Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Keenan Research Centre and Li Ka Shing Knowledge Institute, Unity Health Toronto (St. Michael's Hospital) Toronto, ON, Canada.
Department of Anesthesia, Critical Care Medicine and Emergency, Spedali Civili University Hospital, Brescia, Italy.
Chest. 2021 Oct;160(4):1316-1325. doi: 10.1016/j.chest.2021.05.053. Epub 2021 Jun 6.
Ultrasound may be useful to assess the structure, activity, and function of the abdominal muscles in patients who are mechanically ventilated.
Does measurement of abdominal muscle thickening on ultrasound in patients who are mechanically ventilated provide clinically relevant information about abdominal muscle function and weaning outcomes?
This study consisted of two parts, a physiological study conducted in healthy subjects and a prospective observational study in patients who were mechanically ventilated. Abdominal muscle thickness and thickening fraction were measured during cough and expiratory efforts in 20 healthy subjects, and prior to and during a spontaneous breathing trial in 57 patients being ventilated.
In healthy subjects, internal oblique and rectus abdominis thickening fraction correlated with pressure generated during expiratory efforts (P < .001). In patients being ventilated, abdominal muscle thickness and thickening fraction were feasible to measure in all patients, and reproducibility was moderately acceptable. During a failed spontaneous breathing trial, thickening fraction of transversus abdominis and internal oblique increased substantially from baseline (13.2% [95% CI, 0.9-24.8] and 7.2% [95% CI, 2.2-13.2], respectively). The combined thickening fraction of transversus abdominis, internal oblique, and rectus abdominis measured during cough was associated with an increased risk of reintubation or reconnection to the ventilator following attempted liberation (OR, 2.1; 95% CI, 1.1-4.4 per 10% decrease in thickening fraction).
Abdominal muscle thickening on ultrasound was correlated to the airway pressure generated by expiratory efforts. In patients who were mechanically ventilated, abdominal muscle ultrasound measurements are feasible and moderately reproducible. Among patients who passed a spontaneous breathing trial, reduced abdominal muscle thickening during cough was associated with a high risk of liberation failure.
ClinicalTrials.gov; No.: NCT03567564; URL: www.clinicaltrials.gov.
超声检查可能有助于评估机械通气患者腹部肌肉的结构、活动和功能。
机械通气患者的腹部肌肉超声测量值能否提供与腹部肌肉功能和撤机结局相关的临床相关信息？
本研究由两部分组成，一部分是在健康受试者中进行的生理学研究，另一部分是在机械通气患者中进行的前瞻性观察性研究。在 20 名健康受试者中，在咳嗽和呼气努力期间测量了腹内斜肌和腹直肌的厚度和增厚分数，在 57 名接受通气的患者中，在进行自主呼吸试验之前和期间测量了厚度和增厚分数。
在健康受试者中，腹内斜肌和腹直肌的增厚分数与呼气努力时产生的压力相关（P<0.001）。在接受通气的患者中，所有患者均能测量到腹部肌肉的厚度和增厚分数，且可重复性中等。在自主呼吸试验失败时，横突肌和腹内斜肌的增厚分数从基线显著增加（分别为 13.2%（95%CI，0.9-24.8）和 7.2%（95%CI，2.2-13.2））。咳嗽时测量的腹横肌、腹内斜肌和腹直肌的联合增厚分数与尝试撤机后再次插管或重新连接呼吸机的风险增加相关（OR，2.1；95%CI，1.1-4.4，每减少 10%的增厚分数）。
超声检查显示腹部肌肉增厚与呼气努力时产生的气道压力相关。在接受机械通气的患者中，腹部肌肉超声测量是可行的，且具有中等可重复性。在通过自主呼吸试验的患者中，咳嗽时腹部肌肉增厚减少与撤机失败的高风险相关。
ClinicalTrials.gov；编号：NCT03567564；网址：www.clinicaltrials.gov。
