tailieunhanh - Báo cáo y học: " Increased duration of mechanical ventilation is associated with decreased diaphragmatic force: a prospective observational study"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Increased duration of mechanical ventilation is associated with decreased diaphragmatic force: a prospective observational study. | Hermans et al. Critical Care 2010 14 R127 http content 14 4 R127 c CRITICAL CARE RESEARCH Open Access Increased duration of mechanical ventilation is associated with decreased diaphragmatic force a prospective observational study Greet Hermans 1 Anouk Agten2 Dries Testelmans2 Marc Decramer2 and Ghislaine Gayan-Ramirez2 Abstract Introduction Respiratory muscle weakness is an important risk factor for delayed weaning. Animal data show that mechanical ventilation itself can cause atrophy and weakness of the diaphragm called ventilator-induced diaphragmatic dysfunction VIDD . Transdiaphragmatic pressure after magnetic stimulation TwPdi BAMPS allows evaluation of diaphragm strength. We aimed to evaluate the repeatability of TwPdi BAMPS in critically ill mechanically ventilated patients and to describe the relation between TwPdi and the duration of mechanical ventilation. Methods This was a prospective observational study in critically ill and mechanically ventilated patients admitted to the medical intensive care unit of a university hospital. Nineteen measurements were made in a total of 10 patients at various intervals after starting mechanical ventilation. In seven patients measurements were made on two or more occasions with a minimum interval of 24 hours. Results The TwPdi was cm H2O mean SD indicating severe respiratory muscle weakness. The between-occasion coefficient of variation of TwPdi was comparable with data from healthy volunteers. Increasing duration of mechanical ventilation was associated with a logarithmic decline in TwPdi R P . This association was also found for cumulative time on pressure control R P and pressure-support ventilation P R separately as well as for cumulative dose of propofol R P and piritramide R P . Conclusions Duration of mechanical ventilation is associated with a logarithmic decline in diaphragmatic force which is compatible with the concept of VIDD. The .