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Báo cáo y học: " Diaphragm weakness and mechanical ventilation what’s the critical issue"

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: Diaphragm weakness and mechanical ventilation what’s the critical issue? | Callahan and Supinski Critical Care 2010 14 187 http ccforum.eom content 14 4 187 CRITICAL CARE COMMENTARY L__ Diaphragm weakness and mechanical ventilation -what s the critical issue Leigh Ann Callahan and Gerald S Supinski See related research by Hermans etal. http ccforum.eom content 14 4 R127 Abstract While animal studies indicate that controlled mechanical ventilation MV induces diaphragm weakness and myofiber atrophy there are no data in humans that confirm MV perse produces diaphragm weakness. Whether or not diaphragm weakness results from MV sepsis corticosteroids hyperglycemia or a combination of these factors however is not the most important issue raised by the recent study from Hermans and colleagues. This study makes an important contribution by providing additional evidence that many critically ill patients have profound diaphragm weakness. If diaphragm weakness of this magnitude is present in most mechanically ventilated patients a strong argument can be made that respiratory muscle weakness is a major contributor to respiratory failure. Numerous animal studies indicate that controlled mechanical ventilation MV induces diaphragm weakness and myofiber atrophy but no data in humans confirm MV per se produces diaphragm weakness. In their recent publication Hermans and colleagues 1 used an objective nonvolitional technique of bilateral anterolateral magnetic stimulation of the phrenic nerves to measure twitch transdiaphragmatic pressure TwPdi and assessed the degree of diaphragm weakness in ten critically ill mechanically ventilated patients. Importantly they found an average TwPdi value of 11.5 3.9 cm water which represents a 70 reduction in diaphragm strength when compared to normal individuals. In their analysis the authors suggest that duration of MV is associated with decreased diaphragm force generation. This interpretation however may be misleading. Importantly nine of Correspondence lacall2@email.uky.edu Division of Pulmonary Critical .