Predictors of ventilator weaning in individuals with high cervical spinal cord injury
Predictors of ventilator weaning in individuals with high cervical spinal cord injury
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DOI：
10.1080/10790268.2008.11753984
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发表时间：
2008-01-01
影响因子：
1.7
通讯作者：
Forchheimer, Martin
中科院分区：
文献类型：
--
作者：
Chiodo, Anthony E.;Scelza, William;Forchheimer, Martin
背景/目的：评估哪些测试最能预测呼吸机依赖性四肢瘫痪患者脱离呼吸机的能力。方法：回顾性分析患者。参与者：26例呼吸机依赖性四肢瘫痪患者入住一所大学的脊髓损伤康复中心，美国脊髓损伤协会（ASIA）损伤等级为C2至C6，A或B。结果：未能完全脱离呼吸机的预测缺乏运动单位招聘的一个半隔膜或至少中度减少招聘针肌电图（EMG）在两个半隔膜。膈神经传导研究可以预测，所有脱离呼吸机的患者都会失败。横膈膜透视检查和床旁肺功能测定不能很好地预测脱机能力，分别有44%和19%的病例不能准确预测。ASIA检查也不完全预测，和任何离群值，可能已经预计断奶ASIA检查（即C4或更低的神经水平）的基础上，预测不断奶针electromyography.Conclusions：负吸气力隔膜针肌电图最好的预测能力，从呼吸机断奶。床旁肺功能测定（负吸气力和用力肺活量）是一种准确的床旁测量患者是否准备好脱机。透视检查的膈和膈神经传导的研究是没有帮助的，以确定脱机的潜力呼吸机依赖患者颈椎损伤。
Background/Objective: To evaluate which tests best predict the ability of patients with ventilator-dependent tetraplegia to wean from the ventilator.Methods: Retrospective review of patients.Participants: Twenty-six ventilator-dependent patients with tetraplegia admitted to a university inpatient spinal cord-injury rehabilitation unit with American Spinal Injury Association (ASIA) injury levels C2 to C6, A or B.Results: Failure to wean off the ventilator completely was predicted by absence of motor unit recruitment of one hemidiaphragm or at least moderate decreased recruitment with needle electromyography (EMG) in both hemidiaphragms. Phrenic nerve conduction studies would have predicted that all patients who weaned off the ventilator would have failed. Fluoroscopic examination of the diaphragm and bedside spirometry were not as good predictors of ability to wean, failing to predict accurately in 44% and 19% of cases, respectively. ASIA examination was also not entirely predictive, and any outliers that may have been expected to wean based on ASIA examination (ie, C4 or lower neurological levels) were predicted not to wean by needle electromyography.Conclusions: Negative inspiration force diaphragm needle EMG best predicted the ability to wean from the ventilator. Bedside spirometry (negative inspiratory force and forced vital capacity) is an accurate bedside measure of a patient's readiness to wean. Fluoroscopic examination of the diaphragm and phrenic nerve conduction studies were not helpful in determining weaning potential in ventilator-dependent patients with cervical spine injury.