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. 2024 Sep 28;24(1):607.
doi: 10.1186/s12887-024-05092-4.

Association of diaphragmatic dysfunction with duration of mechanical ventilation in patients in the pediatric intensive care unit: a prospective cohort study

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Association of diaphragmatic dysfunction with duration of mechanical ventilation in patients in the pediatric intensive care unit: a prospective cohort study

Yelin Yao et al. BMC Pediatr. .

Abstract

Background: Mechanical ventilation (MV) can cause diaphragmatic injury and ventilator induced diaphragmatic dysfunction (VIDD). Diaphragm ultrasonography (DU) is increasingly used to assess diaphragmatic anatomy, function and pathology of patients receiving MV in the pediatric intensive care unit (PICU). We report the poor contractile ability of diaphragm during ventilation of critically ill patients in our PICU and the association to prolonged length of MV and PICU stay.

Methods: Patients who received MV within 24 h of admission to the PICU, expected to undergo continuous MV for more than 48 h and succeeded to extubate were included in the study. DU monitoring was performed daily after the initiation of MV until extubation. Diaphragm thickening fraction (DTF) measured by DU was used as an indicator of diaphragmatic contractile activity. Patients with bilateral DTF = 0% during DU assessment were allocated into the severe VIDD group (n = 26) and the rest were into non-severe VIDD group (n = 29). The association of severe VIDD with individual length of MV, hospitalization and PICU stay were analyzed.

Results: With daily DU assessment, severe VIDD occurred on 2.9 ± 1.2 days after the initiation of MV, and lasted for 1.9 ± 1.7 days. Values of DTF of all patients recovered to > 10% before extubation. The severe VIDD group had a significantly longer duration (days) of MV [12.0 (8.0-19.3) vs. 5.0 (3.5-7.5), p < 0.001] and PICU stay (days) [30.5 (14.9-44.5) vs. 13.0 (7.0-24.5), p < 0.001]. The occurrence of severe VIDD, first day of severe VIDD and length of severe VIDD were significantly positively associated with the duration of MV and PICU stay. The occurrence of severe VIDD on the second and third days after initiation of MV significantly associated to longer PICU stay (days) [43.0 (9.0-70.0) vs. 13.0 (3.0-40.0), p = 0.009; 36.0 (17.0-208.0) vs. 13.0 (3.0-40.0), p = 0.005, respectively], and the length of MV (days) was significantly longer in those with severe VIDD on the third day after initiation of MV [16.5 (7.0-29.0) vs. 5.0 (2.0-22.0), p = 0.003].

Conclusions: Daily monitoring of diaphragmatic function with bedside ultrasonography after initiation of MV is necessary in critically ill patients in PICU and the influences and risk factors of severe VIDD need to be further studied. (355 words).

Keywords: Diaphragm thickening fraction; Diaphragmatic ultrasound; Pediatric critical care; Ventilator induced diaphragmatic dysfunction.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Characterized image of diaphragmatic ultrasound. A-A and C-C represent Dtei: diaphragm thickness at end-inspiration; B-B and D-D represent Dtee: diaphragm thickness at end-expiration
Fig. 2
Fig. 2
Flowchart of the experiment. The non-severe VIDD group refers to patients who never experienced bilateral diaphragm thickening fraction (DTF) equaling zero by bedside ultrasonography monitoring after mechanical ventilation initiated till extubation. The severe VIDD group refers to patients who experienced bilateral DTF equaling zero at least once during bedside ultrasonography monitoring. The allocation time of patients were not simultaneous
Fig. 3
Fig. 3
One typical image of diaphragm ultrasound with severe VIDD (a) and the evolutions of functional parameters between groups (b-d). The breath rhythm could be recognized but the difference of diaphragmatic thickness vanished between end-inspiration (A-A or C-C) and end-expiration (B-B or D-D). *: P < 0.05, **: P < 0.01, ***: P < 0.001 compared to non-severe VIDD group on the same day after initiation of MV

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References

    1. Hannan LM, De Losa R, Romeo N, Muruganandan S. Diaphragm dysfunction: a comprehensive review from diagnosis to management. Intern Med J. 2022;52(12):2034–45. - PubMed
    1. Egbuta C, Easley RB. Update on ventilation management in the Pediatric Intensive Care Unit. Paediatr Anaesth. 2022;32(2):354–62. - PubMed
    1. Kim WY, Suh HJ, Hong SB, Koh Y, Lim CM. Diaphragm dysfunction assessed by ultrasonography: influence on weaning from mechanical ventilation. Crit Care Med. 2011;39(12):2627–30. - PubMed
    1. Goligher EC, Brochard LJ, Reid WD, Fan E, Saarela O, Slutsky AS, et al. Diaphragmatic myotrauma: a mediator of prolonged ventilation and poor patient outcomes in acute respiratory failure. Lancet Respir Med. 2019;7(1):90–8. - PubMed
    1. Dres M, Dubé BP, Mayaux J, Delemazure J, Reuter D, Brochard L, et al. Coexistence and impact of limb muscle and diaphragm weakness at time of liberation from mechanical ventilation in medical intensive care unit patients. Am J Respir Crit Care Med. 2017;195(1):57–66. - PubMed

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