Abstract
Objective: To determine the diaphragmatic strength in patients with mechanical ventilation (MV) and to observe the relationship of diaphragmatic weakness and clinical parameters with the prolonged MV. We also observed whether the pressure measured at intra-bladder (Pbla) and endo-tracheal tube (Pet) could reflect the diaphragm strength.
Methods: We measured esophageal pressure (Pes), gastric pressure (Pgas), Pbla and Pet in a total of 20 critical ill, MV patients. We compared the diaphragmatic strength in weaning success and prolonged weaning patients, and assessed the relationship between Pbla-Pet and sniff Pdi.
Results: Mean transdiaphragmatic pressure (Pdi) in the prolonged weaning was lower than in the weaning success group (20.8±5.9 vs. 24.2±5.7 cmH2O; P<0.05). The patients in prolonged weaning had 77.8% mortality while patients with weaning success were all survival. There was a good correlation between measurements of Pbla-Pet and sniff Pdi (r=0.753, P<0.05). The level of CRP and Pro-BNP were reduced before extubation time point compared to before MV in weaning success group (P<0.05). However, in prolonged weaning group the level of CRP and Pro-BNP were significant increased before extubation compared to before MV (P<0.05).
Conclusions: Significant diaphragmatic weakness occurred in prolonged weaning patients, which was associated with poor outcome. Pbla-Pet could provide a noninvasive assessment of diaphragmatic strength in MV patients.
- Copyright ©the authors 2016