在超声波引导下对重症患者进行经皮膈神经刺激:一种评估膈肌功能的新方法。

IF 9.1 1区 医学 Q1 ANESTHESIOLOGY Anesthesiology Pub Date : 2024-10-21 DOI:10.1097/ALN.0000000000005267
Mathieu Capdevila, Audrey De Jong, Fouad Belafia, Aurelie Vonarb, Julie Carr, Nicolas Molinari, Olivier Choquet, Xavier Capdevila, Samir Jaber
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引用次数: 0

摘要

背景:膈肌功能障碍在重症监护室很常见,与断奶失败和死亡率有关。诊断的金标准是通过磁性膈神经刺激诱发经膈或气管压力。然而,这种设备并不常见,而且需要特定的技术技能。我们旨在评估超声引导下的经皮膈神经刺激,通过有针对性的膈神经电刺激对膈肌功能进行日常床旁评估:在这项随机交叉研究中,我们比较了使用外周神经刺激器的超声引导经皮膈神经电刺激新方法(SONOTEPS 方法)和磁性膈神经刺激方法。研究对象包括接受机械通气的重症监护室成人患者,这些患者的里士满激动-镇静-量表评分为-4 或-5 分。每位患者按随机顺序接受两种刺激方法。主要结果是刺激引起的气管压力(Ptrach):我们分析了 116 名患者的 232 次 Ptrach 测量值,其中 77 人出现横膈膜功能障碍(Ptrach < 11 cmH2O),50 人出现严重横膈膜功能障碍(Ptrach < 8 cmH2O)。Passing-Bablok 回归结果显示,SONOTEPS 方法与磁刺激之间无明显差异(截距 A 为 -0.03 [CI95:-0.83-0.52],斜率 B 为 0.98 [CI95:0.90-1.05]),两者呈正相关(R²=0.639)。平均偏差为-1.08 (CI95 5.02, -7.18) cmH2O。接收器工作曲线显示,横膈膜功能障碍和严重横膈膜功能障碍的诊断效果极佳,曲线下面积分别为 0.90 (CI95 0.83-0.97) 和 0.88 (CI95 0.82-0.95)。体重指数或颈部导管的存在对这一性能没有明显影响:SONOTEPS方法是一种简单而准确的工具,可用于对无自发呼吸活动或自发呼吸活动极少的镇静患者进行超声引导下经皮膈神经刺激的膈肌功能床旁评估。
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Ultrasound guided transcutaneous phrenic nerve stimulation in critically ill patients: a new method to evaluate diaphragmatic function.

Background: Diaphragm dysfunction is common in intensive care unit and associated with weaning failure and mortality. Diagnosis gold standard is the transdiaphragmatic or tracheal pressure induced by magnetic phrenic nerve stimulation. However, the equipment is not commonly available and requires specific technical skills. We aimed to evaluate ultrasound guided transcutaneous phrenic nerve stimulation for daily bedside assessment of diaphragm function by targeted electrical phrenic nerve stimulation.

Methods: In this randomized cross-over study we compared a new method of ultrasound guided transcutaneous electrical phrenic nerve stimulation (SONOTEPS method) using a peripheral nerve stimulator, with the magnetic phrenic nerve stimulation. Intensive care unit adult patients under mechanical ventilation with a Richmond-Agitation-Sedation-Scale score of -4 or -5 were included. Each patient received the two methods of stimulation, in a randomized order. The primary outcome was the tracheal pressure (Ptrach) induced by stimulation.

Results: We analyzed 232 measures of Ptrach from 116 patients of whom 77 presented a diaphragm dysfunction (Ptrach < 11 cmH2O) and 50 a severe diaphragm dysfunction (Ptrach < 8 cmH2O). The Passing-Bablok regression showed no significant differences (intercept A of -0.03 [CI95:-0.83-0.52] and slope B of 0.98 [CI95:0.90-1.05]) between SONOTEPS method and magnetic stimulation which were positively correlated (R²=0.639). The mean bias was -1.08 (CI95 5.02, -7.18) cmH2O. The receiver operating curves showed an excellent performance for the diagnosis of diaphragm dysfunction and severe diaphragm dysfunction with respectively an area under curve of 0.90 (CI95 0.83-0.97) and 0.88 (CI95 0.82-0.95). This performance was not significantly affected by the body mass index or the presence of a neck catheter.

Conclusions: The SONOTEPS method is a simple and accurate tool for bedside assessment of diaphragm function with ultrasound guided transcutaneous phrenic nerve stimulation in sedated patients with no or minimal spontaneous respiratory activity.

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来源期刊
Anesthesiology
Anesthesiology 医学-麻醉学
CiteScore
10.40
自引率
5.70%
发文量
542
审稿时长
3-6 weeks
期刊介绍: With its establishment in 1940, Anesthesiology has emerged as a prominent leader in the field of anesthesiology, encompassing perioperative, critical care, and pain medicine. As the esteemed journal of the American Society of Anesthesiologists, Anesthesiology operates independently with full editorial freedom. Its distinguished Editorial Board, comprising renowned professionals from across the globe, drives the advancement of the specialty by presenting innovative research through immediate open access to select articles and granting free access to all published articles after a six-month period. Furthermore, Anesthesiology actively promotes groundbreaking studies through an influential press release program. The journal's unwavering commitment lies in the dissemination of exemplary work that enhances clinical practice and revolutionizes the practice of medicine within our discipline.
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