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

Xue, Yong; Yang, Chun‐Feng; Yu, Ao; Qi, Ji; Jia, Fei‐Yong

doi:10.1186/s12887-020-02310-7

Cited by 16 publications

(22 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The FSS was primarily used during the PICU stay (31)(32)(33), and the POPC was used during the PICU stay or post-PICU discharge (19,20,22,24,28), particularly as a longitudinal measurement. In addition, assessment of muscle wasting and atrophy via ultrasound or muscle strength via dynamometry were conducted longitudinally during the PICU/hospital stay (25,29). This review is similar to a recent review by Ong et al (34), in which diverse measurement tools were used after PICU discharge, such as the Sleep Disturbance Scale for Children (35), the Chalder Fatigue Scale (26), POSAS (21), and MABC-II (36).…”

Section: Discussionmentioning

confidence: 91%

“…The impairments rates in a general PICU population ranged from 0.02 to 10.3% at discharge to 38% at 6 months (19,20,26). However, the rates of impairments in acquired brain injury patients ranged from 28.9 to 70% (23,27,30,32,35), 2 to 69% among those with sepsis (19,21,24), and 20 to 34.3% among those needing MV (25,28,29). Overall, physical function impairments in the included studies ranged from 0.02 to 85.1% during hospitalization/at discharge (15,19), 20 to 55.7% at 6 months (15,28), and 2 to 70% at more than 1 year (19,27).…”

Section: Discussionmentioning

confidence: 99%

“…A longitudinal study demonstrated that some impairments resolve with time as acquired impairments decreased from 18% at 3 months to 2% at 1 year following PICU discharge (19). Some studies measured physical function impairments only once, within 6 months after discharge (19,25,26,29,35). Because impairments may last more than 10 years after discharge (21,36), more prospective studies are warranted to determine changes in impairments over time by conducting long-term follow-up studies of survivors.…”

Section: Discussionmentioning

confidence: 99%

“…ICU-related determinants were also associated with impairments, including disease severity, duration or the presence of mechanical ventilation (MV), and admission diagnosis. Disease severity was the most reported risk factor in the studies (n = 7, 36.8%) (19-21, 23-25, 27), followed by the duration or presence of MV (n = 5, 26.3%) (19,22,25,28,29) and admission diagnosis (n = 5, 26.3%) (20,24,25,28,30).…”

Section: Risk Factors For Physical Function Impairmentsmentioning

confidence: 99%

See 3 more Smart Citations

Risk Factors for Physical Function Impairments in Postintensive Care Syndrome: A Scoping Review

Ding

Yang

2022

Front. Pediatr.

View full text Add to dashboard Cite

ObjectiveSurvivors of critical illness may experience short- and long-term physical function impairments. This review aimed to identify the risk factors for physical function impairments from the current literature.Data SourcesA systematic search of the PubMed, Embase, Web of Science, and Cochrane Library databases following the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews guideline was performed.Study SelectionThe risk factors reported in all human studies reporting physical function impairments in children admitted to the pediatric intensive care unit (PICU) were reviewed and categorized. Two investigators independently screened, evaluated, and selected studies for inclusion. Data from eligible studies were extracted by one investigator, and another investigator reviewed and verified the data. A systematic narrative approach was employed to review and summarize the data.ResultsA total of 264 studies were found to be eligible, with 19 studies meeting the inclusion criteria. Children admitted to the PICU experienced physical function impairments during their stay, which can last for years. The studies varied primarily in the measurement timing and tools used. The most frequently reported risk factors for physical function impairments were age, race or ethnicity, a pre-admission chronic condition, sex, disease severity, duration or the presence of mechanical ventilation, and admission diagnosis.ConclusionsPhysical function impairments may be persistent in PICU survivors. To prevent these impairments in critically ill patients, pediatricians should pay attention to modifiable risk factors, such as the duration of mechanical ventilation. Future studies need to promote a combination of standardized measures for the detection and prevention of physical function impairments.

show abstract

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Risk Factors For Physical Function Impairmentsmentioning

confidence: 99%

See 2 more Smart Citations

Risk Factors for Physical Function Impairments in Postintensive Care Syndrome: A Scoping Review

Ding

Yang

2022

Front. Pediatr.

View full text Add to dashboard Cite

show abstract

“…Critical illness–associated diaphragm weakness develops in the majority of mechanically ventilated critically ill patients and may be associated with difficult weaning, prolonged duration of mechanical ventilation, and even an increase in mortality. 1–5 In addition to mechanical ventilation, other risk factors for this phenomenon have been identified. 6 However, the effects of fluids have not been described in the literature so far.…”

mentioning

confidence: 99%

Early Restrictive Fluid Strategy Impairs the Diaphragm Force in Lambs with Acute Respiratory Distress Syndrome

IJland¹,

Ingelse

Loon

et al. 2022

Anesthesiology

View full text Add to dashboard Cite

Background The effect of fluid management strategies in critical illness–associated diaphragm weakness are unknown. This study hypothesized that a liberal fluid strategy induces diaphragm muscle fiber edema, leading to reduction in diaphragmatic force generation in the early phase of experimental pediatric acute respiratory distress syndrome in lambs. Methods Nineteen mechanically ventilated female lambs (2 to 6 weeks old) with experimental pediatric acute respiratory distress syndrome were randomized to either a strict restrictive fluid strategy with norepinephrine or a liberal fluid strategy. The fluid strategies were maintained throughout a 6-h period of mechanical ventilation. Transdiaphragmatic pressure was measured under different levels of positive end-expiratory pressure (between 5 and 20 cm H2O). Furthermore, diaphragmatic microcirculation, histology, inflammation, and oxidative stress were studied. Results Transdiaphragmatic pressures decreased more in the restrictive group (–9.6 cm H2O [95% CI, –14.4 to –4.8]) compared to the liberal group (–0.8 cm H2O [95% CI, –5.8 to 4.3]) during the application of 5 cm H2O positive end-expiratory pressure (P = 0.016) and during the application of 10 cm H2O positive end-expiratory pressure (–10.3 cm H2O [95% CI, –15.2 to –5.4] vs. –2.8 cm H2O [95% CI, –8.0 to 2.3]; P = 0.041). In addition, diaphragmatic microvessel density was decreased in the restrictive group compared to the liberal group (34.0 crossings [25th to 75th percentile, 22.0 to 42.0] vs. 46.0 [25th to 75th percentile, 43.5 to 54.0]; P = 0.015). The application of positive end-expiratory pressure itself decreased the diaphragmatic force generation in a dose-related way; increasing positive end-expiratory pressure from 5 to 20 cm H2O reduced transdiaphragmatic pressures with 27.3% (17.3 cm H2O [95% CI, 14.0 to 20.5] at positive end-expiratory pressure 5 cm H2O vs. 12.6 cm H2O [95% CI, 9.2 to 15.9] at positive end-expiratory pressure 20 cm H2O; P < 0.0001). The diaphragmatic histology, markers for inflammation, and oxidative stress were similar between the groups. Conclusions Early fluid restriction decreases the force-generating capacity of the diaphragm and diaphragmatic microcirculation in the acute phase of pediatric acute respiratory distress syndrome. In addition, the application of positive end-expiratory pressure decreases the force-generating capacity of the diaphragm in a dose-related way. These observations provide new insights into the mechanisms of critical illness–associated diaphragm weakness. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

show abstract

Diaphragm atrophy during invasive mechanical ventilation is related to extubation failure in preterm infants: An ultrasound study

Nobile,

Sbordone,

Salce

et al. 2024

Pediatric Pulmonology

View full text Add to dashboard Cite

BackgroundDiaphragm dysfunction is associated with poor outcomes in critically ill patients. Ventilator‐induced diaphragmatic dysfunction (VIDD), including diaphragm atrophy (DA), is poorly studied in newborns. We aimed to assess VIDD and its associations in newborns.MethodsSingle‐center prospective study. Diaphragm thickness was measured at end‐inspiration (TDI) and end‐expiration (TDE) on the right midaxillary line. DA was defined as decrease in TDE ≥ 10%. Daily measurements were recorded in preterm newborns on invasive mechanical ventilation (IMV) for ≥2 days. Clinical characteristics of patients and extubation failure were recorded. Univariate analysis, logistic regression, and mixed models were performed to describe VIDD and associated factors.ResultsWe studied 17 patients (median gestational age 270/7 weeks) and 22 IMV cycles (median duration 9 days). Median TDE decreased from 0.118 cm (interquartile range [IQR] 0.094–0.165) on the first IMV day to 0.104 cm (IQR 0.083–0.120) on the last IMV day (p = .092). DA occurred in 11 IMV cycles (50%) from 10 infants early during IMV (median: second IMV day). Mean airway pressure (MAP) and lung ultrasound score (LUS) on the first IMV day were significantly higher in patients who developed DA. DA was more frequent in patients with extubation failure than in those with extubation success within 7 days (83.3 vs. 33.3%, p = .038).ConclusionsDA, significantly associated with extubation failure, occurred in 58.8% of the study infants on IMV. Higher MAP and LUS at IMV start were associated with DA. Our results suggest a potential role of diaphragm ultrasound to assess DA and predict extubation failure in clinical practice.

show abstract

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

Cited by 16 publications

References 33 publications

Risk Factors for Physical Function Impairments in Postintensive Care Syndrome: A Scoping Review

Risk Factors for Physical Function Impairments in Postintensive Care Syndrome: A Scoping Review

Early Restrictive Fluid Strategy Impairs the Diaphragm Force in Lambs with Acute Respiratory Distress Syndrome

Diaphragm atrophy during invasive mechanical ventilation is related to extubation failure in preterm infants: An ultrasound study

Contact Info

Product

Resources

About