机械通气患者自主呼吸试验中膈肌电活动：生理学描述和潜在临床应用。
The diaphragmatic electrical activity during spontaneous breathing trial in patients with mechanical ventilation: physiological description and potential clinical utility.
机构信息
Medical Intensive Care Unit, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
出版信息
BMC Pulm Med. 2024 May 30;24(1):263. doi: 10.1186/s12890-024-03077-8.
BACKGROUNDS
Increased respiratory drive has been demonstrated to correlate with weaning failure, which could be quantified by electrical activity of the diaphragm (EAdi). We described the physiological process of EAdi-based parameters during the spontaneous breathing trial (SBT) and evaluated the change of EAdi-based parameters as potential predictors of weaning failure.
METHODS
We conducted a prospective study in 35 mechanically ventilated patients who underwent a 2-hour SBT. EAdi and ventilatory parameters were continuously measured during the SBT. Diaphragm ultrasound was performed before the SBT and at the 30 min of the SBT. Three EAdi-based parameters were calculated: neuro-ventilatory efficiency, neuro-excursion efficiency and neuro-discharge per min.
RESULTS
Of the thirty 35 patients studied, 25 patients were defined as SBT success, including 22 patients weaning successfully and 3 patients reintubated. Before the SBT, neuro-excursion efficiency differed significantly between two groups and had the highest predictive value for SBT failure (AUROC 0.875, p < 0.01). Early increases in EAdi were observed in SBT, which are more prominent in SBT failure group. One minute, changes in EAdi and neuro-discharge per min also predicted weaning outcome (AUROCs 0.944 and 0.918, respectively).
CONCLUSIONS
EAdi-based parameters, especially neuro-excursion efficiency and changes in neuro-discharge per min, may detect impending weaning failure earlier than conventional indices. EAdi monitoring provides physiological insights and a more tailored approach to facilitate successful weaning. Further research should validate these findings and explore the utility of combined EAdi and diaphragm ultrasound assessment in weaning ICU patients from mechanical ventilation.
TRIAL REGISTRATION
Registered at ClinicalTrials.gov on 20 September 2022 (Identifier: NCT05632822).
背景
呼吸驱动增加已被证明与脱机失败相关，这可以通过膈神经电活动（EAdi）来量化。我们描述了在自主呼吸试验（SBT）期间 EAdi 为基础的参数的生理过程，并评估了 EAdi 为基础的参数变化作为脱机失败的潜在预测因子。
方法
我们对 35 名接受 2 小时 SBT 的机械通气患者进行了前瞻性研究。在 SBT 期间连续测量 EAdi 和通气参数。在 SBT 前和 SBT 30 分钟时进行膈神经超声检查。计算了三个 EAdi 为基础的参数：神经通气效率、神经位移效率和神经放电每分钟。
结果
在 35 名研究患者中，25 名患者被定义为 SBT 成功，其中 22 名患者成功脱机，3 名患者重新插管。在 SBT 前，两组之间的神经位移效率有显著差异，对 SBT 失败有最高的预测价值（AUROC 0.875，p < 0.01）。在 SBT 中观察到 EAdi 的早期增加，在 SBT 失败组中更为明显。EAdi 和神经放电每分钟的变化在 1 分钟时也预测了脱机结果（AUROCs 分别为 0.944 和 0.918）。
结论
EAdi 为基础的参数，特别是神经位移效率和神经放电每分钟的变化，可能比传统指标更早地检测到即将发生的脱机失败。EAdi 监测提供了生理上的见解，并为促进成功脱机提供了更具针对性的方法。进一步的研究应该验证这些发现，并探讨在从机械通气中脱机的 ICU 患者中结合 EAdi 和膈神经超声评估的效用。
试验注册
于 2022 年 9 月 20 日在 ClinicalTrials.gov 注册（标识符：NCT05632822）。
Zotero 插件