The course of diaphragm atrophy in ventilated patients assessed with ultrasound: a longitudinal cohort study

Abstract

IntroductionMechanical ventilation and the effect of respiratory muscle unloading on the diaphragm cause ventilator-induced diaphragmatic dysfunction (VIDD). Atrophy of the diaphragmatic muscle is a major part of VIDD, and has a rapid onset in most animal models. We wanted to assess the clinical evolution and risk factors for VIDD in an adult intensive care unit (ICU) by measuring diaphragm thickness using ultrasound.MethodWe performed a single-centre observational cohort study, including 54 mechanically ventilated patients. The right hemidiaphragm was measured daily at the zone of apposition on the midaxillary line.ResultsMean baseline thickness was 1.9 mm (SD ± 0.4 mm), and mean nadir was 1.3 mm (SD ± 0.4 mm), corresponding with a mean change in thickness of 32 % (95 % CI 27–37 %). Length of mechanical ventilation (MV) was associated with the degree of atrophy, whereas other known risk factors for muscle atrophy in an ICU were not. The largest decrease in thickness occurred during the first 72 hours of MV.ConclusionsDiaphragm atrophy occurs quickly in mechanically ventilated patients and can accurately be monitored using ultrasound. Length of MV, as opposed to other variables, is associated with the degree of atrophy.Clinical trial registrationClinicaltrials.gov NCT02299986. Registered 10/11/2014Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-1141-0) contains supplementary material, which is available to authorized users.

Alterations in diaphragmatic function assessed by ultrasonography in mechanically ventilated patients with sepsis

“…In our cohort, we demonstrated a mean 13% decrease in diaphragm thickness for all patients combined. Our findings are not quite in accordance with the data described in a recent manuscript by Schepens and co‐workers, who reported a 10.9% decrease per day and a mean maximal decrease of 32% in diaphragm thickness for all long‐term ventilated patients . The difference between these two rates can be explained by the fact that patients in Schepens' study spent 77% of time from start of mechanical ventilation to thickness nadir in controlled ventilation modes, whereas patients in our study only spent 26% of the time on controlled ventilation.…”

Sepsis Pathophysiology, Chronic Critical Illness, and Persistent Inflammation-Immunosuppression and Catabolism Syndrome

“…Lung injury associated with mechanical ventilation is well described, but the inflammatory properties of muscle atrophy have not received the appreciation they generally deserve[89]. Patients on mechanical ventilation lose dramatic amounts of diaphragmatic tissue mass over the first week[90]. Surprisingly, this loss is often associated with a local and systemic inflammatory response, and more importantly, therapeutic efforts to reduce this muscle wasting are often associated with reduced inflammatory responses[91].…”

Disfunción diafragmática: una realidad en el paciente ventilado mecánicamente

“…1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 12 Los valores normales en pacientes no ventilados sanos son diferentes para hombres y mujeres, (18±3 mm y 16±3 mm respectivamente) 69 , siendo similares a valores basales encontrados en pacientes ventilados mecánicamente 71 . Se define DD como una excursión menor de 10 mm o una excursión negativa (o movimiento paradójico).…”

“…En el estudio de Schepens et al, donde la mayoría de pacientes recibían ventilación en modalidad control, este valor fue del 10.9% 71 . Aunque no se encontró una asociación directa entre el grosor y la ventilación en modalidad control, los datos anteriormente mencionados muestran un mayor descenso del grosor en los pacientes principalmente ventilados con modalidad controlada.…”