Diaphragm function in mechanical ventilated chronic obstructive pulmonary disease patients before weaning_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

WANG Yinyan ¹ , SHI Ronghua ² , LIN Zhimin ² , CHEN Sibei ² , SANG Ling ² , HUANG Yongbo ² , MAO Pu ² , HE Weiqun ² , LIU Xiaoqing ² ,  LI Yimin ²

1. Department of Respiratory Medicine, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510260, P. R. China;
2. Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, P. R. China;

Corresponding author：

LI Yimin, Email: dryiminli@vip.163.com

Keywords：

Mechanical ventilation; Chronic obstructive pulmonary disease; Diaphragm function; Twitch transdiaphragmatic pressure; Bilateral anterolateral magnetic stimulation of the phrenic nerves

DOI：

10.7507/1671-6205.201812009

Video：

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Objective Twitch transdiaphragmatic pressure is used to evaluate the diaphragm function of mechanical ventilated chronic obstructive pulmonary disease patients before weaning in the intensive care unit, and compared with healthy normal values.Methods Patients were recruited if they were with acute exacerbation of chronic obstructive pulmonary disease, admitted between May to November in 2013 and December 2014 to February 2016 to the intensive care unit in the First Affiliated Hospital of Guangzhou Medical University, intubated and mechanical ventilated more than 72 hours, and recovered to the clinical stability states after passing the readiness to wean, getting ready for spontaneous breathing test. The newly designed esophageal electrode catheter and bilateral anterolateral magnetic phrenic nerves stimulation were utilized to detect the twitch transdiaphragmatic pressure. At the same time, the function of diaphragm was detected in 10 healthy adults for comparison.Results Twenty-two patients were recruited in this study. Two cases had no twitch signals. In the rest 20 cases, the twitch transdiaphragmatic pressure was (7.6±2.5) cm H₂O. In 10 healthy adults, twitch transdiaphragmatic pressure was (26.7±4.9) cm H₂O. There was significant difference between the patients and the health control subjects (P<0.05).Conclusion Twitch transdiaphragmatic pressure is significantly decreased in weaning chronic obstructive pulmonary disease patients compared with healthy adults.

Citation： WANG Yinyan, SHI Ronghua, LIN Zhimin, CHEN Sibei, SANG Ling, HUANG Yongbo, MAO Pu, HE Weiqun, LIU Xiaoqing, LI Yimin. Diaphragm function in mechanical ventilated chronic obstructive pulmonary disease patients before weaning. Chinese Journal of Respiratory and Critical Care Medicine, 2019, 18(5): 423-426. doi: 10.7507/1671-6205.201812009 Copy

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2.	NHLBI Workshop summary. Respiratory muscle fatigue. Report of the Respiratory Muscle Fatigue Workshop Group Respiratory muscle fatigue. Am Rev Respir Dis, 1990, 142(2): 474-480.
3.	王银燕, 林志敏, 陈思蓓, 等. 新型多功能食管电极管和双颈前膈神经磁刺激评估机械通气患者膈肌功能的应用研究. 中国呼吸与危重监护杂志, 2014, 13(4): 348-352.
4.	王银燕, 黎毅敏. 膈神经磁刺激评价膈肌功能在 ICU 的应用. 国际呼吸杂志, 2015, 35(13): 1033-1038.
5.	中华医学会重症医学分会. 机械通气临床应用指南(2006). 中国危重病急救医学, 2007, 19(2): 65-72.
6.	罗远明, 陈荣昌, 钟南山. 磁刺激诱发的膈肌复合动作电位的多导食道电极记录及其在重症监护室患者中的应用. 中华结核和呼吸杂志, 2005, 28(8): 505-508.
7.	Wragg S, Hamnegard C, Road J, et al. Potentiation of diaphragmatic twitch after voluntary contraction in normal subjects. Thorax, 1994, 49(12): 1234-1237.
8.	Luo YM, Hart N, Mustfa N, et al. Reproducibility of twitch and sniff transdiaphragmatic pressures. Respir Physiol Neurobiol, 2002, 132(3): 301-306.
9.	Watson AC, Hughes PD, Louise Harris M, et al. Measurement of twitch transdiaphragmatic, esophageal, and endotracheal tube pressure with bilateral anterolateral magnetic phrenic nerve stimulation in patients in the intensive care unit. Crit Care Med, 2001, 29(7): 1325-1231.
10.	Cattapan SE, Laghi F, Tobin MJ. Can diaphragmatic contractility be assessed by airway twitch pressure in mechanically ventilated patients?. Thorax, 2003, 58(1): 58-62.
11.	Hermans G, Agten A, Testelmans D, et al. Increased duration of mechanical ventilation is associated with decreased diaphragmatic force: a prospective observational study. Crit Care, 2010, 14(4): R12.
12.	ATS/ERS Statement on respiratory muscle testing. ATS/ERS Statement on respiratory muscle testing. Am J Respir Crit Care Med, 2002, 166(4): 518-624.

1. Shehu I, Peli E. Phrenic nerve stimulation. Euro J Anaesthesiol, 2008, 42(Suppl): 186-191.
2. NHLBI Workshop summary. Respiratory muscle fatigue. Report of the Respiratory Muscle Fatigue Workshop Group Respiratory muscle fatigue. Am Rev Respir Dis, 1990, 142(2): 474-480.
3. 王银燕, 林志敏, 陈思蓓, 等. 新型多功能食管电极管和双颈前膈神经磁刺激评估机械通气患者膈肌功能的应用研究. 中国呼吸与危重监护杂志, 2014, 13(4): 348-352.
4. 王银燕, 黎毅敏. 膈神经磁刺激评价膈肌功能在 ICU 的应用. 国际呼吸杂志, 2015, 35(13): 1033-1038.
5. 中华医学会重症医学分会. 机械通气临床应用指南(2006). 中国危重病急救医学, 2007, 19(2): 65-72.
6. 罗远明, 陈荣昌, 钟南山. 磁刺激诱发的膈肌复合动作电位的多导食道电极记录及其在重症监护室患者中的应用. 中华结核和呼吸杂志, 2005, 28(8): 505-508.
7. Wragg S, Hamnegard C, Road J, et al. Potentiation of diaphragmatic twitch after voluntary contraction in normal subjects. Thorax, 1994, 49(12): 1234-1237.
8. Luo YM, Hart N, Mustfa N, et al. Reproducibility of twitch and sniff transdiaphragmatic pressures. Respir Physiol Neurobiol, 2002, 132(3): 301-306.
9. Watson AC, Hughes PD, Louise Harris M, et al. Measurement of twitch transdiaphragmatic, esophageal, and endotracheal tube pressure with bilateral anterolateral magnetic phrenic nerve stimulation in patients in the intensive care unit. Crit Care Med, 2001, 29(7): 1325-1231.
10. Cattapan SE, Laghi F, Tobin MJ. Can diaphragmatic contractility be assessed by airway twitch pressure in mechanically ventilated patients?. Thorax, 2003, 58(1): 58-62.
11. Hermans G, Agten A, Testelmans D, et al. Increased duration of mechanical ventilation is associated with decreased diaphragmatic force: a prospective observational study. Crit Care, 2010, 14(4): R12.
12. ATS/ERS Statement on respiratory muscle testing. ATS/ERS Statement on respiratory muscle testing. Am J Respir Crit Care Med, 2002, 166(4): 518-624.

Chinese Journal of Respiratory and Critical Care Medicine

Diaphragm function in mechanical ventilated chronic obstructive pulmonary disease patients before weaning

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