Sorbonne Université, INSERM, UMR_S1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.
AP-HP Sorbonne Université, Hôpital Pitié-Salpêtrière, Service de Médecine Intensive et Réanimation, Département R3S, Paris, France.
Eur Respir Rev. 2023 Apr 5;32(168). doi: 10.1183/16000617.0205-2022. Print 2023 Jun 30.
Weaning is a critical stage of an intensive care unit (ICU) stay, in which the respiratory muscles play a major role. Weakness of the respiratory muscles, which is associated with significant morbidity in the ICU, is not limited to atrophy and subsequent dysfunction of the diaphragm; the extradiaphragmatic inspiratory and expiratory muscles also play important parts. In addition to the well-established deleterious effect of mechanical ventilation on the respiratory muscles, other risk factors such as sepsis may be involved. Weakness of the respiratory muscles can be suspected visually in a patient with paradoxical movement of the abdominal compartment. Measurement of maximal inspiratory pressure is the simplest way to assess respiratory muscle function, but it does not specifically take the diaphragm into account. A cut-off value of -30 cmHO could identify patients at risk for prolonged ventilatory weaning; however, ultrasound may be better for assessing respiratory muscle function in the ICU. Although diaphragm dysfunction has been associated with weaning failure, this diagnosis should not discourage clinicians from performing spontaneous breathing trials and considering extubation. Recent therapeutic developments aimed at preserving or restoring respiratory muscle function are promising.
脱机是重症监护病房（ICU）治疗的一个关键阶段，在此期间呼吸肌起着重要作用。与 ICU 中显著发病率相关的呼吸肌无力不仅限于膈肌无力和随后的功能障碍；膈肌外吸气和呼气肌也起着重要作用。除了机械通气对呼吸肌的不良影响已被充分证实外，其他风险因素，如败血症，也可能涉及其中。在腹部矛盾运动的患者中，可以通过视觉怀疑呼吸肌无力。最大吸气压力的测量是评估呼吸肌功能的最简单方法，但它不能专门考虑到膈肌。-30cmH₂O 的截断值可以识别有长时间通气脱机风险的患者；然而，超声可能更适合评估 ICU 中的呼吸肌功能。尽管膈肌无力与脱机失败有关，但这一诊断不应阻止临床医生进行自主呼吸试验并考虑拔管。最近旨在保护或恢复呼吸肌功能的治疗进展很有前景。
