Neurally adjusted ventilatory assist in patients with critical illness-associated polyneuromyopathy

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• 作者：Daniel Tuchscherer (1)
  Werner J. Z’Graggen (2) (3)
  Christina Passath (1)
  Jukka Takala (1)
  Christer Sinderby (4) (5)
  Lukas Brander (1) (6)
  
• 关键词：Positive pressure respiration ; Breathing pattern ; Diaphragm ; Electromyography ; Respiratory therapy ; Polyneuropathy
• 刊名：Intensive Care Medicine
• 出版年：2011
• 出版时间：December 2011
• 年：2011
• 卷：37
• 期：12
• 页码：1951-1961
• 全文大小：363KB
• 参考文献：1. Ali NA, O’Brien JM Jr, Hoffmann SP, Phillips G, Garland A, Finley JC, Almoosa K, Hejal R, Wolf KM, Lemeshow S, Connors AF Jr, Marsh CB (2008) Acquired weakness, handgrip strength, and mortality in critically ill patients. Am J Respir Crit Care Med 178:261-68 CrossRef
  2. De JB, Sharshar T, Lefaucheur JP, Authier FJ, Durand-Zaleski I, Boussarsar M, Cerf C, Renaud E, Mesrati F, Carlet J, Raphael JC, Outin H, Bastuji-Garin S (2002) Paresis acquired in the intensive care unit: a prospective multicenter study. JAMA 288:2859-867 CrossRef
  3. De JB, Bastuji-Garin S, Sharshar T, Outin H, Brochard L (2004) Does ICU-acquired paresis lengthen weaning from mechanical ventilation? Intensive Care Med 30:1117-121 CrossRef
  4. Garnacho-Montero J, Madrazo-Osuna J, Garcia-Garmendia JL, Ortiz-Leyba C, Jimenez-Jimenez FJ, Barrero-Almodovar A, Garnacho-Montero MC, Moyano-Del-Estad MR (2001) Critical illness polyneuropathy: risk factors and clinical consequences. A cohort study in septic patients. Intensive Care Med 27:1288-296 CrossRef
  5. Sharshar T, Bastuji-Garin S, Stevens RD, Durand MC, Malissin I, Rodriguez P, Cerf C, Outin H, De JB (2009) Presence and severity of intensive care unit-acquired paresis at time of awakening are associated with increased intensive care unit and hospital mortality. Crit Care Med 37:3047-053 CrossRef
  6. Zochodne DW, Bolton CF, Wells GA, Gilbert JJ, Hahn AF, Brown JD, Sibbald WA (1987) Critical illness polyneuropathy. A complication of sepsis and multiple organ failure. Brain 110 (Pt 4):819-841
  7. Maher J, Rutledge F, Remtulla H, Parkes A, Bernardi L, Bolton CF (1995) Neuromuscular disorders associated with failure to wean from the ventilator. Intensive Care Med 21:737-43 CrossRef
  8. Spitzer AR, Giancarlo T, Maher L, Awerbuch G, Bowles A (1992) Neuromuscular causes of prolonged ventilator dependency. Muscle Nerve 15:682-86 CrossRef
  9. Witt NJ, Zochodne DW, Bolton CF, Grand’Maison F, Wells G, Young GB, Sibbald WJ (1991) Peripheral nerve function in sepsis and multiple organ failure. Chest 99:176-84 CrossRef
  10. Zifko UA, Zipko HT, Bolton CF (1998) Clinical and electrophysiological findings in critical illness polyneuropathy. J Neurol Sci 159:186-93 CrossRef
  11. Sinderby C, Navalesi P, Beck J, Skrobik Y, Comtois N, Friberg S, Gottfried SB, Lindstrom L (1999) Neural control of mechanical ventilation in respiratory failure. Nat Med 5:1433-436 CrossRef
  12. ATS/ERS (2002) ATS/ERS Statement on respiratory muscle testing. Am J Respir Crit Care Med 166:518-624
  13. Beck J, Sinderby C, Lindstrom L, Grassino A (1998) Effects of lung volume on diaphragm EMG signal strength during voluntary contractions. J Appl Physiol 85:1123-134
  14. Jolley CJ, Luo YM, Steier J, Reilly C, Seymour J, Lunt A, Ward K, Rafferty GF, Polkey MI, Moxham J (2009) Neural respiratory drive in healthy subjects and in COPD. Eur Respir J 33:289-97 CrossRef
  15. Sinderby C, Beck J, Spahija J, Weinberg J, Grassino A (1998) Voluntary activation of the human diaphragm in health and disease. J Appl Physiol 85:2146-158
  16. Beck J, Campoccia F, Allo JC, Brander L, Brunet F, Slutsky AS, Sinderby C (2007) Improved synchrony and respiratory unloading by neurally adjusted ventilatory assist (NAVA) in lung-injured rabbits. Pediatr Res 61:289-94 CrossRef
  17. Colombo D, Cammarota G, Bergamaschi V, De LM, Corte FD, Navalesi P (2008) Physiologic response to varying levels of pressure support and neurally adjusted ventilatory assist in patients with acute respiratory failure. Intensive Care Med 34:2010-018 CrossRef
  18. Piquilloud L, Vignaux L, Bialais E, Roeseler J, Sottiaux T, Laterre PF, Jolliet P, Tassaux D (2010) Neurally adjusted ventilatory assist improves patient-ventilator interaction. Intensive Care Med 37:263-71
  19. Spahija J, de Marchie M, Albert M, Bellemare P, Delisle S, Beck J, Sinderby C (2010) Patient-ventilator interaction during pressure support ventilation and neurally adjusted ventilatory assist. Crit Care Med 38:518-26 CrossRef
  20. Terzi N, Pelieu I, Guittet L, Ramakers M, Seguin A, Daubin C, Charbonneau P, du Cheyron D, Lofaso F (2010) Neurally adjusted ventilatory assist in patients recovering spontaneous breathing after acute respiratory distress syndrome: physiological evaluation. Crit Care Med 38:1830-837 CrossRef
  21. Allo JC, Beck JC, Brander L, Brunet F, Slutsky AS, Sinderby CA (2006) Influence of neurally adjusted ventilatory assist and positive end-expiratory pressure on breathing pattern in rabbits with acute lung injury. Crit Care Med 34:2997-004
  22. Brander L, Leong-Poi H, Beck J, Brunet F, Hutchison SJ, Slutsky AS, Sinderby C (2009) Titration and implementation of neurally adjusted ventilatory assist in critically ill patients. Chest 135:695-03 CrossRef
  23. Lecomte F, Brander L, Jalde F, Beck J, Qui H, Elie C, Slutsky AS, Brunet F, Sinderby C (2009) Physiological response to increasing levels of neurally adjusted ventilatory assist (NAVA). Respir Physiol Neurobiol 166:117-24 CrossRef
  24. Passath C, Takala J, Tuchscherer D, Jakob SM, Sinderby C, Brander L (2010) Physiologic response to changing positive end-expiratory pressure during neurally adjusted ventilatory assist in sedated, critically ill adults. Chest 138:578-87 CrossRef
  25. Sinderby C, Beck J, Spahija J, de Marchie M, Lacroix J, Navalesi P, Slutsky AS (2007) Inspiratory muscle unloading by neurally adjusted ventilatory assist during maximal inspiratory efforts in healthy subjects. Chest 131:711-17 CrossRef
  26. Roze H, Lafrikh A, Perrier V, Germain A, Dewitte A, Gomez F, Janvier G, Ouattara A (2011) Daily titration of neurally adjusted ventilatory assist using the diaphragm electrical activity. Intensive Care Med 37:1087-094 CrossRef
  27. Ververidis D, Van GM, Passath C, Takala J, Brander L (2011) Identification of adequate neurally adjusted ventilatory assist (NAVA) during systematic increases in the NAVA level. IEEE Trans Biomed Eng, Jun 16 (e-pub ahead of print), PMID: 21690003
  28. Kleyweg RP, van der Meche FG, Schmitz PI (1991) Interobserver agreement in the assessment of muscle strength and functional abilities in Guillain-Barre syndrome. Muscle Nerve 14:1103-109 CrossRef
  29. Beck J, Reilly M, Grasselli G, Mirabella L, Slutsky AS, Dunn MS, Sinderby C (2009) Patient-ventilator interaction during neurally adjusted ventilatory assist in low birth weight infants. Pediatr Res 65:663-68 CrossRef
  30. Sinderby CA, Beck JC, Lindstrom LH, Grassino AE (1997) Enhancement of signal quality in esophageal recordings of diaphragm EMG. J Appl Physiol 82:1370-377
  31. Sinderby C, Spahija J, Beck J (2001) Changes in respiratory effort sensation over time are linked to the frequency content of diaphragm electrical activity. Am J Respir Crit Care Med 163:905-10
  32. Sinderby C, Spahija J, Beck J, Kaminski D, Yan S, Comtois N, Sliwinski P (2001) Diaphragm activation during exercise in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 163:1637-641
  33. Sessler CN, Gosnell MS, Grap MJ, Brophy GM, O’Neal PV, Keane KA, Tesoro EP, Elswick RK (2002) The Richmond agitation-sedation scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med 166:1338-344 CrossRef
  34. Z’graggen WJ, Brander L, Tuchscherer D, Scheidegger O, Takala J, Bostock H (2011) Muscle membrane dysfunction in critical illness myopathy assessed by velocity recovery cycles. Clin Neurophysiol 122:834-41 CrossRef
  35. Swenson MR, Rubenstein RS (1992) Phrenic nerve conduction studies. Muscle Nerve 15:597-03 CrossRef
  36. MacIntyre NR, Cook DJ, Ely EW Jr, Epstein SK, Fink JB, Heffner JE, Hess D, Hubmayer RD, Scheinhorn DJ (2001) Evidence-based guidelines for weaning and discontinuing ventilatory support: a collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine. Chest 120:375S-95S CrossRef
  37. Mier A, Brophy C, Moxham J, Green M (1987) Phrenic nerve stimulation in normal subjects and in patients with diaphragmatic weakness. Thorax 42:885-88 CrossRef
  38. Luo YM, Polkey MI, Johnson LC, Lyall RA, Harris ML, Green M, Moxham J (1998) Diaphragm EMG measured by cervical magnetic and electrical phrenic nerve stimulation. J Appl Physiol 85:2089-099
  39. Luo YM, Lyall RA, Lou HM, Rafferty GF, Polkey MI, Moxham J (1999) Quantification of the esophageal diaphragm electromyogram with magnetic phrenic nerve stimulation. Am J Respir Crit Care Med 160:1629-634
  40. Beck J, Weinberg J, Hamnegard CH, Spahija J, Olofson J, Grimby G, Sinderby C (2006) Diaphragmatic function in advanced Duchenne muscular dystrophy. Neuromuscul Disord 16:161-67 CrossRef
  41. McKeown MJ, Bolton CF (1998) Electromyography of the diaphragm in neuromuscular disease. Muscle Nerve 21:954-57 CrossRef
  42. Wanke T, Paternostro-Sluga T, Grisold W, Formanek D, Auinger M, Zwick H, Irsigler K (1992) Phrenic nerve function in type 1 diabetic patients with diaphragm weakness and peripheral neuropathy. Respiration 59:233-37 CrossRef
  43. Hering E, Breuer J (1868) Die Selbststeurung der athmung durch den nervus vagus. Sitzber Deut Akad Wiss Wein 57:672-77
  44. Rabbette PS, Costeloe KL, Stocks J (1991) Persistence of the Hering-Breuer reflex beyond the neonatal period. J Appl Physiol 71:474-80
  45. Stanley NN, Altose MD, Kelsen SG, Ward CF, Cherniack NS (1975) Changing effect of lung volume on respiratory drive in man. J Appl Physiol 38:768-73
  46. Widdicombe JG, Tatar M (1988) Upper airway reflex control. Ann N Y Acad Sci 533:252-61 CrossRef
  47. Brander L, Sinderby C, Lecomte F, Leong-Poi H, Bell D, Beck J, Tsoporis JN, Vaschetto R, Schultz MJ, Parker TG, Villar J, Zhang H, Slutsky AS (2009) Neurally adjusted ventilatory assist decreases ventilator-induced lung injury and non-pulmonary organ dysfunction in rabbits with acute lung injury. Intensive Care Med 35:1979-989 CrossRef
  48. Karagiannidis C, Lubnow M, Philipp A, Riegger GA, Schmid C, Pfeifer M, Mueller T (2010) Autoregulation of ventilation with neurally adjusted ventilatory assist on extracorporeal lung support. Intensive Care Med 36:2038-044 CrossRef
  49. Barwing J, Ambold M, Linden N, Quintel M, Moerer O (2009) Evaluation of the catheter positioning for neurally adjusted ventilatory assist. Intensive Care Med 35:1809-814
  50. Markand ON, Kincaid JC, Pourmand RA, Moorthy SS, King RD, Mahomed Y, Brown JW (1984) Electrophysiologic evaluation of diaphragm by transcutaneous phrenic nerve stimulation. Neurology 34:604-14
  51. Ely EW, Margolin R, Francis J, May L, Truman B, Dittus R, Speroff T, Gautam S, Bernard GR, Inouye SK (2001) Evaluation of delirium in critically ill patients: validation of the confusion assessment method for the intensive care unit (CAM-ICU). Crit Care Med 29:1370-379 CrossRef
  
• 作者单位：Daniel Tuchscherer (1)
  Werner J. Z’Graggen (2) (3)
  Christina Passath (1)
  Jukka Takala (1)
  Christer Sinderby (4) (5)
  Lukas Brander (1) (6)
  
  1. Department of Intensive Care Medicine, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
  2. Department of Neurosurgery, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
  3. Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
  4. Interdepartmental Division of Critical Care Medicine, Department of Critical Care Medicine, St. Michael’s Hospital, University of Toronto, Toronto, Canada
  5. Keenan Research Center, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Canada
  6. Department of Anesthesia and Intensive Care Medicine, Luzerner Kantonsspital, 16, 6000, Lucerne, Switzerland
  

文摘

Purpose Diaphragmatic electrical activity (EAdi), reflecting respiratory drive, and its feedback control might be impaired in critical illness-associated polyneuromyopathy (CIPM). We aimed to evaluate whether titration and prolonged application of neurally adjusted ventilatory assist (NAVA), which delivers pressure (P aw) in proportion to EAdi, is feasible in CIPM patients. Methods Peripheral and phrenic nerve electrophysiology studies were performed in 15 patients with clinically suspected CIPM and in 14 healthy volunteers. In patients, an adequate NAVA level (NAVAal) was titrated daily and was implemented for a maximum of 72?h. Changes in tidal volume (V t) generation per unit of EAdi (V t/EAdi) were assessed daily during standardized tests of neuro-ventilatory efficiency (NVET). Results In patients (median [range], 66 [44-0]?years), peripheral electrophysiology studies confirmed CIPM. Phrenic nerve latency (PNL) was prolonged and diaphragm compound muscle action potential (CMAP) was reduced compared with healthy volunteers (p?<?0.05 for both). NAVAal could be titrated in all but two patients. During implementation of NAVAal for 61 (37-4)?h, the EAdi amplitude was 9.0 (4.4-5.2)?μV, and the V t was 6.5 (3.7-4.3)?ml/kg predicted body weight. V t, respiratory rate, EAdi, PaCO2, and hemodynamic parameters remained unchanged, while PaO2/FiO2 increased from 238 (121-37) to 282 (150-40)?mmHg (p?=?0.007) during NAVAal. V t/EAdi changed by ?0 (?6; +31)% during the first NVET and by ?.1 (?6; +77)% during the last NVET (p?=?0.048). Conclusion In most patients with CIPM, EAdi and its feedback control are sufficiently preserved to titrate and implement NAVA for up to 3?days. Whether monitoring neuro-ventilatory efficiency helps inform the weaning process warrants further evaluation.