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Chest, Vol 88, 736-739, Copyright © 1985 by American College of Chest Physicians

ARTICLES

Diaphragmatic strength during weaning from mechanical ventilation

MA Swartz and PL Marino

Respiratory muscle weakness is considered to be a factor in the inability to wean from mechanical ventilation. To assess this possibility, the present study examined the mechanical behavior of the diaphragm by measuring the change in transdiaphragmatic pressure (delta Pdi) during weaning. Nine "T-piece" weanings were carried out in seven patients with prior weaning failure and were terminated with the development of hypercapnia, hypoxemia, or severe tachypnea. Serial measurements of delta Pdi during these weans revealed that (1) in no case was there a decrease in delta Pdi at termination of weaning, and (2) in the subgroup of patients whose weaning failed because of hypercapnia, the increase in arterial carbon dioxide tension (mean increase of 12 mm Hg) was associated with a significant increase in delta Pdi, from the beginning (21.1 +/- 12.1 cm H2O) to the end (24.8 +/- 13.4 cm H2O) of the trial (p less than 0.05). We conclude that failure to wean in these patients, in particular the development of carbon dioxide retention, was not due to failure of the diaphragm as a pressure generator.


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N. R. MacIntyre
Evidence-Based Guidelines for Weaning and Discontinuing Ventilatory Support : A Collective Task Force Facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine
Chest, December 1, 2001; 120(6_suppl): 375S - 396S.
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