Faculty Opinions recommendation of Diaphragmatic dysfunction in patients with ICU-acquired weakness and its impact on extubation failure.

Introduction: Invasive mechanical ventilation contributes to ventilator-induced diaphragmatic dysfunction, delaying extubation and increasing mortality in adults. Despite the possibility of having a higher impact in paediatrics, this dysfunction is not routinely monitored. Diaphragm ultrasound has been proposed as a safe and non-invasive technique for this purpose. The aim of this study was to describe the evolution of diaphragmatic morphology and functional measurements by ultrasound in ventilated children.Material and Methods: Prospective exploratory study. Children admitted to Paediatric Intensive Care Unit requiring mechanical ventilation > 48 hours were included. The diaphragmatic thickness, excursion and the thickening fraction were assessed by ultrasound.Results: Seventeen cases were included, with a median age of 42 months. Ten were male, seven had comorbidities and three in seventeen had malnutrition at admission. The median time under mechanical ventilation was seven days. The median of the initial and minimum diaphragmatic thickness was 2.3 mm and 1.9 mm, respectively, with a median decrease in thickness of 13% under pressure-regulated volume control. Diaphragmatic atrophy was observed in 14/17 cases. Differences in the median thickness variation were found between patients with sepsis and without (0.70 vs 0.25 mm; p = 0.019). During pressure support ventilation there was a tendency to increase diaphragmatic thickness and excursion. Extubation failure occurred for diaphragmatic thickening fraction ≤ 35%.Discussion: Under pressure-regulated volume control there was a tendency for a decrease in diaphragmatic thickness. In the pre-extubation stage under pressure support, there was a tendency for it to increase. These results suggest that, by titrating ventilation using physiological levels of inspiratory effort, we can reduce the diaphragmatic morphological changes associated with ventilation.Conclusion: The early recognition of diaphragmatic changes may encourage a targeted approach, namely titration of ventilation, in order to reduce ventilator-induced diaphragmatic dysfunction and its clinical repercussions.

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A prospective observational study on critically ill children with diaphragmatic dysfunction: clinical outcomes and risk factors

10.21203/rs.3.rs-19423/v2 ◽

2020 ◽

Author(s):

Yang Xue ◽

Chun-Feng Yang ◽

Yu Ao ◽

Ji Qi ◽

Fei-Yong Jia

Keyword(s):

Risk Factors ◽

Length Of Stay ◽

Clinical Outcomes ◽

Critically Ill ◽

Treatment Time ◽

Negative Impact ◽

Extubation Failure ◽

Critically Ill Children ◽

Diaphragmatic Dysfunction ◽

Factors Associated

Abstract Background Diaphragmatic dysfunction (DD) has a great negative impact on clinical outcomes, and it is a well-recognized complication in adult patients with critical illness. However, DD is largely unexplored in the critically ill pediatric population. The aim of this study was to identify risk factors associated with DD, and to investigate the effects of DD on clinical outcomes among critically ill children. Methods Diaphragmatic function was assessed by diaphragm ultrasound. According to the result of diaphragmatic ultrasound, all enrolled subjects were categorized into the DD group (n=24) and the non-DD group (n=46). Collection of sample characteristics in both groups include age, sex, height, weight, primary diagnosis, complications, laboratory findings, medications, ventilatory time and clinical outcomes. Results The incidence of DD in this PICU was 34.3%. The level of CRP at discharge (P=0.003) in the DD group was higher than the non-DD group, and duration of elevated C-reactive protein (CRP) (P<0.001), sedative days (P=0.008) and ventilatory treatment time (P<0.001) in the DD group was significantly longer than the non-DD group. Ventilatory treatment time and duration of elevated CRP were independently risk factors associated with DD. Patients in the DD group had longer PICU length of stay, higher rate of weaning or extubation failure and higher mortality. Conclusion DD is associated with poorer clinical outcomes in critically ill childern, which include a longer PICU length of stay, higher rate of weaning or extubation failure and a higher mortality. The ventilatory treatment time and duration of elevated CRP are main risk factors of DD in critically ill children.

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Clinical outcomes and risk factors in critically ill children with diaphragmatic dysfunction: an prospective observational study

10.21203/rs.3.rs-19423/v1 ◽

2020 ◽

Author(s):

Yang Xue ◽

Chun-Feng Yang ◽

Yu Ao ◽

Ji Qi ◽

Fei-Yong Jia

Keyword(s):

Risk Factors ◽

Length Of Stay ◽

Clinical Outcomes ◽

Critically Ill ◽

Treatment Time ◽

Negative Impact ◽

Extubation Failure ◽

Critically Ill Children ◽

Diaphragmatic Dysfunction ◽

Factors Associated

Abstract Background: Diaphragmatic dysfunction (DD) has a great negative impact on clinical outcomes, and it is a well-recognized complication in adult patients with critical illness. However, DD is largely unexplored in the critically ill pediatric population. The aim of this study was to identify risk factors associated with DD, and to investigate the effects of DD on clinical outcomes among critically ill children.Methods: Diaphragmatic function was assessed by diaphragm ultrasound. According to the result of diaphragmatic ultrasound, all enrolled subjects were categorized into the DD group ( n=24 ) and the non-DD group ( n=46 ). Collection of sample characteristics in both groups include age, sex, height, weight, primary diagnosis, complications, laboratory findings, medications, ventilatory time and clinical outcomes.Results: The incidence of DD in this PICU was 34.3%. The level of CRP at discharge (P=0.003) in the DD group was higher than the non-DD group, and duration of elevated C-reactive protein (CRP) (P<0.001), sedative days (P=0.008) and ventilatory treatment time (P<0.001) in the DD group was significantly longer than the non-DD group. Ventilatory treatment time and duration of elevated CRP were independently risk factors associated with DD. Patients in the DD group had longer PICU length of stay, higher rate of weaning or extubation failure and higher mortality. Conclusion: DD is associated with poorer clinical outcomes in critically ill childern, which include a longer PICU length of stay, higher rate of weaning or extubation failure and a higher mortality. The ventilatory treatment time and duration of elevated CRP are main risk factors of DD in critically ill children.

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