Impact of pressure-targeted modes of ventilation on diaphragmatic function as assessed using ultrasonography in critically ill patients with cerebral insult: a randomized clinical trial

Abstract

BackgroundMechanical ventilation causes diaphragmatic atrophy and reduces diaphragmatic efficiency. Patients with diaphragmatic dysfunction have longer mechanical ventilation durations and intensive care unit stay. There is currently a scarcity of data on the effect of different modes of mechanical ventilation on diaphragmatic function and ultrasound-guided assessment of diaphragmatic efficiency.ResultsSixty mechanically ventilated patients were randomly divided into four equal groups (15 each): patients were ventilated using either assist control pressure-controlled mode (group A), synchronized intermittent mandatory ventilation pressure-controlled mode (group S), bi-level-positive airway pressure mode (group B) or pressure support ventilation mode (group P). The primary outcome was to assess the diaphragmatic excursion, while the secondary outcomes were to assess the diaphragmatic thickness fraction and the duration of the ICU stay. Patients in the P group had the highest diaphragmatic excursion indicating better diaphragmatic function.ConclusionsWhen compared to other pressure-targeted ventilation modes, the pressure support ventilation mode may have the least risk of diaphragmatic dysfunction as preserves diaphragmatic structure and strength.Trial registrationThe clinical trial was retrospectively registered at http://www.pactr.org PACTR202112653971335.