Qian Zhang,1 Xiaomei Wang,1 Mingzhe Liu,1 Bin Li,1 Kun Zhang,1 Yaqi Han,1 Jiali Li,2 Yan Xin,3 Yan Huo,1 Zhenjie Hu1 

1Department of Intensive Care Unit, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, 050000, People’s Republic of China; 2Department of Intensive Care Unit, The Sixth People’s Hospital of Hengshui, Hengshui, Hebei Province, 053000, People’s Republic of China; 3Department of Intensive Care Unit, The Third Hospital of Shijiazhuang, Shijiazhuang, Hebei Province, 050000, People’s Republic of China

Correspondence: Yan Huo; Zhenjie Hu, Department of Intensive Care Unit, The Fourth Hospital of Hebei Medical University, No. 12 of Jiankang Road, Changan District, Shijiazhuang, 050011, People’s Republic of China, Tel +86 311 86095367, Email huoyan523@hebmu.edu.cn; 46400533.hebmu.edu.cn

Objective: The aim of this study is to examine the diagnostic significance of using handgrip dynamometry and diaphragmatic ultrasound in intensive care unit-acquired weakness (ICU-AW).
Methods: This study included patients who received mechanical ventilation in the ICU at the Fourth Hospital of Hebei Medical University from July to December 2020. We collected comprehensive demographic data and selected conscious patients for muscle strength and ICU-AW assessments. The evaluation comprised grip strength measurement and bedside ultrasound for diaphragmatic excursion (DE) and thickening fraction (DTF). Results were documented for comparative analysis between patient groups, focusing on the diagnostic efficacy of grip strength, DE, DTF, and their combined application in diagnosing ICU-AW.
Results: A total of 95 patients were initially considered for inclusion in this study. Following the exclusion of 20 patients, a final cohort of 75 patients were enrolled, comprising of 32 patients (42.6%) diagnosed with ICU-AW and 43 patients (57.4%) classified as non-ICU-AW. Comparative analysis revealed that grip strength, DE, and DTF were significantly lower in the ICU-AW group (P < 0.05). Subgroup analysis specific to male patients demonstrated a noteworthy decrease in grip strength, DE, and DTF within the ICU-AW group (P < 0.05). Receiver operating characteristic curve analysis indicated statistically significant diagnostic value for ICU-AW with grip strength, DE, DTF, and grip strength and diaphragmatic ultrasound (P < 0.01). Furthermore, it was observed that the amalgamation of grip strength and diaphragmatic ultrasound significantly enhanced the diagnostic accuracy of ICU-AW in patients who are critically ill.
Conclusion: Grip strength, DE, DTF, and the combined use of grip strength with diaphragm ultrasound demonstrated diagnostic efficacy in ICU-AW. Notably, the integration of grip strength with diaphragm ultrasound exhibited a heightened capacity to enhance the diagnostic value specifically in patients diagnosed who are critically ill with ICU-AW.

Keywords: diaphragmatic excursion, diaphragm thickening fraction, handgrip dynamometer, ICU acquired weakness