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. 2022 Apr 11;12(1):34.
doi: 10.1186/s13613-022-01005-9.

Severe but reversible impaired diaphragm function in septic mechanically ventilated patients

Marie Lecronier  1   2 , Boris Jung  3   4 , Nicolas Molinari  5 , Jérôme Pinot  6 , Thomas Similowski  6   7 , Samir Jaber  3   4 , Alexandre Demoule  6   7 , Martin Dres  6   7
Affiliations

Severe but reversible impaired diaphragm function in septic mechanically ventilated patients

Marie Lecronier et al. Ann Intensive Care. .

Abstract

Background: Whether sepsis-associated diaphragm dysfunction may improve despite the exposure of mechanical ventilation in critically ill patients is unclear. This study aims at describing the diaphragm function time course of septic and non-septic mechanically ventilated patients.

Methods: Secondary analysis of two prospective observational studies of mechanically ventilated patients in whom diaphragm function was assessed twice: within the 24 h after intubation and when patients were switched to pressure support mode, by measuring the endotracheal pressure in response to bilateral anterior magnetic phrenic nerve stimulation (Ptr,stim). Change in diaphragm function was expressed as the difference between Ptr,stim measured under pressure support mode and Ptr,stim measured within the 24 h after intubation. Sepsis was defined according to the Sepsis-3 international guidelines upon inclusion. In a sub-group of patients, the right hemidiaphragm thickness was measured by ultrasound.

Results: Ninety-two patients were enrolled in the study. Sepsis upon intubation was present in 51 (55%) patients. In septic patients, primary reason for ventilation was acute respiratory failure related to pneumonia (37/51; 73%). In non-septic patients, main reasons for ventilation were acute respiratory failure not related to pneumonia (16/41; 39%), coma (13/41; 32%) and cardiac arrest (6/41; 15%). Ptr,stim within 24 h after intubation was lower in septic patients as compared to non-septic patients: 6.3 (4.9-8.7) cmH2O vs. 9.8 (7.0-14.2) cmH2O (p = 0.004), respectively. The median (interquartile) duration of mechanical ventilation between first and second diaphragm evaluation was 4 (2-6) days in septic patients and 3 (2-4) days in non-septic patients (p = 0.073). Between first and second measurements, the change in Ptr,stim was + 19% (- 13-61) in septic patients and - 7% (- 40-12) in non-septic patients (p = 0.005). In the sub-group of patients with ultrasound measurements, end-expiratory diaphragm thickness decreased in both, septic and non-septic patients. The 28-day mortality was higher in patients with decrease or no change in diaphragm function.

Conclusion: Septic patients were associated with a more severe but reversible impaired diaphragm function as compared to non-septic patients. Increase in diaphragm function was associated with a better survival.

Keywords: Diaphragm dysfunction; Mechanical ventilation; Sepsis; Sepsis-associated diaphragm dysfunction.

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Conflict of interest statement

S. Jaber reports receiving consulting fees from Drager, Medtronic, Baxter, Fresenius, Xenios, and Fisher & Paykel. A. Demoule reports grants, personal fees and non-financial support from Philips, personal fees from Baxter, personal fees and non-financial support from Fisher & Paykel, grants from French Ministry of Health, personal fees from Getinge, grants, personal fees and non-financial support from Respinor, grants, personal fees and non-financial support from Lungpacer, personal fees from Lowenstein, personal fees from Gilead, outside the submitted work. M. Dres received fees from Lungpacer (expertise, lectures). The remaining authors have disclosed that they do not have any conflicts of interest.

Figures

Fig. 1
Fig. 1
A Endotracheal tube pressure induced by bilateral phrenic nerve stimulation during airway occlusion (Ptr,stim) at inclusion (< 24 h of intubation) and at the second measure (pressure support mode) in septic and non-septic patients. p identified by Wilcoxon matched-pairs test. B Relative changes (%) in endotracheal tube pressure induced by bilateral phrenic nerve stimulation during airway occlusion (Ptr,stim) between the two measurements (inclusion and pressure support mode) in septic and non-septic patients. p identified by Mann–Whitney test. C SOFA score at inclusion (< 24 h of intubation) and at the second measure (pressure support mode) in septic and non-septic patients. p identified by paired t test. D End-expiratory diaphragm thickness measured by ultrasound at inclusion (< 24 h of intubation) and at the second measure (pressure support mode) in septic and non-septic patients. p identified by Wilcoxon matched-pairs test. Box plot represent median with interquartile range
Fig. 2
Fig. 2
Diaphragm function time course represented by endotracheal tube pressure induced by bilateral phrenic nerve stimulation during airway occlusion (Ptr,stim) according to time between intubation and measure in septic and non-septic patients. Each black circle represents a single measure of the diaphragm function for a given patient (184 circles in total). The lines represent the regression and the colored shaded areas represent 95% confidence interval for the regression curve
See this image and copyright information in PMC

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