The Predictive Value Of Grip Strength On Weaning Outcome Of Elderly Patients With Endotracheal Intubation And Mechanical Ventilation In ICU

Research Purpose:The purpose of this study was to explore the predictive value of grip strength level on the outcome of weaning of patients,and to seek the best cutoff value of grip strength for weaning failure of elderly patients with mechanical ventilation of different genders,so as to provide a simple auxiliary reference index for clinical medical staff to evaluate whether patients have weaning conditions,better choose the time of weaning,and reduce the rate of weaning failure.Research Methods:In this study,236 cases of mechanically ventilated patients who met the inclusion and exclusion criteria and were admitted to the intensive care unit of a third-class A hospital in Zhejiang Province from January 2020 to December 2020 were selected as the research objects.After the patients passed the weaning screening test,the average level of left and right hand grip strength was measured.The attending physician conducted the spontaneous breathing trial on the patients without knowing the results of grip strength measurement.If the trial was successful,the attending physician would divide the patients into weaning success and weaning failure group based on the outcomes of weaning according to the reference guidelines and clinical experience.Univariate analysis was conducted on the data of the two groups of patients to find out the related factors of weaning failure,and binary Logistic regression analysis was used to find out the independent influencing factors of weaning failure.ROC curve was used to evaluate the predictive value of patients’grip strength level on weaning outcome.Research Results:1.A total of 236 cases of patients were included in this study,52 of whom had weaning failure,with a failure rate of 22.03%.Univariate analysis showed that there were 6 factors related to patients’weaning failure,including the history of lung disease,hand grip strength,mechanical ventilation time before weaning,APACHE II score at admission,APACHE II score at weaning,and duration of sedative drugs,while other factors showed no statistical significance between the two groups(P>0.05).2.Bariate Logistic regression analysis showed that high grip strength(OR=0.705,95%CI:0.603～0.825,P<0.001)was an independent protective factor for weaning failure,while high APACHE II score(OR=1.438,95%CI:1.238～1.670,P<0.001)and long mechanical ventilation time before weaning(OR=1.836,95%CI:1.304～2.585,P=0.001)were independent risk factors for weaning failure.The regression equation was as follows:Logit(P)=-4.114-0.349×grip strength+0.363×APACHE II score+0.608×mechanical ventilation time before weaning.According to the ROC curve,the AUC is 0.932,the sensitivity is 84.6%,the specificity is95.1%,and the prediction accuracy is 90.3%,indicating that the model has good efficiency.Hosmer-Lemeshow test showed that the model had good goodness of fit(?~2=10.100,P=0.258).3.ROC curve was drawn according to the relationship among grip strength levels,APACHE II score while weaning,mechanical ventilate time before weaning and weaning outcome.The results showed that the AUC of grip strength to predict the weaning outcome of patients was 0.798,and the best cutoff value was 13.1kg.When grip strength was≤13.1 kg,the sensitivity and specificity to predict the weaning failure of patients was 86.5%and 64.7%.The AUC of the APACHE II score for predicting the weaning outcome was 0.741,and the best cutoff value was 9points.When the APACHE II score was>9 points,the sensitivity and specificity of the APACHE II score for predicting the weaning failure of patients was 82.7%and 50.5%.The AUC of mechanical ventilation time before weaning to predict weaning outcome was 0.821,and the best cutoff value was 6.17 days.When the mechanical ventilation time before weaning was>6.17 days,the sensitivity and specificity of weaning failure were 67.3%and 83.2%respectively.4.Because the grip strength is a gender specific indicator,the ROC curve will be made according to different genders respectively.The results showed that men’s AUC with grip strength prediction of weaning outcome was 0.815,while the best cutoff value was 13.1 kg.When grip strength is≤13.1 kg,it predict the sensitivity and specificity of the male patients weaning failure was 77.4%,80.5%,positive likelihood ratio and negative likelihood ratio was 3.97 and 0.28respectively,positive predictive value and negative predictive value were 50.0%and 93.4%respectively,false positive rate and false negative rate were 19.5%and 22.6%respectively,the accuracy is 79.9%.Grip strength prediction of female patients weaning outcome AUC was 0.801,the best cutoff value was 9.4 kg.When grip strength was≤9.4 kg,predict the sensitivity of the female patients weaning failure with specific degrees were respectively 76.2%and 83.6%,positive likelihood ratio and negative likelihood ratio is 4.65 and 0.28 respectively,positive predictive value and negative predictive value were 61.5%and 83.6%respectively,false positive rate and false negative rate were 16.4%and 23.8%respectively,the accuracy was 81.7%.Research Conclusion:1.High grip strength was an independent protective factor for weaning failure in elderly patients with endotracheal intubation mechanical ventilation,high APACHE II score at weaning time and long time of mechanical ventilation before weaning were independent risk factors for weaning failure in elderly patients with endotracheal intubation mechanical ventilation.2.The level of grip strength can effectively predict the weaning outcome of elderly patients with endotracheal intubation and mechanical ventilation.When the grip strength of male patients was≤13.1kg and that of female patients was≤9.4kg,the risk of weaning failure of patient’s increased.