title: Trend of maximal inspiratory pressure in mechanically ventilated patients: predictors.
abstract: BACKGROUND
  It is known that mechanical ventilation and many of its features may affect the evolution of inspiratory muscle strength during ventilation. However, this evolution has not been described, nor have its predictors been studied. In addition, a probable parallel between inspiratory and limb muscle strength evolution has not been investigated.
  
  
  OBJECTIVE
  To describe the variation over time of maximal inspiratory pressure during mechanical ventilation and its predictors. We also studied the possible relationship between the evolution of maximal inspiratory pressure and limb muscle strength.
  
  
  METHODS
  A prospective observational study was performed in consecutive patients submitted to mechanical ventilation for > 72 hours. The maximal inspiratory pressure trend was evaluated by the linear regression of the daily maximal inspiratory pressure and a logistic regression analysis was used to look for independent maximal inspiratory pressure trend predictors. Limb muscle strength was evaluated using the Medical Research Council score.
  
  
  RESULTS
  One hundred and sixteen patients were studied, forty-four of whom (37.9%) presented a decrease in maximal inspiratory pressure over time. The members of the group in which maximal inspiratory pressure decreased underwent deeper sedation, spent less time in pressure support ventilation and were extubated less frequently. The only independent predictor of the maximal inspiratory pressure trend was the level of sedation (OR=1.55, 95% CI 1.003 - 2.408; p = 0.049). There was no relationship between the maximal inspiratory pressure trend and limb muscle strength.
  
  
  CONCLUSIONS
  Around forty percent of the mechanically ventilated patients had a decreased maximal inspiratory pressure during mechanical ventilation, which was independently associated with deeper levels of sedation. There was no relationship between the evolution of maximal inspiratory pressure and the muscular strength of the limb.
authors.affiliation: Respiratory Intensive Care Unit, Pulmonary Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil. pedrocaruso@uol.com.br
authors.forename: Pedro
authors.initials: P
authors.lastname: Caruso
authors.forename: Denise Simão
authors.initials: DS
authors.lastname: Carnieli
authors.forename: Keila Harue
authors.initials: KH
authors.lastname: Kagohara
authors.forename: Adriana
authors.initials: A
authors.lastname: Anciães
authors.forename: Jacqueline Santos
authors.initials: JS
authors.lastname: Segarra
authors.forename: Daniel
authors.initials: D
authors.lastname: Deheinzelin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008451:Maximal Voluntary Ventilation / Q000502:physiology*; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology*; D016017:Odds Ratio; D011446:Prospective Studies; D012044:Regression Analysis; D012121:Respiration, Artificial; D012132:Respiratory Muscles / Q000503:physiopathology*; D055815:Young Adult