La tunisie Medicale - 2021 ; Vol 99 ( n°011 ) : 1055-1065
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Résumé

Introduction: Chez les patients de réanimation, le diaphragme est sujet à plusieurs  agressions principalement celles induites par la ventilation mécanique (VM). Actuellement, l'échographie diaphragmatique est devenue le chevet le plus utile pour le clinicien pour évaluer la contractilité du diaphragme.
Objectif: Examiner les effets de la VM sur la contractilité du diaphragme pendant les premiers jours de ventilation.
Méthodes: Deux groupes de sujets ont été étudiés: un groupe d'étude (n=30) de malades adultes recevant la VM contre un groupe témoin (n=30) de volontaires en respiration spontanée (RS). À l'aide d'un appareil échographique, nous  avons comparé la fraction d'épaississement diaphragmatique (FED). Secondairement, nous avons analysé la relation entre la FED et le sevrage.
Résultats: comparativement au groupe RS, les patients du groupe VM avaient un diamètre télé-expiratoire (DTE) plus élevé (2,09 ± 0,6 versus 1,76 ± 0,32 mm, p=0,01) et une FED plus faible (39,9 ± 12,5% contre 49,0 ± 20,5%, p=0,043). Quatorze des 30 malades ventilés ont réussi leur sevrage. On n’a pas démontré de corrélation significative entre la FED et la durée du sevrage (Rho = - 0,464 et p=0,08). Une valeur FED > 33% était proche d’être significativement associée à un succès de sevrage (OR = 2 ; IC à 95% = [1,07-3,7], p=0,05) avec une sensibilité à 85,7%.
Conclusions: la contractilité diaphragmatique était altérée dès les premiers jours de VM. Une valeur de FED > 32,7% était associée au succès de sevrage et cela peut être utile pour prédire un sevrage réussi avec une sensibilité de 85,7%.

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