tailieunhanh - Báo cáo khoa học: " Bench-to-bedside review: Weaning failure – should we rest the respiratory muscles with controlled mechanical ventilation"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Bench-to-bedside review: Weaning failure – should we rest the respiratory muscles with controlled mechanical ventilation? | Available online http content 10 1 204 Review Bench-to-bedside review Weaning failure - should we rest the respiratory muscles with controlled mechanical ventilation Theodoros Vassilakopoulos Spyros Zakynthinos and Charis Roussos Department of Critical Care and Pulmonary Services University of Athens Medical School Evangelismos Hospital Athens Greece Corresponding author Theodoros Vassilakopoulos tvassil @ Published 22 November 2005 This article is online at http content 10 1 204 2005 BioMed Central Ltd Critical Care 2006 10 204 doi cc3917 Abstract The use of controlled mechanical ventilation CMV in patients who experience weaning failure after a spontaneous breathing trial or after extubation is a strategy based on the premise that respiratory muscle fatigue requiring rest to recover is the cause of weaning failure. Recent evidence however does not support the existence of low frequency fatigue the type of fatigue that is long-lasting in patients who fail to wean despite the excessive respiratory muscle load. This is because physicians have adopted criteria for the definition of spontaneous breathing trial failure and thus termination of unassisted breathing which lead them to put patients back on the ventilator before the development of low frequency respiratory muscle fatigue. Thus no reason exists to completely unload the respiratory muscles with CMV for low frequency fatigue reversal if weaning is terminated based on widely accepted predefined criteria. This is important since experimental evidence suggests that CMV can induce dysfunction of the diaphragm resulting in decreased diaphragmatic force generating capacity which has been called ventilator-induced diaphragmatic dysfunction VIDD . The mechanisms of VIDD are not fully elucidated but include muscle atrophy oxidative stress and structural injury. Partial modes of ventilatory support should be used whenever possible since these modes attenuate the deleterious .