Abstract
The aim of the study was to determine whether diaphragm-protective mechanical ventilation can prevent diaphragm atrophy in children with respiratory failure. Materials and methods. We complete 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), 28th (d28). We studied changes in diaphragm thickness at the end of exhalation and compared them with these indicators at patient`s admission to the study (baseline). Primary endpoint was length of stay in ICU, secondary endpoints were complications (prolonged MV). Results are described as arithmetic mean (X) and standard deviation (σ) with level of significance p. Results. There were significant differences in length of stay in ICU among patients of the 1st and 5th age subgroups: in 1st age subgroup this data was in 1.3 times lower in II group, compared with I group (p <0,05); in 5th age subgroup the situation was the opposite - length of stay in ICU was in 1.4 times higher in II group, compared with I group (p<0.05). There were no patients who required lifelong mechanical ventilation in any of the groups. Changes in the thickness of the diaphragm, which indicate its atrophy, were the most significant among patients of the first, second, third and fourth age subgroups and the severity of atrophy was higher among patients of group I, compared with patients of group II. Conclusions. Diaphragm-protective mechanical ventilation significantly prevents diaphragm atrophy in children with respiratory failure in 2nd, 4th, and 5th age subgroups. Providing goal-directed diaphragm-protective MV might reduce the length of stay in ICU among patients of 1st and 5th age subgroups. There were no observed complications like lifelong mechanical ventilation in both patient`s group.
Highlights
Atrophy and weakness of the peripheral and respiratory muscles is well known problem in intensive care unit (ICU) [1]
We studied indicators of diaphragm function, parameters of acid-base balance and mechanical ventilation
5th age subgroups (Table 1): in 1st age subgroup this data was in 1.3 times lower in II group, compared with I group (p < 0,05); in 5th age subgroup the situation was opposite – length of stay in ICU was in 1.4 times higher in II group, compared with I group (p < 0.05)
Summary
Atrophy and weakness of the peripheral and respiratory muscles is well known problem in intensive care unit (ICU) [1]. Severe weakness of the diaphragm frequently occurs due to prolonged mechanical ventilation (MV) and lead to outcomes worsening and increased mortality rate [2, 3]. We know that diaphragmatic function is a major determinant of the ability to be successfully weaned from MV for patients [4]. Enough level of spontaneous breathing pattern function together with work of respiratory muscles might be a key how to solve this clinical problem. It seems to be possible to provide carefull selection of MV parameters with taking into account diaphragm function for each patient
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