| Objective: To study diaphragmatic strength in mechanical ventilated patients and the relationship between diaphragmatic strength and duration of MV.In addition,the relationship between diaphragmatic strength and the prognosis of patients with MV is also evaluated.Methods: A prospective study was conducted.Forty-eight patients receiving MV admitted to intensive care unit?ICU?of Shanghai East Hospital of Tongji University were enrolled.Pdimax value was obtained every day in first three days of intubation,and then was obtained every 48 hours from day 3 of intubation until the day the patient underwent extubation or died.We recorded C-reactive protein?CRP?,procalcitonin?PCT?,NT-pro-BNP,APACHE II score,serum albumin and prealbumin during the study.Results:?1?Diaphragmatic strength was decreased in mechanical ventilated patients,mean Pdimax was 23.6±5.6 cmH2 O.?2?Mean Pdimax decreased progressively over time.Mean Pdimax significantly decreased in the 5 days of MV relative to the 1 days of MV?27.7±5.2 vs 21.5±3.2 cmH2 O,t=6.375,p=0.000?.By the end of the evaluation period at 15 days of MV,mean Pdimax decreased to 17.7±2.9 cmH2 O,decreased about 37%.?3?Mean Pdimax in successful weaning patients was significantly higher than died patients?26.3±5.7 vs 20.7±3.6 cmH2 O,t=8.980,p=0.000?.In addition,duration of MV in successful weaning patients was significantly lower than died patients?153.8±36.2 vs 82.9±15.1 cmH2 O,t=6.941,p=0.000?.?4?There was significantly negative correlation between Pdimax and CRP?r=-0.510,P=0.000?and PCT?r=-0.440,P=0.002?,as well as NT-pro-BNP?r=-0.416,P=0.003?and APACHE II score?r=-0.295,P=0.042?.There was significantly positive correlation between Pdimax and serum albumin?r=0.403,P=0.005?and prealbumin?r=0.447,P=0.001?.Conclusions: MV cause diaphragmatic strength decreased and the decrease in diaphragmatic contractility is time-dependent.Diaphragmatic function may play a key role in successful weaning in patients with MV.In addition,infection,cardiac insufficiency,severity of critically ill and nutritional status also affects the diaphragmatic contractile function. |
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