Résumé
La ventilation mécanique (VM) invasive est une technique permettant de suppléer une défaillance aiguë de la fonction respiratoire. Elle permet la mise au repos des muscles inspirateurs et favorise leur récupération métabolique. Paradoxalement, la mise au repos total des muscles inspirateurs par la VM est grevée d’une atteinte spécifique induite par cette ventilation. Cette atteinte, récemment décrite, est très précoce et peut contribuer à prolonger la VM et donc retarder le sevrage. En effet, l’étiologie de l’échec de sevrage est souvent complexe, mais un facteur important demeure le déséquilibre entre la charge de travail imposée par la ventilation et la capacité des muscles respiratoires. En 1989, T.K. Aldrich a été le premier à faire l’hypothèse que l’entraînement des muscles inspirateurs pourrait faciliter le sevrage de la VM et donc en réduire la durée. Cette technique se justifie au regard des nombreuses complications liées à la VM et des coûts de l’hospitalisation en réanimation. Il existe donc un véritable enjeu de réduire la durée de VM. Cet article tente tout d’abord de faire une mise au point sur l’atteinte des muscles respiratoires sous VM et ses conséquences. Après un rappel sur les méthodes d’évaluation de la fonction musculaire respiratoire des patients ventilés, il propose également des modalités pratiques d’entraînement s’appuyant sur la littérature.
Abstract
Invasive mechanical ventilation (MV) is a technique used to compensate acute respiratory failure. It allows the rest of inspiratory muscles and promotes their metabolic recovery. Paradoxically, complete inspiratory muscle rest by MVis responsible for specific impairment induced by ventilation. This impairment, recently described, is early, can prolong MV, and therefore delay weaning. Causes of weaning failure are often complex; however, imbalance between MVrelated and respiratory muscles capacity remains an important factor. In 1989, TK Aldrich first assumed that inspiratory muscle training may facilitate weaning from MV and shorten its duration. Therefore, the use of this technique appears clearly justified, considering MV-induced complications and costs of hospitalization in the intensive care unit. Reducing MV duration has become a real challenge. This article first attempts to focus at MV-related impairment of inspiratory muscles and its consequences. After reviewing the methods that allow assessing the function of respiratory muscles in ventilated patients, it will present some practical training modalities based on the medical literature.
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Bonnevie, T. Entraînement en force des muscles inspirateurs du patient ventilé — de la dysfonction diaphragmatique au sevrage de la ventilation mécanique. Réanimation 22, 439–446 (2013). https://doi.org/10.1007/s13546-013-0694-7
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DOI: https://doi.org/10.1007/s13546-013-0694-7