Takahashi Yuta, Morisawa Tomoyuki, Okamoto Hiroshi, Nakanishi Nobuto, Matsumoto Noriko, Saitoh Masakazu, Takahashi Tetsuya, Fujiwara Toshiyuki
Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan.
Department of Rehabilitation, St. Luke's International Hospital, Tokyo 104-8560, Japan.
J Clin Med. 2023 Aug 9;12(16):5191. doi: 10.3390/jcm12165191.
Sepsis is a risk factor for diaphragm dysfunction and ICU-acquired weakness (ICU-AW); however, the impact of mechanical ventilation (MV) on these relationships has not been thoroughly investigated. This study aimed to compare the incidence of diaphragm dysfunction and ICU-AW in patients with septic shock, with and without MV. We conducted a single-center prospective observational study that included consecutive patients diagnosed with septic shock admitted to the ICU between March 2021 and February 2022. Ultrasound measurements of diaphragm thickness and manual measurements of limb muscle strength were repeated after ICU admission. The incidences of diaphragm dysfunction and ICU-AW, as well as their associations with clinical outcomes, were compared between patients with MV and without MV (non-MV). Twenty-four patients (11 in the MV group and 13 in the non-MV group) were analyzed. At the final measurements in the MV group, eight patients (72.7%) had diaphragm dysfunction, and six patients (54.5%) had ICU-AW. In the non-MV group, 10 patients (76.9%) had diaphragm dysfunction, and three (23.1%) had ICU-AW. No association was found between diaphragm dysfunction and clinical outcomes. Patients with ICU-AW in the MV group had longer ICU and hospital stays. Among patients with septic shock, the incidence of diaphragm dysfunction was higher than that of ICU-AW, irrespective of the use of MV. Further studies are warranted to examine the association between diaphragm dysfunction and clinical outcomes.
脓毒症是膈肌功能障碍和重症监护病房获得性肌无力（ICU-AW）的危险因素；然而，机械通气（MV）对这些关系的影响尚未得到充分研究。本研究旨在比较有或没有接受MV的感染性休克患者中膈肌功能障碍和ICU-AW的发生率。我们进行了一项单中心前瞻性观察性研究，纳入了2021年3月至2022年2月期间入住ICU的连续诊断为感染性休克的患者。在入住ICU后重复进行膈肌厚度的超声测量和肢体肌肉力量的手动测量。比较了接受MV和未接受MV（非MV）患者的膈肌功能障碍和ICU-AW的发生率，以及它们与临床结局的关联。分析了24例患者（MV组11例，非MV组13例）。在MV组的最后测量中，8例患者（72.7%）有膈肌功能障碍，6例患者（54.5%）有ICU-AW。在非MV组中，10例患者（76.9%）有膈肌功能障碍，3例（23.1%）有ICU-AW。未发现膈肌功能障碍与临床结局之间存在关联。MV组中有ICU-AW的患者在ICU和医院的住院时间更长。在感染性休克患者中，无论是否使用MV，膈肌功能障碍的发生率均高于ICU-AW。有必要进行进一步研究以检查膈肌功能障碍与临床结局之间的关联。
