Effect Of Erector Spinae Plane Block At T8 Plane On The Patient With Acute Gastrointestinal Injury And Outcomes Of Mechanical Ventilation

BackgroundUp to 40%of patients required mechanical ventilation in the settings of intensive care unit(ICU),while just 56%of whom could be weaned successfully after less than three times of spontaneous breath trials.The weaning failure could be largely attributed to the acute gastrointestinal injury(AGI),a leading complication acquired primarily or secondarily during the patient's stay in the ICU.The incidence of AGI in the mechanically ventilated patients was two-times that in the non-mechanically ventilated patients,with a rate of 42.7%vs 20.5%,respectively.It had been reported that patients with AGI spent 2.8 days longer on the ventilator than those without AGI,and AGI and difficult weaning from ventilator were mutually causal,forming vicious cycle.Current treatments for AGI had been proven to be ineffective on the prognosis of the ICU patient.However,as one of the regional nerve block technologies,the erector spinae plane block(ESPB)had shown an efficacy on acute necrosis pancreatitis.It is reasonable to presume that ESPB might have the potential to mitigate the AGI,improve pulmonary function,and increase the likelihood of early weaning from the ventilator.Hitherto,the knowledge concerning the role of ESPB on AGI is limited in the literature,and its impact on pulmonary function and weaning from ventilator is rarely reported.Therefore,we conducted this study on mechanically ventilated patient with AGI,to investigate whether ESPB therapy could improve gastrointestinal function,with focus on the improvement of pulmonary function and early weaning from ventilator.HypothesisESPB therapy could improve the gastrointestinal function in mechanically ventilated patients with AGI,thereby improving pulmonary function,increasing the likelihood of early weaning from the ventilator,and even reducing the case fatality rate of patient with critical illness in the ICU.Objective1.Primary Objective:To investigate whether erector spinae plane block(ESPB)at T8 vertebral plane could improve gastrointestinal function and reduce the incidence of ventilator-dependent(VD)in patients with AGI.2.Secondary Objective:To evaluate whether erector spinae plane block(ESPB)at T8 vertebral plane could reduce case fatality rate of mechanically ventilated patients with AGI.To assess whether erector spinae plane block ESPB)at T8 vertebral plane could reduce the length of ICU stay and hospital stay,and reduce the hospital costs in mechanically ventilated patients with AGI.MethodsThis project is a single-center,prospective,open-label randomized controlled study.Patients admitted into the general ICU of Zhujiang Hospital of Southern Medical University between August 1,2019 and February 28,2020 were screened for eligibility to the study,and those who met the inclusion criteria were enrolled and designated into the intervention group or control group by block randomization.The Acute Physiology and Chronic Health Evaluation score-?(APACHE ? score)was used as a balance factor to avoid the possible bias from grouping.Patients in both groups were treated regularly according to the protocols for management of critical illness and AGI,and ESPB therapy was given to those in the intervention group.Primary outcome:The rate of simple,delayed and difficult weaning from the ventilator;Free days of mechanical ventilation;Secondary outcomes:?Case fatality rate in the ICU;?The length of ICU stay;?The length of hospital stay;?Total expenses in hospital;The clinical data were collected and analyzed,including scores of sequential organ failure assessment(SOFA score)over time;gastrointestinal function score(GIF score);acute gastrointestinal injury score(AGI score);Lung injury score(Murray's score);score of imaging evaluation;white blood cell count;neutrophil count;lymphocyte count;procalcitonin(PCT),HS C-reactive protein(CRP);interleukin-6(IL-6);PaO2/FiO2;alveolar-arterial oxygen pressure difference(A-aDO2);respiratory index(RI);arterial blood lactate(Lac)and arterial partial pressure of carbon dioxide(PaCO2).In addition,the study was supervised by the Research Ethics Committee for protection of participant safety and well-being from negligent harm,and any severe adverse events had been recorded and reported to the committee,including event of death;disability or any adverse event that affecting the patient's selfcare ability.The timepoints for data collection were set at:(1)at enrollment;(2)day 3 after ESPB therapy;(3)day 7 after ESPB therapy;(4)on discharge.Statistical AnalysisDiscrete variables were presented by frequencies(n)and percentages(%),and continuous variables by mean(SD),or median(IQR).Statistical analysis for continuous variables was performed by t-tests or one-way analysis of variance for normally distributed variables,or by Wilcoxon rank-sum tests for non-normally distributed ones.The Pearson chi-square test,Fisher exact test or Mann-Whitney U test was used,as appropriate,for categorical data.All statistical tests were two-sided,P?0.05 was considered statistically significant.Statistical analyses were performed with SPSS 23.0 software packages.ResultsA total of 102 patients were screened and 33 cases met the inclusion criteria,including 17 in the intervention group and 16 in the control group.There was no significant differences in baseline parameters between the two groups(P>0.1).the case fatality rate in the intervention control group was lower than that in the control group,but the difference was insignificant(11.76%vs 31.25%,P=0.139).The rate of successful weaning from ventilator in the intervention control group was higher than that in the control group(82.35%vs 43.75,P=0.032).on day 3 after ESPB therapy,the AGI scores in the two group were 2.64±0.49 and 2.29 ± 0.47 points,P=0.029,and the GIF scores 2.18±0.88 vs 1.35±0.86,P=0.004;on day 7,the AGI score in the two group were 2.67 ± 0.49 vs 1.50±1.09,P=0.004.and the GIF score 2.50± 0.67 vs 1.42±1.08(P=0.003),respectively.In control group,GIF score on the day 7(1.67±0.98 vs 1.00±1.13,P=0.087)was significantly reduced compared with before.There was no significant difference with before in AGI and GIF score on the day 3,and AGI score on day 7(P>0.05)in control group.There was no statistically significant difference between two groups in days of ICU stay,days of hospital stay,and cost of hospitalization(P>0.05).Conclusion1.ESPB therapy improve gastrointestinal function;2.ESPB therapy did not increase weaning success in mechanically ventilated patients with AGI.