Increased Diaphragmatic Contribution to Inspiratory Effort during Neurally Adjusted Ventilatory Assistance versus Pressure Support An Electromyographic Study
Increased Diaphragmatic Contribution to Inspiratory Effort during Neurally Adjusted Ventilatory Assistance versus Pressure Support An Electromyographic Study
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DOI：
10.1097/aln.0000000000000432
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发表时间：
2014-11-01
期刊：
影响因子：
8.8
通讯作者：
Similowski, Thomas
中科院分区：
文献类型：
--
作者：
Cecchini, Jerome;Schmidt, Matthieu;Similowski, Thomas
背景：神经调节通气辅助（NAVA）完全由横膈膜肌电图活动（EA）调节，可影响神经驱动在各吸气肌的分布。本研究的目的是比较12例机械通气患者根据通气方式和辅助水平的EAdi、斜角肌EA （EAscal）和鼻翼EA （EAan）。方法：7个辅助水平的压力支持通气（PSV）和NAVA依次应用。对EAdi、EAscal和EAan进行量化，并以其最大值的百分比表示。通过计算EAscal/EAdi和EAan/EAdi比值来评估膈外肌对吸气力的相对贡献。将导致EAdi值为80 ~ 100%、60 ~ 80%和40 ~ 60%的两种通气模式的辅助水平分别分配给三组（N1、N2和N3）。结果以中位数和四分位数范围表示。结果：PSV和NAVA时，吸气肌EA降低（P < 0.0001）。虽然EAdi在组内保持不变（P = 0.9），但与PSV相比，NAVA在N1和N3中降低了EAscal （NAVA为65%[62至64]和27%[18至34]，PSV为90%[81至100]和49%[40至55]，P = 0.007）。总的来说，NAVA患者的EAscal/EAdi和EAan/EAdi比PSV患者低（NAVA患者为0.7[0.6 ~ 0.7]和0.7 [0.6 ~ 0.8]，PSV患者为0.9[0.8 ~ 1.1]和0.9 [0.7 ~ 1.1],P < 0.05）。结论：NAVA和PSV均降低膈外吸气肌活动，与辅助水平成正比。与PSV相比，NAVA导致膈肌对吸气力的主要贡献。
Background: Neurally adjusted ventilatory assist (NAVA), regulated exclusively by the electromyographic activity (EA) of the diaphragm (EAdi), could affect the distribution of neural drive to the various inspiratory muscles. The objective of this study was to compare EAdi, EA of the scalene (EAscal), and EA of the alae nasi (EAan), according to the ventilatory mode and assist level in 12 mechanically ventilated patients.Methods: Seven assist levels of pressure support ventilation (PSV) and NAVA were sequentially applied. EAdi, EAscal, and EAan were quantified and expressed as a percentage of their maximum values. The relative contributions of extradiaphragmatic muscles to inspiratory efforts were assessed by calculating EAscal/EAdi and EAan/EAdi ratios. Three assist levels for each of the two ventilatory modes that resulted in EAdi values of 80 to 100%, 60 to 80%, and 40 to 60% were assigned to three groups (N1, N2, and N3). Results are expressed as median and interquartile range.Results: EA of inspiratory muscles decreased during PSV and NAVA (P < 0.0001). Although EAdi remained constant within groups (P = 0.9), EAscal was reduced during NAVA compared with PSV in N1 and N3 (65% [62 to 64] and 27% [18 to 34] in NAVA vs. 90% [81 to 100] and 49% [40 to 55] in PSV, P = 0.007). Altogether, EAscal/EAdi and EAan/EAdi ratios were lower in NAVA than PSV (0.7 [0.6 to 0.7] and 0.7 [0.6 to 0.8] in NAVA vs. 0.9 [0.8 to 1.1] and 0.9 [0.7 to 1.1] in PSV, P < 0.05).Conclusions: NAVA and PSV both reduced extradiaphragmatic inspiratory muscle activity, in proportion to the level of assistance. Compared with PSV, NAVA resulted in a predominant contribution of the diaphragm to inspiratory effort.