Buscher H, Valta P, Boie T, Hinz J, Moerer O, Sydow M, Mudaliar M Y, Burchardi H
Department of Anesthesiology, Emergency Medicine and Intensive Care, University of Göttingen, Germany.
Anaesth Intensive Care. 2005 Aug;33(4):483-91. doi: 10.1177/0310057X0503300410.
The objective of this study was to evaluate a non-volitional measurement to assess diaphragmatic function in intubated and mechanically ventilated patients in a prospective pilot interventional clinical trial. The study was conducted in an 18-bed postoperative intensive care unit based at a university hospital. Patients were prospectively assigned to two groups. Group 1 consisted of eight patients with ventilator weaning failure. Group 2 consisted of eight intubated and ventilated patients who were studied shortly after major surgery and were successfully extubated there-after The twitch pressure response after cervical magnetic stimulation of the phrenic nerves was measured at the endotracheal tube at different PEEP levels. In group 2 the twitch transdiaphragmatic pressure, defined as the difference between twitch gastric and twitch oesophageal pressure was also evaluated. In group 1 the mean twitch pressure at the endotracheal tube on PEEP 0, 5 and 10 cmH2O was 5.2, 4.5 and 2.6 cmH2O: In group 2 this was significantly higher (15.1 cmH2O on PEEP 0 and 12.2 cmH2O on PEEP 5). A good correlation was found between twitch diaphragmatic pressure and twitch pressure at the endotracheal tube (r2 = 0.96) and between twitch oesophageal pressure and twitch pressure at the endotracheal tube (r2 = 0.98). Patients with weaning failure have significantly lower twitch pressure at the endotracheal tube suggesting diaphragmatic dysfunction. Twitch pressure at the endotracheal tube may be a useful parameter to screen for diaphragmatic dysfunction in intubated critically ill patients. Further studies are needed to confirm these preliminary findings.
本研究的目的是在一项前瞻性试点干预性临床试验中，评估一种非自主测量方法，以评估插管并接受机械通气患者的膈肌功能。该研究在一家大学医院的18张床位的术后重症监护病房进行。患者被前瞻性地分为两组。第1组由8例撤机失败的患者组成。第2组由8例插管并接受通气的患者组成，这些患者在大手术后不久接受研究，随后成功拔管。在不同呼气末正压（PEEP）水平下，于气管内导管处测量膈神经经颈部磁刺激后的抽搐压力反应。在第2组中，还评估了抽搐跨膈压，其定义为抽搐胃内压与抽搐食管压之差。在第1组中，PEEP为0、5和10 cmH₂O时气管内导管处的平均抽搐压力分别为5.2、4.5和2.6 cmH₂O；在第2组中，该压力显著更高（PEEP为0时为15.1 cmH₂O，PEEP为5时为12.2 cmH₂O）。发现抽搐膈肌压力与气管内导管处的抽搐压力之间具有良好的相关性（r² = 0.96），并且抽搐食管压力与气管内导管处的抽搐压力之间也具有良好的相关性（r² = 0.98）。撤机失败的患者气管内导管处的抽搐压力显著更低，提示膈肌功能障碍。气管内导管处的抽搐压力可能是筛查插管重症患者膈肌功能障碍的有用参数。需要进一步研究来证实这些初步发现。
