Diaphragm Dysfunction on Admission to the Intensive Care Unit Prevalence, Risk Factors, and Prognostic Impact-A Prospective Study

被引：285

作者：

Demoule, Alexandre ^{[1
,2
,3
]}

Jung, Boris ^{[4
,5
]}

Prodanovic, Helene ^{[2
]}

Molinari, Nicolas ^{[6
,7
]}

Chanques, Gerald ^{[4
,5
]}

Coirault, Catherine ^{[3
]}

Matecki, Stefan ^{[5
,8
]}

Duguet, Alexandre ^{[1
,2
]}

Similowski, Thomas ^{[1
,2
]}

Jaber, Samir ^{[4
,5
]}

机构：

[1] Univ Paris 06, ER10, Paris, France

[2] Grp Hosp Pitie Salpetriere, Assistance Publ Hop Paris, Dept Resp & Intens Care Med, F-75651 Paris 13, France

[3] INSERM, U974, Paris, France

[4] St Eloi Hosp, Intens Care & Anesthesiol Dept, Montpellier, France

[5] Univ Montpellier I, INSERM, U1046, Montpellier, France

[6] Hop Arnaud de Villeneuve, Dept Med Informat, Montpellier, France

[7] Univ Montpellier, F-34059 Montpellier, France

[8] Hop Arnaud de Villeneuve, Dept Clin Physiol, Montpellier, France

来源：

AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE | 2013年 / 188卷 / 02期

关键词：

mechanical ventilation; diaphragm; sepsis; CERVICAL MAGNETIC STIMULATION; MECHANICAL VENTILATION; RESPIRATORY MUSCLE; PHRENIC NERVES; TUBE PRESSURE; SEPSIS; STRENGTH; WEAKNESS; PATTERN; ATROPHY;

D O I：

10.1164/rccm.201209-1668OC

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Rationale: Diaphragmatic insults occurring during intensive care unit (ICU) stays have become the focus of intense research. However, diaphragmatic abnormalities at the initial phase of critical illness remain poorly documented in humans. Objectives: To determine the incidence, risk factors, and prognostic impact of diaphragmatic impairment on ICU admission. Methods: Prospective, 6-month, observational cohort study in two ICUs. Mechanically ventilated patients were studied within 24 hours after intubation (Day 1) and 48 hours later (Day 3). Seventeen anesthetized intubated control anesthesia patients were also studied. The diaphragm was assessed by twitch tracheal pressure in response to bilateral anterior magnetic phrenic nerve stimulation (Ptr,stim). Measurements and Main Results: Eighty-five consecutive patients aged 62 (54-75) (median [interquartile range]) were evaluated (medical admission, 79%; Simplified Acute Physiology Score II, 54 [44-68]). On Day 1, Ptr, stim was 8.2 (5.9-12.3) cm H2O and 64% of patients had Ptr, stim less than 11 cm H2O. Independent predictors of low Ptr, stim were sepsis (linear regression coefficient, -3.74; standard error, 1.16; P = 0.002) and Simplified Acute Physiology Score II (linear regression coefficient, -0.07; standard error, 1.69; P = 0.03). Compared with nonsurvivors, ICU survivors had higher Ptr, stim (9.7 [6.3-13.8] vs. 7.3 [5.5-9.7] cm H2O; P = 0.004). This was also true for hospital survivors versus nonsurvivors (9.7 [6.3-13.5] vs. 7.8 [5.5-10.1] cm H2O; P = 0.004). Day 1 and Day 3 Ptr, stim were similar. Conclusions: A reduced capacity of the diaphragm to produce inspiratory pressure (diaphragm dysfunction) is frequent on ICU admission. It is associated with sepsis and disease severity, suggesting that it may represent another form of organ failure. It is associated with a poor prognosis. Clinical trial registered with www.clinicaltrials.gov (NCT 00786526).

引用

页码：213 / 219

页数：7

共 32 条

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