Effectiveness Of Diaphragmatic Pacing In Vitro On Diaphragmatic Dysfunction Associated With Ventilator

Objective:In this study,we performed intermittent stimulation of the phrenic nerve by means of an external diaphragmatic pacemaker in patients undergoing mechanical ventilation after ICU surgery.Diaphragm thickening fraction(TFdi)and maximum inspiratory pressure(MIP)Assess the impact on VIDD.And the predictive value of TFdi for SBT success.Method:We use a prospective randomized controlled clinical study,selected in 2017.01 to2017.12 hospitalized in Qingdao University,general anesthesia after surgery into the ICU patients,using random number table divided into experimental group and control group,the experimental group postoperative mechanical Ventilation was in A / C mode,bilateral phrenic nerve was stimulated by external diaphragmatic pacemaker for 15 minutes at 0h,4h,8h,12 h,16h and 20 h,control group was given mechanical ventilation but not phrenic nerve stimulation at 0h,5h,10 h,15h,20 h PSV mode were measured TFdi,MIP to assess the early phrenic nerve stimulation in vitro on the development of VIDD effectiveness,and TFdi and respiratory index correlation assessment,and then evaluate the impact of TFdi on SBT assessment and prediction.Result:1?A total of 159 cases met the inclusion criteria,of which 18 were not taken off-line,extubated at the end of the study,were excluded during the study,141 were finally enrolled in the statistical analysis,73 in the control group and 68 in vitro diaphragmatic pacing Group in general information,may affect the function of the diaphragm was no significant difference between the factors.2?The diaphragmatic thickening rates of control group and experimental group at t0were(15.47 ± 0.67)%,(15.48 ± 0.44)% and maximum inspiratory negative pressure were(-4.29 ± 0.61)cmH2O,(-4.30 ± 0.52)cmH2O,independent samples t test between the two groups,the difference was not statistically significant.The TFdi measured in eachphase after phrenic nerve stimulation were(17.59±0.50)%,(22.98±0.83)%,(24.95±0.63)%and(28.28±0.58)%,respectively.The measured TFdi were(17.36±0.64)%,(22.55±0.92)%,(24.69±0.94)% and(28.04±0.61)%,respectively.The diaphragmatic thickening rate measured at each stage after stimulation was significantly higher than the control group,the difference was statistically significant.The MIP measured at various stages of the experimental group after phrenic nerve stimulation were:(-6.54±0.32)cmH2O,(-7.11±0.41)cm H2 O,(-14.47±0.47)cmH2O,and(-26.01±0.44)cmH2O;(-6.38±0.62)cmH2O,(-6.89±0.71)cm H2 O,(-14.20±0.84)cmH2O,and(-25.50±1.43)cmH2O respectively.The independent samples t test was used in the two groups.After the phrenic nerve stimulation The maximum negative inspiratory pressure measured at each stage was significantly higher than that of the control group,the difference was statistically significant.3?For all patients participating in the trial,TFdi was measured before SBT,and shallow breathing index was calculated during SBT.Pearson correlation analysis between diaphragmatic thickening rate and shallow breathing index showed significant correlation.Conclusion:1?After a few hours of complete control ventilation,diaphragm contraction function is significantly reduced.2?Early in vitro diaphragmatic pacing therapy in patients with complete controlled ventilation can significantly improve the development of ventilator-associated diaphragmatic dysfunction.3?Measurement of TFdi by bedside ultrasound can be used as one of the assessment methods before SBT.