Abstract
BackgroundCritical illness has detrimental effects on the diaphragm, but the impact of critical illness on other major muscles of the respiratory pump has been largely neglected. This study aimed to determine the impact of critical illness on the most important muscles of the respiratory muscle pump, especially on the expiratory muscles in children during mechanical ventilation. In addition, the correlation between changes in thickness of the expiratory muscles and the diaphragm was assessed.MethodsThis longitudinal observational cohort study performed at a tertiary pediatric intensive care unit included 34 mechanical ventilated children (> 1 month– < 18 years). Thickness of the diaphragm and expiratory muscles (obliquus interna, obliquus externa, transversus abdominis and rectus abdominis) was assessed daily using ultrasound. Contractile activity was estimated from muscle thickening fraction during the respiratory cycle.ResultsOver the first 4 days, both diaphragm and expiratory muscles thickness decreased (> 10%) in 44% of the children. Diaphragm and expiratory muscle thickness increased (> 10%) in 26% and 20% of the children, respectively. No correlation was found between contractile activity of the muscles and the development of atrophy. Furthermore, no correlation was found between changes in thickness of the diaphragm and the expiratory muscles (P = 0.537). Decrease in expiratory muscle thickness was significantly higher in patients failing extubation compared to successful extubation (− 34% vs − 4%, P = 0.014).ConclusionsChanges in diaphragm and expiratory muscles thickness develop rapidly after the initiation of mechanical ventilation. Changes in thickness of the diaphragm and expiratory muscles were not significantly correlated. These data provide a unique insight in the effects of critical illness on the respiratory muscle pump in children.
Highlights
Critical illness has detrimental effects on the diaphragm, but the impact of critical illness on other major muscles of the respiratory pump has been largely neglected
Interquartile range (IQR), interquartile range, Mechanical ventilation (MV), mechanical ventilation a Between patients with > 10% decrease and ≤ 10% change in diaphragm muscle thickness, and between patients with > 10% increase and ≤ 10% change in diaphragm muscle thickness b Between patients with > 10% increase and patients ≤ 10% change in diaphragm thickness c Between patients with > 10% decrease and ≤ 10% change in diaphragm thickness
IQR, interquartile range; m. Obliquus externa (OE), obliquus externa; m. Obliquus interna (OI), obliquus interna; m. Transversus abdominis (TA), transversus abdominis the > 10% decrease in thickness group (N = 15), − 2.6% (IQR, − 4.3–7.4) for the ≤ 10% change in thickness group (N = 12), and 14.5% (IQR, 10.5–27.9) for the > 10% increase in thickness group (N = 7) (Fig. 2b; P ≤ 0.0001)
Summary
Critical illness has detrimental effects on the diaphragm, but the impact of critical illness on other major muscles of the respiratory pump has been largely neglected. This study aimed to determine the impact of critical illness on the most important muscles of the respiratory muscle pump, especially on the expiratory muscles in children during mechanical ventilation. IJland et al Ann. Intensive Care (2020) 10:115 critical illness on the expiratory muscles, both in critically ill adults and children have been largely neglected in the literature so far. Intensive Care (2020) 10:115 critical illness on the expiratory muscles, both in critically ill adults and children have been largely neglected in the literature so far This is surprising given the important role of the expiratory muscles in breathing [6,7,8,9], and in airway clearance. We aimed to investigate the correlation between changes in thickness of the expiratory muscles and the diaphragm
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