Functional state of the diaphragm in patients with cervical spinal cord injury at the stages of respiratory support
Objective. To analyze the role of the functional state of the diaphragm in patients with cervical spinal cord injury at the stages of respiratory support and to substantiate additional criteria for their readiness to transfer to spontaneous breathing. Material and Methods. The state of the diaphrag...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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Ministry of Health of Russian Federation, Federal State Budgetary Institution "Novosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya.L. Tsivyan"
2022-06-01
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| Series: | Хирургия позвоночника |
| Subjects: | |
| Online Access: | https://www.spinesurgery.ru/jour/article/view/1912/1903 |
| _version_ | 1797705341011492864 |
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| author | Ivan A. Statsenko Maya N. Lebedeva Aleksey V. Palmash |
| author_facet | Ivan A. Statsenko Maya N. Lebedeva Aleksey V. Palmash |
| author_sort | Ivan A. Statsenko |
| collection | DOAJ |
| description | Objective. To analyze the role of the functional state of the diaphragm in patients with cervical spinal cord injury at the stages of respiratory support and to substantiate additional criteria for their readiness to transfer to spontaneous breathing.
Material and Methods. The state of the diaphragm was assessed by ultrasound in 24 patients with spinal cord injury. The excursion of the
diaphragm during quiet breathing, the excursion and thickness of the diaphragm during forced breathing, and the change in forced expiratory volume from the moment of admission till the end of mechanical ventilation were analyzed.
Results. On the first day, on the background of mechanical ventilation, there was a significant decrease in the excursion and thickness
of the diaphragm during forced breathing (p = 0.002; p = 0.008) which persisted up to 3 days (p < 0.001; p < 0.001); by the fifth day of mechanical ventilation, the indicators increased to the initial levels (p = 0.112; p = 0.433); and by the 10th day they exceeded the initial values (p < 0.001). When comparing the excursion and thickness of the diaphragm during the transfer of patients to spontaneous breathing
with the data on their admission, a significant difference was obtained (p < 0.001; p < 0.001). The dynamics of forced expiratory volume
indicators was similar to those of diaphragm excursion during forced breathing.
Conclusion. A peculiarity of the functional state of the diaphragm in patients with cervical spinal cord injury in the acute period was a significant decrease in diaphragm excursion and the development of ventilator-induced diaphragm dysfunction (VIDD) associated with mechanical ventilation in replacement modes. The tactics of early tracheostomy and the use of auxiliary ventilation modes determined the absence of progression of VIDD during prolonged mechanical ventilation. The presence of a strong correlation between the diaphragm
excursion during forced breathing and the forced expiratory volume allows concluding that these indicators can be additional objective
criteria for the readiness of patients with cervical SC injury to transfer to spontaneous breathing, since they reflect not only the functional
state of the diaphragm, but also the state of the lung tissue. |
| first_indexed | 2024-03-12T05:35:45Z |
| format | Article |
| id | doaj.art-a8b8fe58c5ed4885820ad6b9aabdc377 |
| institution | Directory Open Access Journal |
| issn | 1810-8997 2313-1497 |
| language | English |
| last_indexed | 2024-03-12T05:35:45Z |
| publishDate | 2022-06-01 |
| publisher | Ministry of Health of Russian Federation, Federal State Budgetary Institution "Novosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya.L. Tsivyan" |
| record_format | Article |
| series | Хирургия позвоночника |
| spelling | doaj.art-a8b8fe58c5ed4885820ad6b9aabdc3772023-09-03T06:31:40ZengMinistry of Health of Russian Federation, Federal State Budgetary Institution "Novosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya.L. Tsivyan"Хирургия позвоночника1810-89972313-14972022-06-01192404610.14531/ss2022.2.40-46Functional state of the diaphragm in patients with cervical spinal cord injury at the stages of respiratory supportIvan A. Statsenko0https://orcid.org/0000-0003-2860-9566Maya N. Lebedeva1https://orcid.org/0000-0002-9911-8919Aleksey V. Palmash2https://orcid.org/0000-0002-2454-477XNovosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya.L. Tsivyan, Novosibirsk, RussiaNovosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya.L. Tsivyan, Novosibirsk, RussiaNovosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya.L. Tsivyan, Novosibirsk, RussiaObjective. To analyze the role of the functional state of the diaphragm in patients with cervical spinal cord injury at the stages of respiratory support and to substantiate additional criteria for their readiness to transfer to spontaneous breathing. Material and Methods. The state of the diaphragm was assessed by ultrasound in 24 patients with spinal cord injury. The excursion of the diaphragm during quiet breathing, the excursion and thickness of the diaphragm during forced breathing, and the change in forced expiratory volume from the moment of admission till the end of mechanical ventilation were analyzed. Results. On the first day, on the background of mechanical ventilation, there was a significant decrease in the excursion and thickness of the diaphragm during forced breathing (p = 0.002; p = 0.008) which persisted up to 3 days (p < 0.001; p < 0.001); by the fifth day of mechanical ventilation, the indicators increased to the initial levels (p = 0.112; p = 0.433); and by the 10th day they exceeded the initial values (p < 0.001). When comparing the excursion and thickness of the diaphragm during the transfer of patients to spontaneous breathing with the data on their admission, a significant difference was obtained (p < 0.001; p < 0.001). The dynamics of forced expiratory volume indicators was similar to those of diaphragm excursion during forced breathing. Conclusion. A peculiarity of the functional state of the diaphragm in patients with cervical spinal cord injury in the acute period was a significant decrease in diaphragm excursion and the development of ventilator-induced diaphragm dysfunction (VIDD) associated with mechanical ventilation in replacement modes. The tactics of early tracheostomy and the use of auxiliary ventilation modes determined the absence of progression of VIDD during prolonged mechanical ventilation. The presence of a strong correlation between the diaphragm excursion during forced breathing and the forced expiratory volume allows concluding that these indicators can be additional objective criteria for the readiness of patients with cervical SC injury to transfer to spontaneous breathing, since they reflect not only the functional state of the diaphragm, but also the state of the lung tissue.https://www.spinesurgery.ru/jour/article/view/1912/1903spinal cord injuryrespiratory failurediaphragm dysfunctionmechanical ventilationdiaphragm ultrasoundweaning from mechanical ventilation |
| spellingShingle | Ivan A. Statsenko Maya N. Lebedeva Aleksey V. Palmash Functional state of the diaphragm in patients with cervical spinal cord injury at the stages of respiratory support Хирургия позвоночника spinal cord injury respiratory failure diaphragm dysfunction mechanical ventilation diaphragm ultrasound weaning from mechanical ventilation |
| title | Functional state of the diaphragm in patients with cervical spinal cord injury at the stages of respiratory support |
| title_full | Functional state of the diaphragm in patients with cervical spinal cord injury at the stages of respiratory support |
| title_fullStr | Functional state of the diaphragm in patients with cervical spinal cord injury at the stages of respiratory support |
| title_full_unstemmed | Functional state of the diaphragm in patients with cervical spinal cord injury at the stages of respiratory support |
| title_short | Functional state of the diaphragm in patients with cervical spinal cord injury at the stages of respiratory support |
| title_sort | functional state of the diaphragm in patients with cervical spinal cord injury at the stages of respiratory support |
| topic | spinal cord injury respiratory failure diaphragm dysfunction mechanical ventilation diaphragm ultrasound weaning from mechanical ventilation |
| url | https://www.spinesurgery.ru/jour/article/view/1912/1903 |
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