{"id":21901,"date":"2022-07-16T04:17:00","date_gmt":"2022-07-15T20:17:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=21901"},"modified":"2022-07-16T06:10:49","modified_gmt":"2022-07-15T22:10:49","slug":"blue-journal%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e8%84%b1%e6%9c%ba%e5%9b%b0%e9%9a%be%e6%82%a3%e8%80%85%e4%b8%b4%e6%97%b6%e6%80%a7%e7%bb%8f%e9%9d%99%e8%84%89%e8%86%88%e7%a5%9e%e7%bb%8f","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=21901","title":{"rendered":"[Blue Journal\u53d1\u8868\u8bba\u6587]\uff1a\u8131\u673a\u56f0\u96be\u60a3\u8005\u4e34\u65f6\u6027\u7ecf\u9759\u8109\u8188\u795e\u7ecf\u523a\u6fc0\u7684\u968f\u673a\u4e34\u5e8a\u8bd5\u9a8c"},"content":{"rendered":"\n

Randomized Clinical Study of Temporary Transvenous Phrenic Nerve Stimulation in Difficult-to-Wean Patients<\/h1>\n\n\n\n

<\/a>Martin Dres,\u00a0\u00a0Marcelo Gama de Abreu,\u00a0\u00a0Hamid Merdji,\u00a0et al<\/h3>\n\n\n\n

Am J Respir Crit Care Med Vol 205, Iss 10, pp 1169\u20131178, May 15, 2022<\/h3>\n\n\n\n

Abstract<\/h4>\n\n\n\n

Rationale:<\/strong> Diaphragm dysfunction is frequently observed in critically ill patients with difficult weaning from mechanical ventilation.<\/p>\n\n\n\n

Objectives:<\/strong> To evaluate the effects of temporary transvenous diaphragm neurostimulation on weaning outcome and maximal inspiratory pressure.<\/p>\n\n\n\n

Methods:<\/strong> Multicenter, open-label, randomized, controlled study. Patients aged \u2a7e18 years on invasive mechanical ventilation for \u2a7e4 days and having failed at least two weaning attempts received temporary transvenous diaphragm neurostimulation using a multielectrode stimulating central venous catheter (bilateral phrenic stimulation) and standard of care (treatment) (n<\/em>\u2009=\u200957) or standard of care (control) (n<\/em>\u2009=\u200955). In seven patients, the catheter could not be inserted, and in seven others, pacing therapy could not be delivered; consequently, data were available for 43 patients. The primary outcome was the proportion of patients successfully weaned. Other endpoints were mechanical ventilation duration, 30-day survival, maximal inspiratory pressure, diaphragm-thickening fraction, adverse events, and stimulation-related pain.<\/p>\n\n\n\n

Measurements and Main Results:<\/strong> The incidences of successful weaning were 82% (treatment) and 74% (control) (absolute difference [95% confidence interval (CI)], 7% [\u221210 to 25]), P<\/em>\u2009=\u20090.59. Mechanical ventilation duration (mean\u2009\u00b1\u2009SD) was 12.7\u2009\u00b1\u20099.9 days and 14.1\u2009\u00b1\u200910.8 days, respectively, P<\/em>\u2009=\u20090.50; maximal inspiratory pressure increased by 16.6 cm H2<\/sub>O and 4.8 cm H2<\/sub>O, respectively (difference [95% CI], 11.8 [5 to 19]), P<\/em>\u2009=\u20090.001; and right hemidiaphragm thickening fraction during unassisted spontaneous breathing was +17% and \u221214%, respectively, P<\/em>\u2009=\u20090.006, without correlation with changes in maximal inspiratory pressure. Serious adverse event frequency was similar in both groups. Median stimulation-related pain in the treatment group was 0 (no pain).<\/p>\n\n\n\n

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Conclusions:<\/strong> Temporary transvenous diaphragm neurostimulation did not increase the proportion of successful weaning from mechanical ventilation. It was associated with a significant increase in maximal inspiratory pressure, suggesting reversal of the course of diaphragm dysfunction.<\/p>\n\n\n\n

Clinical trial registered with www.clinicaltrials.gov<\/a> (NCT 03096639) and the European Database on Medical Devices (CIV-17-06-020004)<\/p>\n","protected":false},"excerpt":{"rendered":"

Randomized Clinical Study of Temporary Transvenous Phre […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/21901"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=21901"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/21901\/revisions"}],"predecessor-version":[{"id":21902,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/21901\/revisions\/21902"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=21901"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=21901"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=21901"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}