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01.08.2010 | Research | Ausgabe 4/2010 Open Access

Critical Care 4/2010

Increased duration of mechanical ventilation is associated with decreased diaphragmatic force: a prospective observational study

Zeitschrift:
Critical Care > Ausgabe 4/2010
Autoren:
Greet Hermans, Anouk Agten, Dries Testelmans, Marc Decramer, Ghislaine Gayan-Ramirez
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​cc9094) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

GH drafted the protocol, performed the measurements, analyzed the pressure tracings, obtained patient data, and drafted the manuscript. AA assisted in performing the measurements, obtained patient data, and revised the manuscript. DT assisted in performing the measurements and revised the manuscript. MD had a major impact on the interpretation of data and critical appraisal of the manuscript. GG-R assisted in performing the measurements, obtaining patient data, and had a major impact on the interpretation of data and critical appraisal of the manuscript.

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 11.5 ± 3.9 cm H2O (mean ± SD), indicating severe respiratory muscle weakness. The between-occasion coefficient of variation of TwPdi was 9.7%, comparable with data from healthy volunteers. Increasing duration of mechanical ventilation was associated with a logarithmic decline in TwPdi (R = 0.69; P = 0.038). This association was also found for cumulative time on pressure control (R = 0.71; P = 0.03) and pressure-support ventilation (P = 0.05; R = 0.66) separately, as well as for cumulative dose of propofol (R = 0.66; P = 0.05) and piritramide (R = 0.79; P = 0.01).

Conclusions

Duration of mechanical ventilation is associated with a logarithmic decline in diaphragmatic force, which is compatible with the concept of VIDD. The observed decline may also be due to other potentially contributing factors such as sedatives/analgesics, sepsis, or others.
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