膈肌肌电图与超声检查在预测机械通气撤机结果中的比较

Diaphragm Electromyography Versus Ultrasonography in the Prediction of Mechanical Ventilation Liberation Outcome.

作者信息

Al Tayar Ashraf S, Abdelshafey Eslam E

机构信息

Security Forces Hospital Dammam, Dammam, Saudi Arabia.

Critical Care Medicine, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.

出版信息

Respir Care. 2022 Oct 20;67(11):1437-1442. doi: 10.4187/respcare.09779.

DOI:10.4187/respcare.09779

PMID:35853707

Abstract

BACKGROUND

ICU-acquired diaphragm paresis occurs in about 25% of patients after prolonged mechanical ventilation. Diaphragm function can be evaluated via several approaches including monitoring of electrical activity of diaphragm (electromyography [EMG]) or ultrasound (US) measurements. We aimed to assess the usefulness of diaphragm EMG indices in predicting liberation outcome in comparison with diaphragm US measurements.

METHODS

We included consecutive subjects invasively ventilated for > 48 h for acute respiratory failure and who were considered ready to undergo a spontaneous breathing trial (SBT). Exclusion criteria were age < 18 y, pregnancy, tracheostomy, or patients with confirmed neuromuscular diseases. To start the SBT, we set pressure support to 0 cm HO and PEEP to 5 cm HO. During the initial 5 min of SBT, mean values of Δ electrical activity of the diaphragm (ΔEA) (EA peak - EA minimal), tidal volume (V), and breathing frequency were measured. Neuroventilatory efficiency was calculated as V divided by ΔEA. Rapid shallow breathing index was calculated as breathing frequency divided by V. US examination of the diaphragm and assessment of diaphragmatic excursion (DE) and diaphragm thickening fraction (DTF) were recorded 30 min after initiation of SBT.

RESULTS

Twenty-four subjects were included; DTF predicted weaning failure with area under the curve 0.96 and value < .001 with sensitivity 100% and specificity 94% for the cutoff value ≤ 15%. DE for the cutoff ≤ 1.56 cm showed sensitivity 75% and specificity 69%, whereas ΔEA with cutoff value ≤ 4 μV showed sensitivity 25% and specificity 100%. Neuroventilatory efficiency with cutoff value ≤ 29 mL/μV showed sensitivity 50% and specificity 81%. All 3 parameters showed nonsignificant results with area under the curve 0.73, 0.56, and 0.62 and values .08, .65, and .34, respectively.

CONCLUSIONS

Diaphragm EMG indices were inferior to diaphragm ultrasonography in prediction of mechanical ventilation liberation outcome.

摘要

背景

在长时间机械通气后，约25%的患者会发生重症监护病房获得性膈肌麻痹。膈肌功能可通过多种方法进行评估，包括监测膈肌电活动（肌电图[EMG]）或超声（US）测量。我们旨在评估膈肌肌电图指标与膈肌超声测量相比在预测脱机结果方面的有用性。

方法

我们纳入了因急性呼吸衰竭进行有创通气超过48小时且被认为准备好进行自主呼吸试验（SBT）的连续受试者。排除标准为年龄<18岁、妊娠、气管切开术或确诊为神经肌肉疾病的患者。为开始SBT，我们将压力支持设置为0 cm H₂O，呼气末正压（PEEP）设置为5 cm H₂O。在SBT的最初5分钟内，测量膈肌电活动变化量（ΔEA）（EA峰值 - EA最小值）、潮气量（V）和呼吸频率的平均值。神经通气效率计算为V除以ΔEA。快速浅呼吸指数计算为呼吸频率除以V。在SBT开始30分钟后记录膈肌的超声检查以及膈肌移动度（DE）和膈肌增厚分数（DTF）的评估结果。

结果

纳入了24名受试者；DTF预测脱机失败的曲线下面积为0.96，P值<0.001，对于截断值≤15%，敏感性为100%，特异性为94%。对于截断值≤1.56 cm的DE，敏感性为75%，特异性为69%，而对于截断值≤4 μV的ΔEA，敏感性为25%，特异性为100%。对于截断值≤29 mL/μV的神经通气效率，敏感性为50%，特异性为81%。所有这3个参数的曲线下面积分别为0.73、0.56和0.62，P值分别为0.08、0.65和0.34，结果均无统计学意义。