Increased duration of mechanical ventilation is associated with decreased diaphragmatic force: a prospective observational study.
Increased duration of mechanical ventilation is associated with decreased diaphragmatic force: a prospective observational study.
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DOI：
10.1186/cc9094
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发表时间：
2010
期刊：
影响因子：
--
通讯作者：
Gayan-Ramirez G
中科院分区：
文献类型：
--
作者：
Hermans G;Agten A;Testelmans D;Decramer M;Gayan-Ramirez G
呼吸肌无力是延迟脱机的重要危险因素。动物数据显示，机械通气本身可引起膈肌萎缩和虚弱，称为呼吸机诱导的膈肌功能障碍（VIDD）。磁刺激后的经颅压（TwPdi BAMPS）可用于评价膈肌强度。我们的目的是评价TwPdi BAMPS在危重机械通气患者中的可重复性，并描述TwPdi与机械通气持续时间之间的关系。这是一项在一所大学医院的重症监护室收治的重症和机械通气患者中进行的前瞻性观察性研究。共10例患者在开始机械通气后的不同时间间隔进行了19次测量。在7名患者中，测量了两次或更多次，最小间隔为24小时。TwPdi为11.5 ± 3.9 cm H2O（平均值± SD），表明重度呼吸肌无力。TwPdi的事件间变异系数为9.7%，与健康志愿者的数据相当。机械通气持续时间的增加与TwPdi的对数下降相关（R = 0.69; P = 0.038）。压力控制（R = 0.71; P = 0.03）和压力支持通气（P = 0.05; R = 0.66）的累积时间以及丙泊酚（R = 0.66; P = 0.05）和吡硝酰胺（R = 0.79; P = 0.01）的累积剂量也存在这种相关性。机械通气的持续时间与呼吸力的对数下降相关，这与VIDD的概念一致。观察到的下降也可能是由于其他潜在的影响因素，如镇静剂/镇痛剂、败血症或其他。
Respiratory muscle weakness is an important risk factor for delayed weaning. Animal data show that mechanical ventilation itself can cause atrophy and weakness of the diaphragm, called ventilator-induced diaphragmatic dysfunction (VIDD). Transdiaphragmatic pressure after magnetic stimulation (TwPdi BAMPS) allows evaluation of diaphragm strength. We aimed to evaluate the repeatability of TwPdi BAMPS in critically ill, mechanically ventilated patients and to describe the relation between TwPdi and the duration of mechanical ventilation. This was a prospective observational study in critically ill and mechanically ventilated patients, admitted to the medical intensive care unit of a university hospital. Nineteen measurements were made in a total of 10 patients at various intervals after starting mechanical ventilation. In seven patients, measurements were made on two or more occasions, with a minimum interval of 24 hours. The TwPdi was 11.5 ± 3.9 cm H2O (mean ± SD), indicating severe respiratory muscle weakness. The between-occasion coefficient of variation of TwPdi was 9.7%, comparable with data from healthy volunteers. Increasing duration of mechanical ventilation was associated with a logarithmic decline in TwPdi (R = 0.69; P = 0.038). This association was also found for cumulative time on pressure control (R = 0.71; P = 0.03) and pressure-support ventilation (P = 0.05; R = 0.66) separately, as well as for cumulative dose of propofol (R = 0.66; P = 0.05) and piritramide (R = 0.79; P = 0.01). Duration of mechanical ventilation is associated with a logarithmic decline in diaphragmatic force, which is compatible with the concept of VIDD. The observed decline may also be due to other potentially contributing factors such as sedatives/analgesics, sepsis, or others.
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影响因子：
38.9
作者：
Garnacho-Montero, J;Madrazo-Osuna, J;Moyano-Del-Estad, MR
通讯作者：
Moyano-Del-Estad, MR
影响因子：
8.8
作者：
Anzueto, A;Peters, JI;Coalson, JJ
通讯作者：
Coalson, JJ
影响因子：
38.9
作者：
Capdevila, X;Lopez, S;Prefaut, C
通讯作者：
Prefaut, C
影响因子：
38.9
作者：
Radell, PJ;Remahl, S;Eriksson, LI
通讯作者：
Eriksson, LI
DOI：
10.1164/rccm.200401-042oc
发表时间：
2004-09-15
影响因子：
24.7
作者：
Sassoon, CSH;Zhu, EC;Caiozzo, VJ
通讯作者：
Caiozzo, VJ