Clinical manifestations of inspiratory muscle fatigue

Cohen, Carol; Zagelbaum, Gary; Gross, D; Roussos, Ch.; Macklem, Peter T.

doi:10.1016/0002-9343(82)90711-2

Cited by 438 publications

(147 citation statements)

References 18 publications

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“…Few data exist in this area. In a very influential study, COHEN et al [89] studied 12 patients with various disorders leading to hypercapnic respiratory failure after discontinuation of mechanical ventilation. To detect diaphragmatic fatigue, the power spectrum of diaphragmatic surface electromyographic activity was analysed.…”

Section: The Final Pathway To Weaning Failure: Fatigue/hypercapnia/dymentioning

confidence: 99%

Respiratory muscles and weaning failure

Vassilakopoulos¹,

Zakynthinos²,

Roussos³

1996

Eur Respir J

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116

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R Re es sp pi ir ra at to or ry y m mu us sc cl le es s a an nd d w we ea an ni in ng g f fa ai il lu ur re e ABSTRACT: Weaning failure is, unfortunately, a rather common phenomenon for mechanically-ventilated patients (especially those with chronic obstructive pulmonary disease (COPD)), and the respiratory muscles play a pivotal role in its development.Weaning fails whenever an imbalance exists between the ventilatory needs and the neurocardiorespiratory capacity. This can happen if there is an increase in the energy demands of the respiratory muscles, a decrease in the energy available, a decrease in neuromuscular competence, or if the respiratory muscles pose an impediment to the heart and blood flow.The imbalance created will lead to weaning failure through the development of respiratory muscle fatigue, hypercapnia, dyspnoea, anxiety and organ dysfunction.

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Section: The Final Pathway To Weaning Failure: Fatigue/hypercapnia/dymentioning

confidence: 99%

Respiratory muscles and weaning failure

Vassilakopoulos¹,

Zakynthinos²,

Roussos³

1996

Eur Respir J

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116

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“…If the required VT and inspiratory flow are higher than what the ventilator supplies, the WOB increases and the patient may develop fatigue [10]. Consequently, the main advantage of ACV over PSV is that ACV ensures a set VT during conditions of variable ventilatory drive and mechanics [9].…”

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confidence: 99%

Different modes of assisted ventilation in patients with acute respiratory failure

Chiumello¹,

Pelosi²,

Calvi³

et al. 2002

European Respiratory Journal

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The aim of the present study was to verify that the patient/ventilator interaction is similar, regardless of the mode of assisted mechanical ventilation (i.e. pressure-or volume-limited) used, if tidal volume (VT) and peak inspiratory flow (PIF) are matched. Therefore, the authors compared the effects of three different modes of assisted ventilation on the work of breathing (WOB) and gas exchange in patients with acute respiratory failure.For Protocol 1, in seven patients, the authors compared pressure support, assist pressure control and assist control (with square and decelerating wave inspiratory flow pattern) set to deliver the same VT and PIF. For Protocol 2, in another 10 patients, the authors compared pressure support and assist control with high (0.8 L?s -1 ) and low (0.6 L?s -1 ) PIFs set to deliver the same VT.In Protocol 1, there was no difference in WOB and gas exchange between the three modes of assisted ventilation tested. In Protocol 2, the decrease of PIFs during assist control significantly increased WOB.In conclusion, different modes of assisted ventilation similarly reduce work of breathing and provide adequate gas exchange at fixed tidal volume and peak inspiratory flow only. During assist control, tidal volume and peak inspiratory flow (set by the physician) are the main determinants of the patient/ventilator interaction. A primary goal of mechanical ventilation is to improve gas exchange and reduce the work of breathing (WOB) of patients with acute respiratory failure, without causing iatrogenic lung injury [1]. Assisted ventilation allows the patient to contribute to minute ventilation (V9E) and offers several advantages over controlled ventilation. It can reduce the need for sedation and paralysis, decrease the risk of barotrauma [2], improve intrapulmonary gas distribution [3], and prevent muscle atrophy [4,5]. During assisted ventilation, the WOB is dependent on both the ventilator settings and the patient9s ventilatory demand and mechanics.Pressure support ventilation (PSV) is a pressurelimited, flow-cycled mode of assisted ventilation, in which each breath is supported by a constant level of pressure at the airway (Paw), so that the tidal volume (VT) and inspiratory flow are more adaptable to the patient9s own ventilatory demand [6]. This manner of supporting the patient9s own ventilatory effort may be responsible for an improved comfort and synchrony with the ventilator, and has been shown to reduce the WOB and prevent diaphragmatic fatigue in patients with respiratory failure [7]. The main disadvantage of PSV is that it only works best in patients with stable respiratory conditions (i.e. an adequate sufficient ventilatory drive and somewhat preserved respiratory mechanics [8,9]).Assist control ventilation (ACV) is a volume-limited mode of assisted ventilation, in which the VT and the peak inspiratory flow (PIF) are set by the clinician and are not altered by the patient9s ventilatory demand. If the required VT and inspiratory flow are higher than what the ventilator suppli...

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“…The diaphragm is a specialised skeletal muscle. It has been shown the diaphragm responds like skeletal muscle in terms of fatiguability and training (Cohen, 1982). Lieberman found that 55" 0 of the fibres in the human diaphragm are red, slow twitch fibres.…”

Section: Resultsmentioning

confidence: 99%

Progressive resistive exercise in weaning high quadriplegics from the ventilator

Lerman

Weiss

1987

Spinal Cord

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SummaryAcutely high level quadriplegics may experience neuromuscular respiratory insuf ficiency secondary to loss of use of intercostal and abdominal muscles as well as partial involvement of the phrenic nerve. Frequently, these patients will require mechanical ventilation in the initial stages of their treatment. These patients may present difficulty with weaning off the ventilator. In addition, poor respiratory reserve increases the risk of episodic decompensation. We have instituted a progres sive resistive exercise protocol (PRE) analogous to PRE commonly used in training skeletal muscle, to wean patients off the ventilator. This involves determining the patient's endurance to the development of fatigue while off the ventilator. Patients are re-evaluated weekly until they are weaned from the ventilator. Three case studies are reported in which this protocol was used. In addition to our standard respiratory therapy and physical therapy protocols, values for vital capacity and maximum inspiratory force at admission and post-weaning were recorded. After completion of the programme, none of the patients required re-intubation or sub sequent mechanical ventilation. This method of diaphragm training may be useful in weaning high level quadriplegics from the ventilator.

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Clinical manifestations of inspiratory muscle fatigue

Cited by 438 publications

References 18 publications

Respiratory muscles and weaning failure

Respiratory muscles and weaning failure

Different modes of assisted ventilation in patients with acute respiratory failure

Progressive resistive exercise in weaning high quadriplegics from the ventilator

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