机构：[1]Emergency Department, The First Affiliated Hospital of Kunming Medical University, 295 Xi Chang Road, Kunming 650032, Yunnan, China.内科科室急诊医学科昆明医科大学附属第一医院[2]Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France.
Background A spontaneous breathing trial (SBT) is a major diagnostic tool to predict successfully extubation in patients. Several factors may lead to weaning failure, including the degree of lung aeration loss and diaphragm dysfunction. The main objective was to compare the diaphragmatic contractility between patients with high lung aeration loss and low lung aeration loss during a 30-minute SBT by ultrasound. Methods This was a prospective single-center study. Lung ultrasound aeration score (LUS) and diaphragmatic thickening fraction (DTF) were measured during mechanical ventilation 1 h before SBT (T-1), 30 min (T1), and 120 min (T2) after the start of the SBT during quiet breathing. The right and left DTF were compared between patients with LUS >= 14 (high lung aeration loss), considered at high risk of post-extubation distress, and those with LUS < 14 (low lung aeration loss). The relationship between the LUS and DTF and the changes in LUS and DTF from T-1 to T2 in patients with LUS >= 14 were assessed. Results Forty-nine patients were analyzed; 33 had LUS >= 14 and 16 had LUS < 14 at T1. The DTF at T1 was significantly higher in patients with LUS >= 14 than in those with LUS < 14: the right median (IQR) DTF was 22.2% (17.1 to 30.9%) vs. 14.8% (10.2 to 27.0%) (p = 0.035), and the left median (IQR) DTF was 25.0% (18.4 to 35.0%) vs. 18.6% (9.7 to 24.2%) (p = 0.017), respectively. There was a moderate positive correlation between the LUS and the DTF (Rho = 0.3, p = 0.014). A significant increase in the LUS was observed from T-1 to T1, whereas no change was found between T1 and T2. The DTF remained stable from T-1 to T2. Conclusions During a SBT, diaphragmatic contraction acts differently depending on the degree of pulmonary aeration. In patients with high lung aeration loss, increased diaphragmatic contractility indicates an additional respiratory effort to compensate lung volume loss that would contribute to successful SBT. Further studies are needed to evaluate the combined evaluation of lung aeration and diaphragmatic function to predict the successful weaning of patients from mechanical ventilation.
基金：
Health Commission of Yunnan province [H-201616]; China Scholarship Council (CSC)China Scholarship Council [201608530178]
第一作者机构：[1]Emergency Department, The First Affiliated Hospital of Kunming Medical University, 295 Xi Chang Road, Kunming 650032, Yunnan, China.
通讯作者：
推荐引用方式(GB/T 7714)：
Xia Jing,Qian Chuan-Yun,Yang Li,et al.Influence of lung aeration on diaphragmatic contractility during a spontaneous breathing trial: an ultrasound study[J].JOURNAL OF INTENSIVE CARE.2019,7(1):doi:10.1186/s40560-019-0409-x.
APA：
Xia Jing,Qian Chuan-Yun,Yang Li,Li Mei-Ju,Liu Xiao-Xue...&Qin Lu.(2019).Influence of lung aeration on diaphragmatic contractility during a spontaneous breathing trial: an ultrasound study.JOURNAL OF INTENSIVE CARE,7,(1)
MLA：
Xia Jing,et al."Influence of lung aeration on diaphragmatic contractility during a spontaneous breathing trial: an ultrasound study".JOURNAL OF INTENSIVE CARE 7..1(2019)
