Etude non invasive des réserves cardio-respiratoires, hémodynamiques et musculaires au cours de l'effort du patient handicapé respiratoire

Abstract : Muscular and exercise capacities of patients have become priority issues in taking care in acute or chronic respiratory disease. It is now well established in Intensive Care Unit or Chronic Obstructive Pulmonary Disease that muscle function is an independently factor associated with the prognosis of patients. Investigations for the study of cardiorespiratory and muscle reserves are essential to optimize the taking care of patients. As part of this thesis, we sought to explore by non-invasive ways the ability of patients to deploy their cardiopulmonary reserve during different conditions (to weaning from mechanical ventilation to pulmonary rehabilitation). In the first part we observed the inspiratory muscle strength on 124 intubated patients during weaning from mechanical ventilation. We have defined the weakness of the respiratory muscles by a maximum inspiratory pressure less than 30 cmH2O. We observed that the inspiratory muscle weakness at extubation was an independently factor associated with one year-mortality. Then we have shown on 90 patients that the maximum respiratory pressure measurement via a tube were reliable. Finally we have differentiated the inspiratory muscle damage and peripheral muscle weakness on 99 patients and we have seen that an overlap weakness was associated with an increase in the short term mortality. In the second part we evaluated the cardiovascular response and muscle microcirculation of 20 sedated patients and under mechanical ventilation during 4 early rehabilitation techniques. We have found that 3 techniques on 4 did not alter metabolism to the effort. Only one technique combining movement and muscle contraction induced by functional electrical stimulation (FES-Cycling) induced a physiological response suggesting efficient muscle activity. In the last part, we studied on 25 COPD patients the FES-Cycling in a single session of pulmonary rehabilitation at a moderate intensity (50% of the VO2peak). Compared to placebo, the FES-Cycling training increased VO2 during exercise without increased the perceived dyspnoea, suggesting an intensity reached more important. Thereby, we used several non-invasive methods to study and optimize the muscle condition during exerise of respiratory disabled patients.
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Clément Medrinal. Etude non invasive des réserves cardio-respiratoires, hémodynamiques et musculaires au cours de l'effort du patient handicapé respiratoire. Pneumologie et système respiratoire. Normandie Université, 2018. Français. ⟨NNT : 2018NORMR162⟩. ⟨tel-02169926⟩

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