neuroventilatory efficiency and extubation readiness in critically ill patientsneuroventilatory效率和拔管准备在危重病人.pdfVIP

Liu et al. Critical Care 2012, 16:R143 /content/16/4/R143 RESEARCH Open Access Neuroventilatory efficiency and extubation readiness in critically ill patients 1 1 1 1 1 2,3 2,4 Ling Liu , Huogen Liu , Yi Yang , Yingzi Huang , Songqiao Liu , Jennifer Beck , Arthur S Slutsky , Christer Sinderby2,4* and Haibo Qiu1 Abstract Introduction: Based on the hypothesis that failure of weaning from mechanical ventilation is caused by respiratory demand exceeding the capacity of the respiratory muscles, we evaluated whether extubation failure could be characterized by increased respiratory drive and impaired efficiency to generate inspiratory pressure and ventilation. Methods: Airway pressure, flow, volume, breathing frequency, and diaphragm electrical activity were measured in a heterogeneous group of patients deemed ready for a spontaneous breathing trial. Efficiency to convert neuromuscular activity into inspiratory pressure was calculated as the ratio of negative airway pressure and diaphragm electrical activity during an inspiratory occlusion. Efficiency to convert neuromuscular activity into volume was calculated as the ratio of the tidal volume to diaphragm electrical activity. All variables were obtained during a 30-minute spontaneous breathing trial on continuous positive airway pressure (CPAP) of 5 cm H2O and compared between patients for whom extubation succeeded with those for whom either the spontaneous breathing trial failed or for those who passed, but then the extubation failed. Results: Of 52 patients enrolled in the study, 35 (67.3%) were successfully extubated, and 17 (32.7%) were not. Patients for whom it failed had higher diaphragm electrical activity (48%; P 0.001)