Abstract
BackgroundDiaphragmatic 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.MethodsDiaphragmatic 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.ResultsThe 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.ConclusionDD 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.Trial registrationCurrent Controlled Trials ChiCTR1800020196, Registered 01 Dec 2018.
Highlights
Diaphragmatic dysfunction (DD) has a great negative impact on clinical outcomes, and it is a wellrecognized complication in adult patients with critical illness
In children with a critical illness, mechanical ventilation (MV) is widely used as a conventional treatment process of pediatric intensive care unit (PICU); a significant number of children (30%) in the PICU were given the support of MV [5], and nearly two-fifth (38%) of them suffered from DD [6]
For the first time in studies done to date, we report a relationship between elevated C-reactive protein (CRP) duration and DD in children with a critical illness, indicating an important risk factor in the form of the body’s inflammatory response
Summary
Diaphragmatic dysfunction (DD) has a great negative impact on clinical outcomes, and it is a wellrecognized complication in adult patients with critical illness. 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. A remarkably negative effect of diaphragmatic dysfunction or DD is exerted on the respiratory ability, a general complication in critically ill adult patients, among those on mechanical ventilation (MV) [2]. In children with a critical illness, MV is widely used as a conventional treatment process of pediatric intensive care unit (PICU); a significant number of children (30%) in the PICU were given the support of MV [5], and nearly two-fifth (38%) of them suffered from DD [6]. There is a high risk for difficult, delayed weaning and failed extubation, in DD patients, besides the increased possibility of poor functional outcomes, a longer stay in the PICU, and death [7,8,9]
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