Abstract
Methods for assessing diaphragmatic function can be useful in determining the functional status of the respiratory system and can contribute to determining an individual's prognosis, depending on their pathology. They can also be a useful tool for making objective decisions regarding mechanical ventilation weaning and extubation. Esophageal and transdiaphragmatic pressure measurement, diaphragm ultrasound, diaphragmatic excursion, surface electromyography (sEMG) and some serum biomarkers are of increasing interest and use in clinical and intensive care settings to offer a more objective process for withdrawing mechanical ventilation; especially in the situation that we are experiencing with the increased demand for mechanical ventilation to treat patients with Covid-19-associated viral pneumonia. In this literature review, we updated the clinical and physiological indicators with more evidence to improve ventilator withdrawal techniques. We concluded that, to ensure successful extubation in a way that is useful, cost-effective, practical for health personnel and non-invasive for the patient, further studies of novel techniques such as surface electromyography should be implemented.
Highlights
The respiratory muscles are composed of contractile proteins which generate differences in pressure when they contract, thereby enabling the flow of air for gas exchange
Their most important functional characteristics are strength and endurance: their strength is related to the contractile proteins and is evaluated by maximum inspiratory pressures [1, 2]
During patients’ stay in intensive care units (ICU), deleterious processes take place in the respiratory muscles which are related to factors that accelerate proteolysis, such as systemic inflammation, immobility, side effects of drugs and the use of mechanical ventilation (MV) [3,4,5]
Summary
The respiratory muscles are composed of contractile proteins which generate differences in pressure when they contract, thereby enabling the flow of air for gas exchange. Their most important functional characteristics are strength and endurance: their strength is related to the contractile proteins and is evaluated by maximum inspiratory pressures [1, 2]. Extubation failure predictors that have been evidenced include arterial carbon dioxide tension (PaCO2) > 5.99 kPa (45 mm Hg), prolongation of mechanical ventilation > 72 h, abundant secretions, upper airway disorders, and a prior frustrated weaning attempt [8]
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