Effect Of External Diaphragm Pacer On Diaphragmatic Function In Patients Requiring Mechanical Ventilation With Sepsis

Objective:To investigate the effects of external diaphragm pacer（EDP）on mechanical ventilation（MV）in sepsis-related to diaphragmatic function in patients with sepsis,and to provide a reference for clinical prevention and treatment of diaphragmatic dysfunction（DD）in patients with septic MV.Methods:Patients requiring mechanical ventilation with sepsis who were hospitalized in the third affiliated hospital of Zunyi Medical University from November 2020 to December 2021 were divided into the EDP treatment group and the conventional treatment group according to their medical needs and personal wishes,and 61 patients who met the inclusion and exclusion criteria were selected from each of the two groups using the random number table method to form the EDP group and the control group as the study subjects.The control group was treated conventionally,while the EDP group was treated with EDP on top of the conventional treatment.The baseline data and blood biochemical indicators before and after treatment were collected.And the diaphragmatic ultrasonic indexes of the two groups were measured,including diaphragmatic excursion（DE）,diaphragmatic thickness at the end of inspiration（DTei）,and diaphragmatic thickness at the end of expiration（DTee）of patients before and after treatment.Then calculated diaphragmatic thickness fraction（DTF）.The ventilator weaning situation and prognosis were observed.Finally,data were analyzed.Results:1.Gender,age,BMI index（BMI）,Sequential Organ Failure Assessment（SOFA）,Acute Physiology and Chronic Health Evaluation（APACHE）Ⅱscore,basic disease,etiology,septic shock at the time of diagnosis of sepsis,days of diagnosis of sepsis,duration of mechanical ventilation,duration of ICU,and vital signs at the time of enrollment were no significant differences（P>0.05）.2.After treatment,the partial pressure of oxygen（PaO₂）and oxygenation index（PaO₂/FiO₂）of the EDP group were greater than those of the control group（P<0.05）,but there was no significant difference in the potential of hydrogen（pH）and partial pressure of carbon dioxide（PaCO₂）between the two groups.After treatment,pH,PaO₂and PaO₂/FiO₂in two groups increased and PaCO₂decreased（P<0.01）.3.After treatment showed that blood lactic acid（BLAC）was lower in the EDP group than in the control group（P=0.03）.The intra-group comparison showed that BLAC decreased significantly in both groups after treatment compared with that before treatment（P<0.05）.4.After treatment,the EDP group had lower C-Reactive Protein（CRP）in comparison with the control group（P=0.04）,but White Blood Cells（WBC）were almost equivalent.The intra-group comparison showed that WBC and CRP in both groups were decreased after treatment（P<0.01）.5.After treatment,DE,DTee and DTF in the EDP group were significantly increased than those in the control group（P<0.05）.The intra-group comparison showed that DE,DTee,and DTF in the two groups were all higher than before（P<0.01）.6.The success rate of withdrawal in the EDP group was 95.08%higher than 81.97%in the control group（P=0.04）.The duration of evacuation and total MV in the EDP group was shorter than in the other group（P<0.05）.7.The incidence of DD was 22.95%in the EDP group and 42.62%in the control group,with a significant difference between the two groups（P=0.02）.The total ICU length of stay in the EDP group was significantly lower than that in the control group（P=0.02）.However,no differences were found between the tracheotomy,re-intubation within 30 days,and death occurrence of them（P>0.05）.8.DTee and DTF were important factors influencing the total length of stay in ICU（P<0.05）.Conclusion:EDP could effectively prevent and treat DD in MV patients with sepsis,improve the success rate of withdrawal,and shorten the duration of MV and ICU stay.