Change in Diaphragm Thickness in Mechanically Ventilated Children

Abstract Background Acute increases in muscle sonographic echodensity reflect muscle injury. Diaphragm echodensity has not been measured in mechanically ventilated patients. We undertook to develop a technique to characterize changes in diaphragm echodensity during mechanical ventilation and to assess whether these changes are correlated with prolonged mechanical ventilation. Methods Diaphragm ultrasound images were prospectively collected in mechanically ventilated patients and in 10 young healthy subjects. Echodensity was quantified based on the right-skewed distribution of grayscale values (50th percentile, ED50; 85th percentile, ED85). Intra- and inter-analyzer measurement reproducibility was determined. Outcomes recorded included duration of ventilation and ICU complications (including reintubation, tracheostomy, prolonged ventilation, or death). Results Echodensity measurements were obtained serially in 34 patients comprising a total of 104 images. Baseline (admission) diaphragm ED85 was increased in mechanically ventilated patients compared to younger healthy subjects (median 56, interquartile range (IQR) 42–84, vs. 39, IQR 36–52, p = 0.04). Patients with an initial increase in median echodensity over time (≥ + 10 in ED50 from baseline) had fewer ventilator-free days to day 60 (n = 13, median 46, IQR 0–52) compared to patients without this increase (n = 21, median 53 days, IQR 49–56, unadjusted p = 0.03). Both decreases and increases in diaphragm thickness during mechanical ventilation were associated with increases in ED50 over time (adjusted p = 0.03, conditional R2 = 0.80) and the association between increase in ED50 and outcomes persisted after adjusting for changes in diaphragm thickness. Conclusions Many patients exhibit increased diaphragm echodensity at the outset of mechanical ventilation. Increases in diaphragm echodensity during the early course of mechanical ventilation are associated with prolonged mechanical ventilation. Both decreases and increases in diaphragm thickness during mechanical ventilation are associated with increased echodensity.

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ULTRASOUND DETERMINATION OF DIAPHRAGM THICKNESS IN MECHANICALLY VENTILATED, ACUTELY CRITICALLY ILL PATIENTS

CHEST Journal ◽

10.1378/chest.130.4_meetingabstracts.278s-c ◽

2006 ◽

Vol 130 (4) ◽

pp. 278S ◽

Cited By ~ 1

Author(s):

Keith M. Rose ◽

Dennis McCool ◽

David Nierman

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Diaphragm Thickness ◽

Mechanically Ventilated

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Influence of Dexmedetomidine on Diaphragm Function and Postoperative Outcomes in ICU Patients with Mechanical Ventilation

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2021/1990838 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Chengda Zhao ◽

Meihua Huang ◽

Baiyun Wang ◽

Huanhui Zhong ◽

Wen Meng

Keyword(s):

Mechanical Ventilation ◽

Success Rate ◽

Ventilator Weaning ◽

Postoperative Outcomes ◽

Control Group ◽

Diaphragm Thickness ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Diaphragm Function ◽

Ventilated Patients

Objective. To probe into the influence of dexmedetomidine (DEX) on diaphragm function and postoperative outcomes of mechanically ventilated patients in the intensive care unit (ICU). Methods. 84 patients with mechanical ventilation (MV) in the ICU of our hospital were selected as the research participants, including 38 patients in the control group (CG) sedated with midazolam (MZ) and 46 patients in the research group (RG) with DEX sedation. Ramsay sedation score, visual analogue scale (VAS), and restlessness score (RS) were used to evaluate their state before sedation (T0), as well as 2 h (T1), 6 h (T2), and 24 h (T3) after sedation, and the alterations of mean arterial pressure (MAP) and heart rate (HR) were recorded. Serum cortisol (Cor), adrenocorticotropic hormone (ACTH), superoxide dismutase (SOD), malondialdehyde (MDA), interleukin- (IL-) 1β, IL-6, and tumor necrosis factor-α (TNF-α) were measured before and 24 h after sedation. The end-inspiratory diaphragm thickness (DTei) and end-expiratory diaphragm thickness (DTee) were measured within 2 h after the initiation of MV and 5 min after the spontaneous breathing test (SBT), and the diaphragm thickening fraction (DTF) was calculated. Finally, the ventilator weaning, MV time, and the incidence of adverse reactions (ADs) of the two groups were counted. Results. T0 and T3 witnessed no distinct difference in Ramsay, VAS, and RS scores between the two arms ( P > 0.05 ), but at T1 and T2, RG had better sedation state and lower VAS and RS scores than CG ( P < 0.05 ), with more stable vital signs ( P < 0.05 ). After sedation, the contents of oxidative stress and inflammatory factors in RG were lower, while DTee, DTei, and DTF were higher, versus CG ( P < 0.05 ). Moreover, RG presented higher success rate of first ventilator weaning, less MV time, and lower incidence of ADs than CG ( P < 0.05 ). Conclusions. DEX is effective in mechanically ventilated patients in the ICU, which can protect patients against diaphragm function damage, improve the success rate of ventilator weaning, and benefit the postoperative outcome, with excellent and rapid sedation effect and less stress damage to patients.

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