Kássia Macêdo da Silva Bezerra Naiara, Araújo Lima de Oliveira Elis Fernanda, Bernardo Figueirêdo Bárbara, Schwingel Paulo Adriano, André Freire Magalhães Paulo
Graduate Program in Rehabilitation and Functional Performance (PPGRDF), Universidade de Pernambuco, Petrolina, Pernambuco, Brazil.
Physiother Res Int. 2025 Oct;30(4):e70100. doi: 10.1002/pri.70100.
Severe neurological injuries frequently necessitate prolonged invasive mechanical ventilation (IMV), which contributes to diaphragm atrophy and weakness. These factors can complicate the weaning process and have a detrimental impact on clinical outcomes in neurocritical care patients. This study aimed to examine the morphology and function of the diaphragm in neurocritical patients undergoing IMV, with a particular focus on the relationship between these factors and respiratory muscle strength.
This prospective observational study included 20 neurocritical patients admitted consecutively to an intensive care unit (ICU). All patients were mechanically ventilated in pressure support ventilation (PSV) mode for 24-72 h. Diaphragm morphology and function were assessed using ultrasound, while respiratory muscle strength was measured via manovacuometry to determine maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP).
The mean diaphragm thickness (DT) was 1.7 mm (95% CI: 1.4-1.9), and diaphragmatic excursion (DE) was 20.4 mm (95% CI: 17.5-23.2). The mean MIP was -50 cmH2O (95% CI: -55.0 to -40.6), and the mean MEP was 30 cmH2O (95% CI: 26.5-42.9). There was a moderate correlation between MIP and DT (r = -0.45, p < 0.05) and between MEP and DT (r = 0.50, p = 0.03). Ultrasound measurements showed no significant relationship with ICU length of stay, IMV duration, or demographic variables such as sex, age, or body mass index (BMI). However, DT at the end of expiration influenced maximal respiratory pressure (MRP), with female patients exhibiting 92% weaker MIP compared to males.
Diaphragm thickness was found to moderately correlate with respiratory muscle strength in neurocritical care patients on IMV, suggesting its potential as a marker for muscle strength assessment. However, no significant relationship was found between other ultrasound variables and clinical outcomes such as IMV duration or ICU stay. These findings underscore the need for further longitudinal studies to explore diaphragmatic muscle behavior throughout hospitalization and its impact on clinical outcomes.
严重的神经损伤常常需要长时间的有创机械通气（IMV），这会导致膈肌萎缩和无力。这些因素会使撤机过程复杂化，并对神经重症监护患者的临床结局产生不利影响。本研究旨在检查接受IMV的神经重症患者膈肌的形态和功能，特别关注这些因素与呼吸肌力量之间的关系。
这项前瞻性观察性研究纳入了20名连续入住重症监护病房（ICU）的神经重症患者。所有患者均采用压力支持通气（PSV）模式进行机械通气24至72小时。使用超声评估膈肌形态和功能，同时通过压力肺活量测定法测量呼吸肌力量，以确定最大吸气压力（MIP）和最大呼气压力（MEP）。
平均膈肌厚度（DT）为1.7毫米（95%置信区间：1.4至1.9），膈肌移动度（DE）为20.4毫米（95%置信区间：17.5至23.2）。平均MIP为-50厘米水柱（95%置信区间：-55.0至-40.6），平均MEP为30厘米水柱（95%置信区间：26.5至42.9）。MIP与DT之间存在中度相关性（r = -0.45，p < 0.05），MEP与DT之间也存在中度相关性（r = 0.50，p = 0.03）。超声测量结果与ICU住院时间、IMV持续时间或性别、年龄、体重指数（BMI）等人口统计学变量之间无显著关系。然而，呼气末的DT会影响最大呼吸压力（MRP），女性患者的MIP比男性患者弱92%。
研究发现，在接受IMV的神经重症监护患者中，膈肌厚度与呼吸肌力量存在中度相关性，这表明其有可能作为肌肉力量评估的指标。然而，未发现其他超声变量与IMV持续时间或ICU住院时间等临床结局之间存在显著关系。这些发现强调需要进一步进行纵向研究，以探讨住院期间膈肌的肌肉行为及其对临床结局的影响。
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