Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 4th Floor, Room 411, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada.
Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
Crit Care. 2021 Jan 11;25(1):26. doi: 10.1186/s13054-020-03435-y.
In patients intubated for mechanical ventilation, prolonged diaphragm inactivity could lead to weakness and poor outcome. Time to resume a minimal diaphragm activity may be related to sedation practice and patient severity.
Prospective observational study in critically ill patients. Diaphragm electrical activity (EAdi) was continuously recorded after intubation looking for resumption of a minimal level of diaphragm activity (beginning of the first 24 h period with median EAdi > 7 µV, a threshold based on literature and correlations with diaphragm thickening fraction). Recordings were collected until full spontaneous breathing, extubation, death or 120 h. A 1 h waveform recording was collected daily to identify reverse triggering.
Seventy-five patients were enrolled and 69 analyzed (mean age ± standard deviation 63 ± 16 years). Reasons for ventilation were respiratory (55%), hemodynamic (19%) and neurologic (20%). Eight catheter disconnections occurred. The median time for resumption of EAdi was 22 h (interquartile range 0-50 h); 35/69 (51%) of patients resumed activity within 24 h while 4 had no recovery after 5 days. Late recovery was associated with use of sedative agents, cumulative doses of propofol and fentanyl, controlled ventilation and age (older patients receiving less sedation). Severity of illness, oxygenation, renal and hepatic function, reason for intubation were not associated with EAdi resumption. At least 20% of patients initiated EAdi with reverse triggering.
Low levels of diaphragm electrical activity are common in the early course of mechanical ventilation: 50% of patients do not recover diaphragmatic activity within one day. Sedatives are the main factors accounting for this delay independently from lung or general severity. Trial Registration ClinicalTrials.gov (NCT02434016). Registered on April 27, 2015. First patients enrolled June 2015.
在接受机械通气插管的患者中，长时间膈肌失用可能导致肌无力和预后不良。恢复膈肌最小活动的时间可能与镇静实践和患者严重程度有关。
对危重症患者进行前瞻性观察研究。在插管后连续记录膈肌电活动（EAdi），寻找恢复膈肌最小活动水平的起点（最初 24 小时内 EAdi 中位数＞7μV，这一阈值基于文献和与膈肌增厚分数的相关性）。记录收集直至完全自主呼吸、拔管、死亡或 120 小时。每天采集 1 小时的波形记录以识别反向触发。
共纳入 75 例患者，其中 69 例进行了分析（平均年龄±标准差为 63±16 岁）。通气原因分别为呼吸（55%）、血流动力学（19%）和神经（20%）。发生 8 次导管脱落。EAdi 恢复的中位时间为 22 小时（0-50 小时的四分位间距）；69 例患者中有 35 例（51%）在 24 小时内恢复活动，而 4 例在 5 天后仍未恢复。延迟恢复与镇静药物的使用、丙泊酚和芬太尼的累积剂量、控制通气和年龄（年龄较大的患者接受较少的镇静）有关。疾病严重程度、氧合、肾功能和肝功能、插管原因与 EAdi 恢复无关。至少 20%的患者以反向触发开始 EAdi。
在机械通气的早期，膈肌电活动水平较低很常见：50%的患者在一天内无法恢复膈肌活动。镇静剂是导致这种延迟的主要因素，与肺部或全身严重程度无关。
试验注册ClinicalTrials.gov（NCT02434016）。于 2015 年 4 月 27 日注册。2015 年 6 月开始招募首批患者。
