Clinical implication of thoracic skeletal muscle volume as predictors of weaning failure in brain-injured patients

SESSION TITLE: Mechanical Ventilation: Beyond the basics SESSION TYPE: Original Investigations PRESENTED ON: 10/09/2023 08:30 am - 09:30 am PURPOSE: Sarcopenia is a generalized loss of skeletal muscle mass and function. Although the development of sarcopenia is mainly related to aging, it has recently attracted attention in diagnosing and treating patients with brain injuries such as stroke. Brain injury-associated sarcopenia and modifications of the respiratory function may explain an increased risk of weaning failure in brain-injured patients. However, the relationship between sarcopenia and the weaning outcome has not been fully studied for patients with brain injury. In this study, we aimed to the influence of reduced respiratory muscle mass on ventilation weaning in patients with brain injury. METHODS: This observational study retrospectively reviewed the medical records of patients with brain injury from January 2017 to December 2019. The thoracic skeletal muscle volume measurement was retrieved from thoracic CT images and our institute’s three-dimensional modeling software program. The thoracic skeletal muscle volumes index (TSMVI) was normalized by dividing muscle volume by the square of height. Sarcopenia was defined as TSMVI less than the 50th sex-specific percentile. The primary outcome was a weaning failure, defined as requiring ventilator support within 48hr after a spontaneous breathing trial. Regression analyses were used to identify variables associated with weaning from mechanical ventilation. Additionally, the receiver operating characteristic (ROC) curve was examined to assess the ability of sarcopenia to predict a weaning outcome. RESULTS: Among 73 analyzed patients with brain injury, 12 (16.5%) patients failed to wean from mechanical ventilation. The patients in the weaning-failure group had a significantly higher SOFA score [7.8 ± 2.7 vs. 6.1 ± 2.2, P = 0.022] and lower thoracic skeletal muscle volume index [652.5 ± 252.4 vs. 1000.4 ± 347.3, P = 0.002] compared with those in the weaning success group. On multivariate analysis, sarcopenia was significantly associated with an increased risk of weaning failure (odds ratio (OR) 12.72, 95% confidence interval (CI) 2.87–70.48, p = 0.001). ROC curve analysis of the TSMVI for weaning outcomes was used to predict weaning failure more accurately. The AUC of the TSMVI to predict weaning failure was 0.840 (P < 0.001). CONCLUSIONS: Our study shows a significant association between TSMVI and weaning outcomes in patients with brain injury. CLINICAL IMPLICATIONS: This study is the first to demonstrate the usefulness of thoracic skeletal muscle volume as a risk assessment tool for weaning outcomes in patients with brain injury. Despite comorbidity or higher SOFA, sarcopenia is associated with increased weaning failure rates. Therefore, sarcopenia may benefit-risk stratification in patients with brain injury preparing for weaning from MV. Finally, thoracic skeletal muscle mass is an adjustable predictor, and sarcopenia can be used to determine appropriate nutritional interventions, which may improve weaning outcomes in patients with brain injury. DISCLOSURES: No relevant relationships by Youngick Ahn No relevant relationships by Hak-Ryul Kim No relevant relationships by jimi oh No relevant relationships by chul park