Effect of theophylline on ventilator-induced diaphragmatic dysfunction

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• 作者：Won-Young Kim ; MD^a ; ¹ ; ^{steve8126@hanmail.net" class="auth_mail" title="E-mail the corresponding author} ; So Hee Park ; MD^a ; ¹ ; ^{sojjang01@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Won Young Kim ; MD ; PhD^b ; ^{wonpia@yahoo.co.kr" class="auth_mail" title="E-mail the corresponding author} ; Jin Won Huh ; MD ; PhD^a ; ^{jwhuh@amc.seoul.kr" class="auth_mail" title="E-mail the corresponding author} ; Sang-Bum Hong ; MD ; PhD^a ; ^{sbhong@amc.seoul.kr" class="auth_mail" title="E-mail the corresponding author} ; Younsuck Koh ; MD ; PhD^a ; ^{yskoh@amc.seoul.kr" class="auth_mail" title="E-mail the corresponding author} ; Chae-Man Lim ; MD ; PhD^a ; ^{cmlim@amc.seoul.kr" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Theophylline ; Diaphragm ; Ventilator-induced diaphragmatic dysfunction ; Ultrasonography ; Weaning ; Mechanical ventilation
• 刊名：Journal of Critical Care
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：33
• 期：Complete
• 页码：145-150
• 全文大小：456 K

文摘

To evaluate the effect of theophylline in patients with ventilator-induced diaphragmatic dysfunction (VIDD).

Materials and Methods

Patients who required mechanical ventilation at least 72 hours, met the criteria for a spontaneous breathing trial, and had evidence of VIDD by ultrasonography were included in the study.

Results

Of the 40 patients, 21 received theophylline and 19 did not. Clinical characteristics were similar in the 2 groups. Assessment of VIDD showed no between-group differences in baseline diaphragmatic excursion (DE) of both hemidiaphragms. Changes in DE from baseline to 72 hours (ΔDE) were significantly higher in the theophylline group than in the nontheophylline group in the right (3.5 ± 4.5 mm vs 0.4 ± 2.1 mm; P = .004) and left (3.2 ± 5.1 mm vs 0.1 ± 4.0 mm; P = .03) hemidiaphragms and in the total DE of both diaphragms (6.9 ± 9.1 mm vs 0.5 ± 5.7 mm; P = .02). In the theophylline group, theophylline was effective for the diaphragms with VIDD, whereas it was not effective for the diaphragms without VIDD. ΔDE in the right (r_s = − 0.49, P = .006) hemidiaphragm and total Δ DE in both diaphragms (r_s = − 0.46, P = .01) correlated negatively with weaning time.

Conclusions

Theophylline significantly improved diaphragmatic movements in patients with VIDD. Our results warrant a larger study to determine whether theophylline use has benefits during weaning from mechanical ventilation.