Menis Apostolos-Alkiviadis, Tsolaki Vasiliki, Papadonta Maria-Eirini, Vazgiourakis Vasileios, Mantzarlis Konstantinos, Zakynthinos Epaminondas, Makris Demosthenes
Intensive Care Unit, University Hospital of Larissa, Larissa, Greece.
Medical School, University of Thessaly, Larissa, Greece.
Crit Care. 2025 May 13;29(1):190. doi: 10.1186/s13054-025-05436-1.
Failure to wean from invasive mechanical ventilation is multifactorial, with diaphragmatic dysfunction a significant contributing factor. Diaphragmatic function can be easily and non-invasively assessed by ultrasound. However, it remains unknown how ultrasound measurements of diaphragm function are affected by changes in apparent work of breathing.
In patients undergoing weaning from mechanical ventilation, we evaluated diaphragmatic ultrasound measurements [diaphragmatic excursion (Dex), diaphragmatic thickening fraction (Tfdi)] simultaneously with manometric indices of breathing effort and load [esophageal pressure swings (ΔPes), transdiaphragmatic pressure swings (ΔPdi), and the pressure-time product of esophageal pressure (PTPes)]. These assessments were performed during two distinct phases; during an unassisted spontaneous breathing trial (phase SBT) and during an inspiratory resistive loading with 30 cmHO/L/s (phase IRL), applied during the same SBT. Our primary aim was to evaluate the relationship between diaphragmatic ultrasound and breathing effort using the method of repeated measures correlation.
Forty-nine patients were enrolled. Dex correlated with ΔPes (r = 0.5, p < 0.001), ΔPdi (r = 0.55, p = < 0.001) and PTPes (r = 0.32, p = 0.031). Tfdi did not correlate with ΔPes (r = 0.27, p = 0.052), ΔPdi (r = 0.2, p = 0.235) and PTPes (r = 0.24, p = 0.110). Dex and Tfdi increased during IRL compared to SBT [1.44(0.89-1.96) vs. 1.05(0.7-1.59), p = 0.002], [0.55(± 0.32) vs 0.46(± 0.2), p = 0.019] as did Pes, Pdi and PTPes [(11.87 (7.86, 18.32) vs. 6.8 (4.6-10.23), p < 0.001), (10.89 (± 6.42) vs. 7.94 (± 3.81), p < 0.001), and (181.10 (108.34, 311.7) vs. 97.52 (55.96-179.87), p < 0.001), respectively].
In critical care patients spontaneously breathing under resistive load, diaphragmatic excursion had a weak to moderate correlation with indices of breathing effort and differed between weaning success and failure.
有创机械通气撤机失败是多因素导致的，其中膈肌功能障碍是一个重要的促成因素。膈肌功能可通过超声轻松且无创地进行评估。然而，尚不清楚呼吸作功的变化如何影响膈肌功能的超声测量。
在接受机械通气撤机的患者中，我们同时评估了膈肌超声测量指标[膈肌移动度（Dex）、膈肌增厚分数（Tfdi）]以及呼吸努力和负荷的压力测量指标[食管压力波动（ΔPes）、跨膈压波动（ΔPdi）和食管压力的压力 - 时间乘积（PTPes）]。这些评估在两个不同阶段进行；在无辅助自主呼吸试验期间（SBT阶段）以及在同一SBT期间施加30 cmH₂O/L/s的吸气阻力负荷期间（IRL阶段）。我们的主要目的是使用重复测量相关性方法评估膈肌超声与呼吸努力之间的关系。
共纳入49例患者。Dex与ΔPes（r = 0.5，p < 0.001）、ΔPdi（r = 0.55，p < 0.001）和PTPes（r = 0.32，p = 0.031）相关。Tfdi与ΔPes（r = 0.27，p = 0.052）、ΔPdi（r = 0.2，p = 0.235）和PTPes（r = 0.24，p = 0.110）不相关。与SBT相比，IRL期间Dex和Tfdi增加[1.44(0.89 - 1.96) 对比 1.05(0.7 - 1.59)，p = 0.002]，[0.55(± 0.32) 对比 0.46(± 0.2)，p = 0.019]，Pes、Pdi和PTPes也增加[分别为(11.87 (7.86, 18.32) 对比 6.8 (4.6 - 10.23)，p < 0.001)，(10.89 (± 6.42) 对比 7.94 (± 3.81)，p < 0.001)，以及(181.10 (108.34, 311.7) 对比 97.52 (55.96 - 179.87)，p < 0.001)]。
在承受阻力负荷下自主呼吸的重症监护患者中，膈肌移动度与呼吸努力指标具有弱至中度相关性，且在撤机成功和失败之间存在差异。
