Abstract
BackgroundIn patients intubated for mechanical ventilation, prolonged diaphragm inactivity could lead to weakness and poor outcome. Time to resume a minimal diaphragm activity may be related to sedation practice and patient severity.MethodsProspective observational study in critically ill patients. Diaphragm electrical activity (EAdi) was continuously recorded after intubation looking for resumption of a minimal level of diaphragm activity (beginning of the first 24 h period with median EAdi > 7 µV, a threshold based on literature and correlations with diaphragm thickening fraction). Recordings were collected until full spontaneous breathing, extubation, death or 120 h. A 1 h waveform recording was collected daily to identify reverse triggering.ResultsSeventy-five patients were enrolled and 69 analyzed (mean age ± standard deviation 63 ± 16 years). Reasons for ventilation were respiratory (55%), hemodynamic (19%) and neurologic (20%). Eight catheter disconnections occurred. The median time for resumption of EAdi was 22 h (interquartile range 0–50 h); 35/69 (51%) of patients resumed activity within 24 h while 4 had no recovery after 5 days. Late recovery was associated with use of sedative agents, cumulative doses of propofol and fentanyl, controlled ventilation and age (older patients receiving less sedation). Severity of illness, oxygenation, renal and hepatic function, reason for intubation were not associated with EAdi resumption. At least 20% of patients initiated EAdi with reverse triggering.ConclusionLow levels of diaphragm electrical activity are common in the early course of mechanical ventilation: 50% of patients do not recover diaphragmatic activity within one day. Sedatives are the main factors accounting for this delay independently from lung or general severity.Trial Registration ClinicalTrials.gov (NCT02434016). Registered on April 27, 2015. First patients enrolled June 2015.
Highlights
IntroductionDiaphragm weakness is exceedingly common and has been described in more than 60% of patients [1]
In critically ill adults, diaphragm weakness is exceedingly common and has been described in more than 60% of patients [1]
Considering only the 29 patients under controlled ventilation either the day before or the day of electrical activity of the diaphragm (EAdi) resumption, reverse triggering was present in 38% of cases. In this short-term observational physiological study, we evaluated the temporal pattern of EAdi resumption in critically ill adult patients requiring endotracheal intubation
Summary
Diaphragm weakness is exceedingly common and has been described in more than 60% of patients [1]. There is mounting evidence that it may be associated with poor outcomes in mechanically ventilated patients, including difficult weaning, prolonged. Examination of the diaphragm with ultrasound in critically ill ventilated patients has shown a progressive reduction of the thickness of the diaphragm occurring in the first three days in approximately 40% of patients [2, 3]. Studies in specific populations such as brain-dead organ donors have demonstrated muscle fiber atrophy and contractile dysfunction occurring within a few hours or days of controlled mechanical ventilation [8]. Changes in diaphragm thickness were correlated with the amount of inactivity and are associated with complications of mechanical ventilation and a poor outcome [12, 13]. In patients intubated for mechanical ventilation, prolonged diaphragm inactivity could lead to weak‐ ness and poor outcome. Time to resume a minimal diaphragm activity may be related to sedation practice and patient severity
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
