"Wake-Up-And-Breathe" Protocol May Be Superior to Traditional Mechanical Ventilation of ICU Patients
Breathing muscles which go unused during ventilator-assisted respiration weaken more rapidly than previously understood, according to a new study published in a recent edition of the New England Journal of Medicine.
Scientists conducting this most recent study analyzed the microscopic condition of muscle fibers from the diaphragms of two types of patients: brain-dead organ donors who had been placed on ventilators for periods between 18 and 69 hours, and lung surgery patients (the control group) who had been placed on ventilators for periods of only 2 or 3 hours during their operations. They determined that muscle fibers from the diaphragms of those on longer-term ventilation were significantly more atrophied than those of the control group. In fact, a 57% decrease in slow-twitch muscle fibers and a 53% decrease in fast-twitch fibers was observed -- decreases that demonstrate much more rapid rates of muscle wasting than had once been suspected. The study does, however, reflect the results of recent, similar animal research.
Approximately 1/3 of patients in intensive care are mechanically ventilated, according to authors of the study, and experts have debated how long the diaphragm muscles should be allowed to rest without exercise, while a mechanical ventilator is being used. This latest study supports recent recommendations by other research teams that a "wake-up-and-breathe" ventilator protocol that periodically halts ventilation so that patients can breathe on their own may improve patient outcomes, overall.
The study also raises the possibility that certain chemical pathways responsible for muscle degeneration might somehow be blocked pharmaceutically, in order to stop or slow the deterioration. Such an intervention could help patients transition off of a ventilator much more easily.
Just as muscles tend to atrophy during prolonged bed-rest or extended space travel, researchers caution, total rest of breathing muscles during respiratory ventilation also appears to take a significant toll on the integrity of muscle tissue.
Previously on the DC Metro Area Medical Malpractice Law Blog, we have posted articles related to:
- How low nurse staffing ratios lead to Ventilator-Associated Pneumonia in ICUs
- Data suggesting that many U.S. hospitals aren't working to prevent infections
- Why survival rates for in-hospital heart attacks are lower on evenings and weekends
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