Abstract
The aim of the study was to establish the prevalence of diaphragmatic dysfunction (DD), depending on the strategy of mechanical ventilation (MV). Materials and methods. We completed the prospective single-center cohort study. Data analysis included 82 patients (1 month – 18 years old), divided into I group (lung-protective MV) and II group (diaphragm-protective in addition to lung-protective MV). Patients were divided into age subgroups. Stages of the study: 1st day (d1), 3rd (d3), 5th (d5), 7th (d7), 9th (d9), 14th (d14), 28th (d28). We studied amplitude of diaphragm movement; thickening fraction, parameters of acid-base balance and MV. Results are described as median [IQR - interquartile range] with level of significance p. Results. In patients of the 1st age subgroup in I group there were episodes with under-assist during MV, while in II group diaphragm overload was registered only on d5. In patients of 2nd subgroup in I group we found over-assist of MV with excessive work of the right hemidiaphragm and low contractions of left dome at all stages of study, while in II group – the only episode of diaphragmatic weakness on d3 due to under-assist of MV. In the 3rd subgroup the proper diaphragmatic activity in I group was restored significantly later than in II group. In 4th subgroup of I group there was episode of high work of diaphragm on d5, whereas in II group – all data were within the recommended parameters for diaphragm-protective strategy of MV. In 5th subgroup of I group excessive work of both right and left domes of diaphragm was significantly more often registered than in II group, however, in II group there were found episodes of both type changes – diaphragmatic weakness and excessive work. Conclusion: The prevalence and variety of manifestations of DD depend on the strategy of MV. Low incidence of DD was associated with lower duration of MV: in 1st age subgroup in 1.5 times; in 2nd age subgroup – in 2.4 times; in 4th age subgroup – in 1.75 times; in 5th age subgroup – in 4.25 times.
Highlights
Diaphragm weakness is highly prevalent in critically ill patients
We studied indicators of diaphragm function, parameters of acid-base balance and mechanical ventilation
According to thickening fraction of diaphragm, we identified age-specific features in children during mechanical ventilation (MV): in patients of the first age subgroup in I group there were found weakness of right hemidiaphragm with compensatory excessive level of work for its left dome on d1and d9, on the other hand, in group II diaphragm overload was registered only at stage d5
Summary
Diaphragm weakness is highly prevalent in critically ill patients. It may exist prior to ICU admission and may precipitate the need for mechanical ventilation but it frequently develops during the ICU stay [1, 2]. Severe weakness of the diaphragm is frequent in mechanically ventilated patients, in whom it contributes to poor outcomes including increased mortality [3, 4]. Taking into account that from 30 % to 64 % of children in PICU need mechanical ventilation (MV), this clinical issue is highly important nowadays [5]. The described problem can be solved with reducing the incidence of diaphragmatic dysfunction and maintaining normal ranges both amplitude of diaphragm movement and its thickening fraction during MV. It will be possible with careful titration of mechanical ventilation parameters and taking into account data of diaphragm function for each patient individually
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