De Jonghe Bernard, Bastuji-Garin Sylvie, Durand Marie-Christine, Malissin Isabelle, Rodrigues Pablo, Cerf Charles, Outin Hervé, Sharshar Tarek
Réanimation Médico-chirurgicale, Centre Hospitalier de Poissy-Saint-Germain en Laye, Poissy, France.
Crit Care Med. 2007 Sep;35(9):2007-15. doi: 10.1097/01.ccm.0000281450.01881.d8.
Although critical illness neuromyopathy might interfere with weaning from mechanical ventilation, its respiratory component has not been investigated. We designed a study to assess the level of respiratory muscle weakness emerging during the intensive care unit stay in mechanically ventilated patients and to examine the correlation between respiratory and limb muscle strength and the specific contribution of respiratory weakness to delayed weaning.
Prospective observational study.
Two medical, one surgical, and one medicosurgical intensive care units in two university hospitals and one university- affiliated hospital.
A total of 116 consecutive patients were enrolled after >or=7 days of mechanical ventilation.
None.
Maximal inspiratory and expiratory pressures and vital capacity were measured via the tracheal tube on the first day of return to normal consciousness. Muscle strength was measured using the Medical Research Council score. After standardized weaning, successful extubation was defined as the day from which mechanical ventilatory support was no longer required within the next 15 days. The median value (interquartile range) of maximal inspiratory pressure was 30 (20-40) cm H2O, maximal expiratory pressure was 30 (20-50) cm H2O, and vital capacity was 11.1 (6.3-19.8) mL/kg. Maximal inspiratory pressure, maximal expiratory pressure, and vital capacity were significantly correlated with the Medical Research Council score. The median time (interquartile range) from awakening to successful extubation was 6 (1-17) days. Low maximal inspiratory pressure (hazard ratio, 1.86; 95% confidence interval, 1.07-3.23), maximal expiratory pressure (hazard ratio, 2.18; 95% confidence interval, 1.44-3.84), and Medical Research Council score (hazard ratio, 1.96; 95% confidence interval, 1.27-3.02) were independent predictors of delayed extubation. Septic shock before awakening was significantly associated with respiratory weakness (odds ratio, 3.17; 95% confidence interval, 1.17-8.58).
Respiratory and limb muscle strength are both altered after 1 wk of mechanical ventilation. Respiratory muscle weakness is associated with delayed extubation and prolonged ventilation. In our study, septic shock is a contributor to respiratory weakness.
尽管危重病性神经肌肉病可能会干扰机械通气的撤机过程，但其呼吸方面的影响尚未得到研究。我们设计了一项研究，以评估机械通气的重症监护病房患者在住院期间出现的呼吸肌无力程度，并研究呼吸肌与肢体肌肉力量之间的相关性，以及呼吸肌无力对延迟撤机的具体影响。
前瞻性观察性研究。
两所大学医院和一所大学附属医院的两个内科、一个外科及一个内外科重症监护病房。
共纳入116例机械通气≥7天的连续患者。
无。
在恢复正常意识的第一天，通过气管导管测量最大吸气压、最大呼气压和肺活量。使用医学研究委员会评分法测量肌肉力量。在标准化撤机后，成功拔管定义为在接下来15天内不再需要机械通气支持的日期。最大吸气压的中位数（四分位间距）为30（20 - 40）cmH₂O，最大呼气压为30（20 - 50）cmH₂O，肺活量为11.1（6.3 - 19.8）mL/kg。最大吸气压、最大呼气压和肺活量与医学研究委员会评分显著相关。从苏醒到成功拔管的中位时间（四分位间距）为6（1 - 17）天。低最大吸气压（风险比，1.86；95%置信区间，1.07 - 3.23）、最大呼气压（风险比，2.18；95%置信区间，1.44 - 3.84）和医学研究委员会评分（风险比，1.96；95%置信区间，1.27 - 3.02）是延迟拔管的独立预测因素。苏醒前的感染性休克与呼吸肌无力显著相关（比值比，3.17；95%置信区间，1.17 - 8.58）。
机械通气1周后，呼吸肌和肢体肌肉力量均发生改变。呼吸肌无力与延迟拔管和通气时间延长有关。在我们的研究中，感染性休克是呼吸肌无力的一个因素。
