| Budget Amount *help |
¥4,120,000 (Direct Cost: ¥3,400,000、Indirect Cost: ¥720,000)
Fiscal Year 2007: ¥3,120,000 (Direct Cost: ¥2,400,000、Indirect Cost: ¥720,000)
Fiscal Year 2006: ¥1,000,000 (Direct Cost: ¥1,000,000)
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| Research Abstract |
We investigated diaphragmatic dysfunction in mechanical ventilation by using rat model and bed side studies.
Animal study :
(Background) The contractile performance of the respiratory muscle is impaired by ventilator-induced diaphragmatic dysfunction (VIDD). Our objective was to examine the relationship between peak inspiratory airway pressure (PIP) and the occurrence of VIDD. (Method) Tracheostomized rats (n= 28) received mechanical ventilation with three different settings fir 12 h (ventilatory rate, 80/min; PEEP, 1 cm H2O; and inspiratory time, 0.3 s). In the low PIP group (Group L), PIP was set at 8 cm H2O. In the high PIP group (Group H), PIP was set at 18 cm H2O. In a third group, characterized by reduced chest wall and abdominal compliance (Group R), we placed 50 g of weight on the abdomen, bound the chest wall with a chest band, and set the PIP at 16 cm H20. A muscle relaxant was administered continuously in the mechanical ventilation groups. To prevent hypocapnia, we introduced
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a mechanical dead space in Groups H and R. Control animals spontaneously breathed oxygen for 12 h. After 12 h, we examined diaphragmatic function using the isolated diaphragmatic strip method. (Results) The values of maximal tetanic tension in Groups L (16.4±2.5g/mm2), H (146±2.1g/mm2), and R (12.0±1.9g/mm2) were lower compared with the control (19.4±1.3g/mm2), and those in Groups H and R were lower oompared with Group L. (Conclusion) In conclusion, the progression of VIDD was affected by the setting of mechanical ventilation. A high level of PIP may accelerate the progression of VIDD.
Bed side studies :
We examined the relationship between airway pressure produced by percutaneous pluenic nerve twitch stimulation and maximal inspiratory pressure at five ICU ventilator dependent patients. There was no significant relationship between them.
We investigated the relationship between the length of mechanical ventilation and plasma protein C in post esophageal resection. We also examined the relationship between the length of mechanical ventilation and plasma procalcitonin in post transplantation. In both studies, lower level of plasma protein C and higher level of plasma procalcitonin were related to the longer length of mechanical ventilation. Humoral factors such as protein C and procalitonin may be related to the diaphragmatic dysfunction in ICU. Less
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