Late Breaking Abstract - Effects of levosimendan on diaphragm contractile efficiency in patients weaning from mechanical ventilation

L. Roesthuis, H. V. D. Hoeven, C. Sinderby, T. Frenzel, C. Ottenheijm, L. Brochard, J. Doorduin, L. Heunks
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Abstract

Introduction: Respiratory muscle weakness frequently develops in critically ill patients and is associated with difficult weaning from mechanical ventilation and increased mortality. No drug has been approved to improve respiratory muscle function. However, we have previously shown that the calcium sensitizer levosimendan improves contractility of diaphragm muscle fibers in vitro and diaphragm contractility in healthy subjects in vivo. Objectives: To investigate the effects of levosimendan on diaphragm contractile efficiency in mechanically ventilated patients. Methods: In a double-blind placebo-controlled trial mechanically ventilated patients (N=39) performed two continuous positive airway pressure (CPAP) trials for 30-minutes each with 5 hour interval. After the first CPAP trial, study medication (either levosimendan 0.2 µg/kg/min or placebo) was administered. During both trials electrical activity of the diaphragm (EAdi), transdiaphragmatic pressure (Pdi) and tidal volume (TV) were continuously measured. Neuromechanical efficiency (primary outcome parameter) was defined as ΔPdi/ΔEAdi. Results: Neuromechanical efficiency did not improve after levosimendan. However, ΔEAdi and tidal volume were higher after levosimendan administration (31% and 11%, respectively). P0.1, a measure for respiratory load, increased in the placebo group by 41%, while it remained constant in the levosimendan group. PaCO2 significantly decreased (44 mmHg vs 42 mmHg) in response to levosimendan administration. Conclusions: Although levosimendan did not improve diaphragm contractile efficiency, tidal volume increased, while P0.1 and PaCO2 decreased.
摘要-左西孟旦对机械通气患者膈肌收缩效率的影响
危重患者经常出现呼吸肌无力,并伴有机械通气困难脱机和死亡率增加。目前还没有药物被批准用于改善呼吸肌功能。然而,我们之前已经表明,钙敏化剂左西孟旦在体外改善膈肌纤维的收缩力,在体内改善健康受试者的膈肌收缩力。目的:探讨左西孟旦对机械通气患者膈肌收缩效率的影响。方法:在一项双盲安慰剂对照试验中,机械通气患者(N=39)进行两次持续气道正压通气(CPAP)试验,每次30分钟,间隔5小时。在第一次CPAP试验后,给予研究药物(左西孟旦0.2µg/kg/min或安慰剂)。在两次试验中,连续测量膈肌电活动(EAdi)、横膈膜压力(Pdi)和潮气量(TV)。神经机械效率(主要结局参数)定义为ΔPdi/ΔEAdi。结果:左西孟旦后神经力学效率无明显提高。但左西孟旦给药后ΔEAdi和潮气量升高(分别为31%和11%)。衡量呼吸负荷的P0.1在安慰剂组增加了41%,而左西孟旦组保持不变。左西孟旦组PaCO2显著降低(44 mmHg vs 42 mmHg)。结论:左西孟旦虽未提高膈肌收缩效率,但潮气量升高,P0.1和PaCO2降低。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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