Is weaning failure caused by low-frequency fatigue of the diaphragm?

Franco Laghi, Steven E. Cattapan, Amal Jubran, Sairam Parthasarathy, Paul Warshawsky, Yoon Sub A. Choi, Martin J. Tobin

Research output: Contribution to journalArticlepeer-review

243 Scopus citations

Abstract

Because patients who fail a trial of weaning from mechanical ventilation experience a marked increase in respiratory load, we hypothesized that these patients develop diaphragmatic fatigue. Accordingly, we measured twitch transdiaphragmatic pressure using phrenic nerve stimulation in 11 weaning failure and 8 weaning success patients. Measurements were made before and 30 minutes after spontaneous breathing trials that lasted up to 60 minutes. Twitch transdiaphragmatic pressure was 8.9 ± 2.2 cm H2O before the trials and 9.4 ± 2.4 cm H2O after their completion in the weaning failure patients (p = 0.17); the corresponding values in the weaning success patients were 10.3 ± 1.5 and 11.2 ± 1.8 cm H2O (p = 0.18). Despite greater load (p = 0.04) and diaphragmatic effort (p = 0.01), the weaning failure patients did not develop low-frequency fatigue probably because of greater recruitment of rib cage and expiratory muscles (p = 0.004) and because clinical signs of distress mandating the reinstitution of mechanical ventilation arose before the development of fatigue. Twitch pressure revealed considerable diaphragmatic weakness in many weaning failure patients. In conclusion, in contrast to our hypothesis, weaning failure was not accompanied by low-frequency fatigue of the diaphragm, although many weaning failure patients displayed diaphragmatic weakness.

Original languageEnglish (US)
Pages (from-to)120-127
Number of pages8
JournalAmerican journal of respiratory and critical care medicine
Volume167
Issue number2
DOIs
StatePublished - Jan 15 2003
Externally publishedYes

Keywords

  • Muscle fatigue
  • Phrenic nerve
  • Respiratory insufficiency
  • Respiratory muscles
  • Ventilator weaning

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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