Spadaro Savino, Dalla Corte Francesca, Scaramuzzo Gaetano, Grasso Salvatore, Cinnella Gilda, Rosta Valentina, Chiavieri Valentina, Alvisi Valentina, Di Mussi Rosa, Volta Carlo Alberto, Bellini Tiziana, Trentini Alessandro
Department of Translational Medicine, Anesthesia and Intensive Care, University of Ferrara, Ferrara, Italy.
Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy.
Front Med (Lausanne). 2021 Dec 22;8:770408. doi: 10.3389/fmed.2021.770408. eCollection 2021.
Patients with acute respiratory failure (ARF) may need mechanical ventilation (MV), which can lead to diaphragmatic dysfunction and muscle wasting, thus making difficult the weaning from the ventilator. Currently, there are no biomarkers specific for respiratory muscle and their function can only be assessed trough ultrasound or other invasive methods. Previously, the fast and slow isoform of the skeletal troponin I (fsTnI and ssTnI, respectively) have shown to be specific markers of muscle damage in healthy volunteers. We aimed therefore at describing the trend of skeletal troponin in mixed population of ICU patients undergoing weaning from mechanical ventilation and compared the value of fsTnI and ssTnI with diaphragmatic ultrasound derived parameters. In this prospective observational study we enrolled consecutive patients recovering from acute hypoxemic respiratory failure (AHRF) within 24 h from the start of weaning. Every day an arterial blood sample was collected to measure fsTnI, ssTnI, and global markers of muscle damage, such as ALT, AST, and CPK. Moreover, thickening fraction (TF) and diaphragmatic displacement (DE) were assessed by diaphragmatic ultrasound. The trend of fsTnI and ssTnI was evaluated during the first 3 days of weaning. We enrolled 62 consecutive patients in the study, with a mean age of 67 ± 13 years and 43 of them (69%) were male. We did not find significant variations in the ssTnI trend ( = 0.623), but fsTnI significantly decreased over time by 30% from Day 1 to Day 2 and by 20% from Day 2 to Day 3 ( < 0.05). There was a significant interaction effect between baseline ssTnI and DE [ = 4.396, = 0.015], with high basal levels of ssTnI being associated to a higher decrease in DE. On the contrary, the high basal levels of fsTnI at day 1 were characterized by significant higher DE at each time point. Skeletal muscle proteins have a distinctive pattern of variation during weaning from mechanical ventilation. At day 1, a high basal value of ssTnI were associated to a higher decrease over time of diaphragmatic function while high values of fsTnI were associated to a higher displacement at each time point.
急性呼吸衰竭（ARF）患者可能需要机械通气（MV），这可能导致膈肌功能障碍和肌肉萎缩，从而使撤机变得困难。目前，尚无针对呼吸肌的生物标志物，其功能只能通过超声或其他侵入性方法进行评估。此前，骨骼肌肌钙蛋白I的快、慢亚型（分别为fsTnI和ssTnI）已被证明是健康志愿者肌肉损伤的特异性标志物。因此，我们旨在描述接受机械通气撤机的ICU患者混合群体中骨骼肌肌钙蛋白的变化趋势，并将fsTnI和ssTnI的值与膈肌超声衍生参数进行比较。在这项前瞻性观察研究中，我们纳入了从撤机开始24小时内从急性低氧性呼吸衰竭（AHRF）中恢复的连续患者。每天采集动脉血样本以测量fsTnI、ssTnI以及肌肉损伤的整体标志物，如ALT、AST和CPK。此外，通过膈肌超声评估增厚分数（TF）和膈肌位移（DE）。在撤机的前3天评估fsTnI和ssTnI的变化趋势。我们在研究中纳入了62例连续患者，平均年龄为67±13岁，其中43例（69%）为男性。我们未发现ssTnI变化趋势有显著差异（=0.623），但fsTnI随时间显著下降，从第1天到第2天下降30%，从第2天到第3天下降20%（<0.05）。基线ssTnI与DE之间存在显著的交互作用效应[=4.396，=0.015]，ssTnI的高基础水平与DE的更大下降相关。相反，第1天fsTnI的高基础水平在每个时间点的DE显著更高。在机械通气撤机过程中，骨骼肌蛋白具有独特的变化模式。在第1天，ssTnI的高基础值与膈肌功能随时间的更大下降相关，而fsTnI的高值与每个时间点的更大位移相关。
