy older adults.
        JAMA. 2007; 297: 1772-1774
        • Truong A.D.
        • Fan E.
        • Brower R.G.
        • Needham D.M
        Bench-to-bedside review: mobilizing patients in the intensive care unit–from pathophysiology to clinical trials.
        Crit Care. 2009; 13: 216
        • Maltais F.
        • Decramer M.
        • Casaburi R.
        • et al.
        An official American Thoracic Society/European Respiratory Society statement: update on limb muscle dysfunction in chronic obstructive pulmonary disease.
        Am J Respir Crit Care Med. 2014; 189: e15-e62
        • Files D.C.
        • Sanchez M.A.
        • Morris P.E
        A conceptual framework: the early and late phases of skeletal muscle dysfunction in the acute respiratory distress syndrome.
        Crit Care. 2015; 19: 266
        • Batt J.
        • dos Santos C.C.
        • Cameron J.I.
        • Herridge M.S
        Intensive care unit-acquired weakness: clinical phenotypes and molecular mechanisms.
        Am J Respir Crit Care Med. 2013; 187: 238-246
        • de Jonghe B.
        • Lacherade J.-.C.
        • Sharshar T.
        • Md P.
        • Outin H
        Intensive care unit-acquired weakness: risk factors and prevention.
        Crit Care Med. 2009; 37: S309-S315
        • Latronico N.
        • Herridge M.
        • Hopkins R.O.
        • et al.
        The ICM research agenda on intensive care unit-acquired weakness.
        Intensive Care Med. 2017;
        • Herridge M.S.
        • Batt J.
        • Santos C.D
        ICU-acquired weakness, morbidity, and death.
        Am J Respir Crit Care Med. 2014; 190: 360-362
        • Azoulay E.
        • Vincent J.-.L.
        • Angus D.C.
        • et al.
        Recovery after critical illness: putting the puzzle together—a consensus of 29.
        Crit Care. 2017; 21: 296
        • Herridge M.S.
        Building consensus on ICU-acquired weakness.
        Intensive Care Med. 2009; 35: 1-3
        • Jolley S.E.
        • Bunnell A.E.
        • Hough C.L
        ICU-acquired weakness.
        Chest. 2016; 150: 1129-1140
        • Pina I.L.
        • Apstein C.S.
        • Balady G.J.
        • et al.
        Exercise and heart failure: a statement from the American Heart Association Committee on exercise, rehabilitation, and prevention.
        Circulation. 2003; 107: 1210-1225
        • Berry M.J.
        • Morris P.E.
        Early exercise rehabilitation of muscle weakness in acute respiratory failure patients.
        Exerc Sport Sci Rev. 2013; 41: 208-215
        • Major M.E.
        • Kwakman R.
        • Kho M.E.
        • et al.
        Surviving critical illness: what is next? An expert consensus statement on physical rehabilitation after hospital discharge.
        Crit Care. 2016; 20: 354
        • Bean J.F.
        • Kiely D.K.
        • Herman S.
        • et al.
        The relationship between leg power and physical performance in mobility-limited older people.
        J Am Geriatr Soc. 2002; 50: 461-467
        • Reid K.F.
        • Fielding R.A
        Skeletal muscle power: a critical determinant of physical functioning in older adults.
        Exerc Sport Sci Rev. 2012; 40: 4-12
        • Foldvari M.
        • Clark M.
        • Laviolette L.C.
        • et al.
        Association of muscle power with functional status in community-dwelling elderly women.
        J Gerontol Ser A. 2000; 55: M192-M199
        • Evans W.J
        Editorial: exercise strategies should be designed to increase muscle power.
        J Gerontol Ser A. 2000; 55: M309-M310
        • Herridge M.S.
        Recovery and long-term outcome in acute respiratory distress syndrome.
        Crit Care Clin. 2011; 27: 685-704
        • Herridge M.S.
        • Tansey C.M.
        • Matte A.
        • et al.
        Functional disability 5 years after acute respiratory distress syndrome.
        New Engl J Med. 2011; 364: 1293-1304
        • Poulsen J.B.
        • Rose M.H.
        • Jensen B.R.
        • Moller K.
        • Perner A
        Biomechanical and nonfunctional assessment of physical capacity in male ICU survivors.
        Crit Care Med. 2013; 41: 93-101
        • Baldwin C.E.
        • Paratz J.D.
        • Bersten A.D
        Muscle strength assessment in critically ill patients with handheld dynamometry: an investigation of reliability, minimal detectable change, and time to peak force generation.
        J Crit Care. 2013; 28: 77-86
        • Byrne C.
        • Faure C.
        • Keene D.J.
        • Lamb S.E
        Ageing, muscle power and physical function: a systematic review and implications for pragmatic training interventions.
        Sports Med. 2016; 46 (Auckland, NZ): 1311-1332
        • Morgan P.
        • Embry A.
        • Perry L.
        • Holthaus K.
        • Gregory C.M
        Feasibility of lower-limb muscle power training to enhance locomotor function poststroke.
        J Rehabil Res Dev. 2015; 52: 77-84
        • Aaron S.E.
        • Hunnicutt J.L.
        • Embry A.E.
        • Bowden M.G.
        • Gregory C.M
        POWER training in chronic stroke individuals: differences between responders and nonresponders.
        Top Stroke Rehabil. 2017; 24: 496-502
        • Hunnicutt J.L.
        • Aaron S.E.
        • Embry A.E.
        • et al.
        The effects of POWER training in young and older adults after stroke.
        Stroke Res Treat. 2016; 20167316250
        • Corti M.
        • McGuirk T.E.
        • Wu S.S.
        • Patten C
        Differential effects of power training versus functional task practice on compensation and restoration of arm function after stroke.
        Neurorehabil Neural Repair. 2012; 26: 842-854
        • Potiaumpai M.
        • Gandia K.
        • Rautray A.
        • Prendergast T.
        • Signorile J.F
        Optimal loads for power differ by exercise in older adults.
        J Strength Cond Res. 2016; 30: 2703-2712
        • Fielding R.A.
        • LeBrasseur N.K.
        • Cuoco A.
        • Bean J.
        • Mizer K.
        • Singh M.A.F
        High-velocity resistance training increases skeletal muscle peak power in older women.
        J Am Geriatr Soc. 2002; 50: 655-662
        • Alcazar J.
        • Guadalupe-Grau A.
        • García-García F.J.
        • Ara I.
        • Alegre L.M
        Skeletal muscle power measurement in older people: a systematic review of testing protocols and adverse events.
        J Gerontol Ser A. 2017; 73: 914-924
        • Latronico N.
        • Gosselink R.
        A guided approach to diagnose severe muscle weakness in the intensive care unit.
        Rev Bras Ter Intensiva. 2015; 27: 199-201
        • Connolly B.A.
        • Jones G.D.
        • Curtis A.A.
        • et al.
        Clinical predictive value of manual muscle strength testing during critical illness: an observational cohort study.
        Crit Care. 2013; 17: R229
        • De Jonghe B.
        • Sharshar T.
        • Lefaucheur J.P.
        • et al.
        Paresis acquired in the intensive care unit: a prospective multicenter study.
        JAMA. 2002; 288: 2859-2867
        • Hough C.L.
        • Lieu B.K.
        • Caldwell E.S
        Manual muscle strength testing of critically ill patients: feasibility and interobserver agreement.
        Crit Care. 2011; 15 (R43-R43)
        • Bohannon R.W.
        Test-retest reliability of hand-held dynamometry during a single session of strength assessment.
        Phys Ther. 1986; 66: 206-209
        • Stark T.
        • Walker B.
        • Phillips J.K.
        • Fejer R.
        • Beck R
        Hand-held dynamometry correlation with the gold standard isokinetic dynamometry: a systematic review.
        PM & R J Inj Funct Rehabil. 2011; 3: 472-479
        • Parry S.M.
        • Berney S.
        • Granger C.L.
        • et al.
        A new two-tier strength assessment approach to the diagnosis of weakness in intensive care: an observational study.
        Crit Care. 2015; 19: 52
        • Sarwal A.
        • Parry S.M.
        • Berry M.J.
        • et al.
        Interobserver reliability of quantitative muscle sonographic analysis in the critically Ill population.
        J Ultrasound Med Off J Am Inst Ultrasound Med. 2015; 34: 1191-1200
        • Cartwright M.S.
        • Kwayisi G.
        • Griffin L.P.
        • et al.
        Quantitative neuromuscular ultrasound in the intensive care unit.
        Muscle Nerve. 2013; 47: 255-259
        • Connolly B.
        • MacBean V.
        • Crowley C.
        • et al.
        Ultrasound for the assessment of peripheral skeletal muscle architecture in critical illness: a systematic review.
        Crit Care Med. 2015; 43: 897-905
        • Mourtzakis M.
        • Wischmeyer P.
        Bedside ultrasound measurement of skeletal muscle.
        Curr Opin Clin Nutr Metab Care. 2014; 17: 389-395
        • Mourtzakis M.
        • Parry S.
        • Connolly B.
        • Puthucheary Z
        Skeletal muscle ultrasound in critical care: a tool in need of translation.
        Ann Am Thorac Soc. 2017; 14: 1495-1503
        • Needham D.M.
        • Sepulveda K.A.
        • Dinglas V.D.
        • et al.
        Core outcome measures for clinical research in acute respiratory failure survivors. An international modified Delphi consensus study.
        Am J Respir Crit Care Med. 2017; 196: 1122-1130
        • Chan K.S.
        • Aronson Friedman L.
        • Dinglas V.D.
        • et al.
        Evaluating physical outcomes in acute respiratory distress syndrome survivors: validity, responsiveness, and minimal important difference of 4-meter gait speed test.
        Crit Care Med. 2016; 44: 859-868
        • Parry S.M.
        • Denehy L.
        • Beach L.J.
        • Berney S.
        • Williamson H.C.
        • Granger C.L
        Functional outcomes in ICU - what should we be using? An observational study.
        Crit Care. 2015; 19: 127
        • Perracini M.R.
        • Mello M.
        • de Oliveira Maximo R.
        • et al.
        Diagnostic accuracy of the short physical performance battery for detecting frailty in older people.
        Phys Ther. 2019;
        • American Thoracic Society
        ATS statement: guidelines for the six-minute walk test.
        Am J Respir Crit Care Med. 2002; 166: 111-117
        • Brummel N.E.
        • Bell S.P.
        • Girard T.D.
        • et al.
        Frailty and subsequent disability and mortality among patients with critical illness.
        Am J Respir Crit Care Med. 2016; 196: 64-72
        • Parry S.M.
        • Huang M.
        • Needham D.M
        Evaluating physical functioning in critical care: considerations for clinical practice and research.
        Crit Care. 2017; 21: 249
        • Pedersen M.M.
        • Petersen J.
        • Bean J.F.
        • et al.
        Feasibility of progressive sit-to-stand training among older hospitalized patients.
        PeerJ. 2015; 3 (e1500-e1500)
        • Sharshar T.
        • Bastuji-Garin S.
        • Stevens R.D.
        • et al.
        Presence and severity of intensive care unit-acquired paresis at time of awakening are associated with increased intensive care unit and hospital mortality.
        Crit Care Med. 2009; 37: 3047-3053
        • Muscedere J.
        • Waters B.
        • Varambally A.
        • et al.
        The impact of frailty on intensive care unit outcomes: a systematic review and meta-analysis.
        Intensive Care Med. 2017; 43: 1105-1122
        • Zampieri F.G.
        • Iwashyna T.J.
        • Viglianti E.M.
        • et al.
        Association of frailty with short-term outcomes, organ support and resource use in critically ill patients.
        Intensive Care Med. 2018; 44: 1512-1520
        • Essam Behiry M.
        • Mogawer S.
        • Yamany A.
        • et al.
        Ability of the short physical performance battery frailty index to predict mortality and hospital readmission in patients with liver cirrhosis.
        Int J Hepatol. 2019; 2019 (8092865-8092865)
        • Tschopp M.
        • Sattelmayer M.K.
        • Hilfiker R
        Is power training or conventional resistance training better for function in elderly persons? A meta-analysis.
        Age Ageing. 2011; 40: 549-556
        • Metter E.J.
        • Conwit R.
        • Tobin J.
        • Fozard J.L
        Age-associated loss of power and strength in the upper extremities in women and men.
        J Gerontol Ser A Biol Sci Med Sci. 1997; 52: B267-B276
        • Petrella J.K.
        • Kim J.S.
        • Tuggle S.C.
        • Hall S.R.
        • Bamman M.M
        Age differences in knee extension power, contractile velocity, and fatigability.
        J Appl Physiol. 2005; 98 (Bethesda, Md: 1985): 211-220
        • Skelton D.A.
        • Greig C.A.
        • Davies J.M.
        • Young A
        Strength, power and related functional ability of healthy people aged 65-89 years.
        Age Ageing. 1994; 23: 371-377
        • Bean J.F.
        • Leveille S.G.
        • Kiely D.K.
        • Bandinelli S.
        • Guralnik J.M.
        • Ferrucci L
        A comparison of leg power and leg strength within the InCHIANTI study: which influences mobility more?.
        J Gerontol Ser A Biol Sci Med Sci. 2003; 58: 728-733
        • Milbrandt E.B.
        • Eldadah B.
        • Nayfield S.
        • Hadley E.
        • Angus D.C
        Toward an integrated research agenda for critical illness in aging.
        Am J Respir Crit Care Med. 2010; 182: 995-1003
        • Ferrante L.E.
        • Pisani M.A.
        • Murphy T.E.
        • Gahbauer E.A.
        • Leo-Summers L.S.
        • Gill T.M
        Factors associated with functional recovery among older intensive care unit survivors.
        Am J Respir Crit Care Med. 2016; 194: 299-307
        • Wang S.
        • Allen D.
        • Kheir Y.N.
        • Campbell N.
        • Khan B
        Aging and post-intensive care syndrome: a critical need for geriatric psychiatry.
        Am J Geriatr Psychiatry. 2018; 26: 212-221
        • Iwashyna T.J.
        • Ely E.W.
        • Smith D.M.
        • Langa K.M
        Long-term cognitive impairment and functional disability among survivors of severe sepsis.
        JAMA. 2010; 304: 1787-1794
        • Tanner R.E.
        • Brunker L.B.
        • Agergaard J.
        • et al.
        Age-related differences in lean mass, protein synthesis and skeletal muscle markers of proteolysis after bed rest and exercise rehabilitation.
        J Physiol Lond. 2015; 593: 4259-4273
        • Pelletier D.
        • Gingras-Hill C.
        • Boissy P
        Power training in patients with knee osteoarthritis: a pilot study on feasibility and efficacy.
        Physiother Can. 2013; 65: 176-182
        • Lima L.O.
        • Rodrigues-de-Paula F
        Recruitment rate, feasibility and safety of power training in individuals with Parkinson's disease: a proof-of-concept study.
        Braz J Phys Ther. 2013; 17: 49-56
        • Ni M.
        • Signorile J.F.
        • Balachandran A.
        • Potiaumpai M
        Power training induced change in bradykinesia and muscle power in Parkinson's disease.
        Parkinsonism Relat Disord. 2016; 23: 37-44
        • Yoon D.H.
        • Kang D.
        • Kim H.J.
        • Kim J.S.
        • Song H.S.
        • Song W
        Effect of elastic band-based high-speed power training on cognitive function, physical performance and muscle strength in older women with mild cognitive impairment.
        Geriatr Gerontol Int. 2017; 17: 765-772
        • Marra A.
        • Pandharipande P.P.
        • Girard T.D.
        • et al.
        Co-occurrence of post-intensive care syndrome problems among 406 survivors of critical illness.
        Crit Care Med. 2018; 46: 1393-1401
        • Morris P.E.
        • Berry M.J.
        • Files D.C.
        • et al.
        Standardized rehabilitation and hospital length of stay among patients with acute respiratory failure: a randomized clinical trial.
        JAMA. 2016; 315: 2694-2702