LETTER TO THE EDITOR
Dear authors,
We thank you for the comments on the article titled "Influence of peripheral muscle strength on the decannulation success rate", recently published in this journal.(1) We do agree that the study design (case control study) is disposed to bias and confounding factors as no clear event sequence, such as standardized physiotherapy care, is established.
Therefore, our understanding is that this subject should be better assessed by longitudinal trials, including larger patient samples, in order to provide better evidence for the association between peripheral muscle strength and the decannulation process. However, as this was a short-term and low-cost study, appropriate for small samples, it provides odds ratio results, which usually provide a good approximation to the relative risk for uncommon outcomes.
In this study, several diseases, including diabetes mellitus (DM) and septic complications of the underlying disease, led to the patients' intensive care unit admissions and mechanical ventilation (MV). Although the causes leading to MV were not discussed in this study, no significant intergroup (success or failure) difference was identified during the sample characterization that could have had a direct influence on the decannulation procedure outcome.
The influence of DM and sepsis on the decannulation process was not described in the study report, but their pernicious effects on peripheral muscle structure as assessed by the Medical Research Council (MRC) proposed strength score are presented(2); these clinical conditions are considered risk factors for the paresis of critically ill patients. According to De Jonghe et al.(3), glycemic changes and sepsis are common during early critical disease phases and are frequently considered as risk factors for intensive care unit-acquired paresis. Van den Berghe et al.(4) suggest that maintaining normal glycemic levels can prevent and mitigate polyneuropathy among critically ill patients. Therefore, we believe that both factors can have a determinant impact on peripheral muscle strength and, consequently, may have contributed to the decannulation process outcome.
Therefore, we would like to thank you for your comments and reiterate that new studies are necessary for a better understanding of the influence of peripheral muscle strength on the outcome of the decannulation process.
Sincerely,
Andrezza de Lemos Bezerra
General Intensive Care Unit, Hospital Agamenon Magalhães; Physiotherapy Course of the Faculdade Pernambucana de Saúde - Recife (PE), Brazil.
Marçal Durval Siqueira Paiva Júnior
General Intensive Care Unit, Hospital Agamenon Magalhães; Intensive Care Unit, Hospital Dom Helder - Recife (PE), Brazil.
Flávio Maciel Dias Andrade
Physiotherapy Course, Universidade Católica de Pernambuco and Faculdade Integrada do Recife - Recife (PE), Brazil
Eduardo Eriko Tenório França
Residency Program in Intensive Care Physiotherapy, Hospital Agamenon Magalhães - HAM - Recife(PE), Brazil; Physiotherapy Course, Universidade Católica de Pernambuco - Recife (PE), Brazil.
REFERENCES
- 1. Lima CA, Siqueira TB, Travassos EF, Macedo CMG, Bezerra AL, Paiva Júnior MDS, Andrade FMD, França EET. Influência da força da musculatura periférica no sucesso da decanulação. Rev Bras Ter Intensiva. 2011;23(1):56-61
- 2. Witt NJ, Zochodne DW, Bolton CF, Grand'Maison F, Wells G, Young GB, Sibbald WJ. Peripheral nerve function in sepsis and multiple organ failure. Chest. 1991;99(1):176-84.
- 3. De Jonghe B, Sharshar T, Hopkinson N, Outin H. Paresis following mechanical ventilation. Curr Opin Crit Care. 2004;10(1):47-52. Review.
- 4. Van den Berghe G, Wouters PJ, Bouillon R, Weekers F, Verwaest C, Schetz M, et al. Outcome benefit of intensive insulin therapy in the critically ill: Insulin dose versus glycemic control. Crit Care Med. 2003;31(2):359-66.
Influence of peripheral muscle strength on the decannulation success rate
Publication Dates
-
Publication in this collection
24 Oct 2011 -
Date of issue
Sept 2011
