膈肌肌病：急性呼吸衰竭中导致通气时间延长和患者预后不良的中介因素。

Diaphragmatic myotrauma: a mediator of prolonged ventilation and poor patient outcomes in acute respiratory failure.

机构信息

Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Department of Medicine, Division of Respirology, University Health Network, Toronto, ON, Canada; Toronto General Hospital Research Institute, Toronto, ON, Canada.

Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada.

出版信息

Lancet Respir Med. 2019 Jan;7(1):90-98. doi: 10.1016/S2213-2600(18)30366-7. Epub 2018 Nov 16.

DOI:10.1016/S2213-2600(18)30366-7

PMID:30455078

Abstract

Several mechanisms of diaphragm muscle injury (myotrauma) can result in ventilator-induced diaphragm dysfunction, including ventilator over-assistance, under-assistance, eccentric contractions, and end-expiratory shortening. In this Personal View, we summarise the evidence for the clinical relevance of these mechanisms, and present new data based on mediation analysis supporting the hypothesis that myotrauma due to ventilator over-assistance and under-assistance contribute, in part, to the effect of mechanical ventilation on clinical outcomes. The concept of diaphragmatic myotrauma has important implications for research and clinical practice.

摘要

几种膈肌肌肉损伤（肌损伤）的机制可导致呼吸机诱导的膈肌功能障碍，包括呼吸机过度辅助、辅助不足、偏心收缩和呼气末缩短。在本个人观点中，我们总结了这些机制的临床相关性证据，并提出了基于中介分析的新数据，支持了呼吸机过度辅助和辅助不足导致的肌损伤部分导致机械通气对临床结果影响的假设。膈肌肌损伤的概念对研究和临床实践具有重要意义。