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Diaphragm muscle weakness appear in COPD with a difficult weaning from mechanical ventilation.The calcium sensitizer Levosimendan(Levo) enhances the force-generating capacity of isolated diaphragm fibers (1) We found with bedside US (bUS) that Levo improved diaphragmatic excursion (E) in COPD patients. Materials and Methods 52 ECOPD (type II) pts (age 66 ± 15 36f Apache II max 16)to need for a trial of NIV. We excluded pts with CHF, sepsis, paralysis. bUS was carried out by two operators , double-blind with 3.5-5 MHz convex probe positioned in the right subcostal transversely at the level of midclavicular line with the patient placed at 45°. We used B Mode for the Dome and M Mode for the inspiratory T in sec. (Ti), expiratory T (Te) and the E in( cm) in agreement with literature data (2) In 35 pts with difficult weaning ( E 72 hours) fig1, we used Levo (40 mg/kg bolus followed by 0.1/0.2mg/kg/mg )fig2 , monitoring the E with US, and finally we had a possible weaning Conclusions: A rapidily detection of diaphragmatic dysfunction with bUS in COPD is useful in the changes of the times and modes of NIV and in use drugs to increase diaphragmatic E to have faster weaning and rapidily discharge from ED 1)Doorduin J et al.Am J Resp Crit Care Med. Jan 2012vol 185 pp 90-95. 2)A Testa,G Soldati et: Ultrasound Med Biol vol 37n1pp44-52 2011. |
