Diaphragm Dysfunction in Mechanically Ventilated Patients

Dot, Irene; Samper, Manuel-Andrés; Masclans, Joan-Ramon

doi:10.1016/j.arbr.2016.12.011

Cited by 30 publications

(38 citation statements)

References 80 publications

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“…The outcomes of our analyses are in accordance with those obtained after assessing DD in hospitalized adult patients. In these patients, we observed a longer time of total ventilation, increased rates of failed extubation or weaning and mortality than in children who did not have DD [ 6 , 19 , 20 ]. Few reports on DD in severely ill children observed an independent association of respiratory weakness with longer time of ventilation and reintubation [ 9 , 21 ].…”

Section: Discussionmentioning

confidence: 88%

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

Xue

Yang

et al. 2020

BMC Pediatr

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Background: Diaphragmatic dysfunction (DD) has a great negative impact on clinical outcomes, and it is a wellrecognized 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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Section: Discussionmentioning

confidence: 88%

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

Xue

Yang

et al. 2020

BMC Pediatr

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“…The beneficial effects of both modalities of ventilatory support on respiratory muscles and other physiological components as well as on clinical outcomes are similar, but IMV increases the number of complications (236). Moreover, fully controlled forms of IMV should be avoided as far as possible, since they have serious negative effects on respiratory muscles, which suffer from deconditioning and oxidative stress, and become atrophic and functionally impaired (237)(238)(239).…”

Section: Mechanical Ventilationmentioning

confidence: 99%

Clinical management of chronic obstructive pulmonary disease patients with muscle dysfunction

et al. 2016

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Muscle dysfunction is frequently observed in chronic obstructive pulmonary disease (COPD) patients, contributing to their exercise limitation and a worsening prognosis. The main factor leading to limb muscle dysfunction is deconditioning, whereas respiratory muscle dysfunction is mostly the result of pulmonary hyperinflation. However, both limb and respiratory muscles are also influenced by other negative factors, including smoking, systemic inflammation, nutritional abnormalities, exacerbations and some drugs. Limb muscle weakness is generally diagnosed through voluntary isometric maneuvers such as handgrip or quadriceps muscle contraction (dynamometry); while respiratory muscle loss of strength is usually recognized through a decrease in maximal static pressures measured at the mouth. Both types of measurements have validated reference values. Respiratory muscle strength can also be evaluated determining esophageal, gastric and transdiaphragmatic maximal pressures although there is a lack of widely accepted reference equations. Non-volitional maneuvers, obtained through electrical or magnetic stimulation, can be employed in patients unable to cooperate. Muscle endurance can also be assessed, generally using repeated submaximal maneuvers until exhaustion, but no validated reference values are available yet. The treatment of muscle dysfunction is multidimensional and includes improvement in lifestyle habits (smoking abstinence, healthy diet and a good level of physical activity, preferably outside), nutritional measures (diet supplements and occasionally, anabolic drugs), and different modalities of general and muscle training.

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“…Increased understanding of the negative effects of sedation and paralysis on the clinical outcome of mechanically ventilated patients (1,2) together with relevant technology advancements (3,4) recently led to larger emphasis on early switch to some form of assisted spontaneous ventilation. A recent large observational study (5) reported that around 30% of invasively ventilated patients with acute hypoxemic respiratory failure (AHRF) and acute respiratory distress syndrome (ARDS) breath spontaneously since day 1 from intubation, regardless from their severity, and this proportion tends to increase significantly within the first week of intubation.…”

Section: Introductionmentioning

confidence: 99%

Spontaneous breathing: a double-edged sword to handle with care

Mauri¹,

Cambiaghi²,

Spinelli³

et al. 2017

Ann. Transl. Med.

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In acute hypoxemic respiratory failure (AHRF) and acute respiratory distress syndrome (ARDS) patients, spontaneous breathing is associated with multiple physiologic benefits: it prevents muscles atrophy, avoids paralysis, decreases sedation needs and is associated with improved hemodynamics. On the other hand, in the presence of uncontrolled inspiratory effort, severe lung injury and asynchronies, spontaneous ventilation might also worsen lung edema, induce diaphragm dysfunction and lead to muscles exhaustion and prolonged weaning. In the present review article, we present physiologic mechanisms driving spontaneous breathing, with emphasis on how to implement basic and advanced respiratory monitoring to assess lung protection during spontaneous assisted ventilation. Then, key benefits and risks associated with spontaneous ventilation are described. Finally, we propose some clinical means to promote protective spontaneous breathing at the bedside. In summary, early switch to spontaneous assisted breathing of acutely hypoxemic patients is more respectful of physiology and might yield several advantages. Nonetheless, risk of additional lung injury is not completely avoided during spontaneous breathing and careful monitoring of target physiologic variables such as tidal volume (Vt) and driving transpulmonary pressure should be applied routinely. In clinical practice, multiple interventions such as extracorporeal CO removal exist to maintain inspiratory effort, Vt and driving transpulmonary pressure within safe limits but more studies are needed to assess their long-term efficacy.

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Diaphragm Dysfunction in Mechanically Ventilated Patients

Cited by 30 publications

References 80 publications

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

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

Clinical management of chronic obstructive pulmonary disease patients with muscle dysfunction

Spontaneous breathing: a double-edged sword to handle with care

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