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Author Spotlight: Unraveling the Impact of Mechanical Ventilation on Diaphragm Function and Patient Outcomes
Published on: November 3, 2023
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Patterns of diaphragm function in critically ill patients receiving prolonged mechanical ventilation: a prospective
Alexandre Demoule1,2,3, Nicolas Molinari4, Boris Jung5,6
1INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Sorbonne Universités, UPMC Univ Paris 06, Paris, France. alexandre.demoule@aphp.fr.
Annals of Intensive Care
|August 6, 2016
Summary
Diaphragmatic dysfunction (DD) affects most intensive care unit patients on mechanical ventilation (MV). This condition can arise upon initiation of MV or develop during the ICU stay, impacting mortality and ventilation duration.
Area of Science:
- Critical Care Medicine
- Pulmonology
- Physiology
Background:
- Diaphragmatic dysfunction (DD) is a known complication in intensive care unit (ICU) patients, potentially occurring at ICU admission or during their stay.
- The incidence and temporal patterns of DD in relation to mechanical ventilation (MV) initiation and progression have not been well-characterized.
- Understanding these trends is crucial for managing mechanically ventilated patients.
Purpose of the Study:
- To investigate the incidence and temporal development of diaphragmatic dysfunction (DD) in mechanically ventilated (MV) patients.
- To describe the different patterns of DD, including onset at MV initiation and ICU-acquired DD.
- To explore the association between DD and clinical outcomes such as mortality and duration of MV.
Main Methods:
- Prospective, observational cohort study of 43 mechanically ventilated (MV) patients in two ICUs over 6 months.
- Diaphragm function assessed using twitch tracheal pressure (Ptr,stim) via magnetic phrenic nerve stimulation at MV initiation and every 48-72 hours thereafter.
- Diaphragm dysfunction (DD) defined as Ptr,stim < 11 cmH2O; analysis focused on patients with MV for ≥5 days, comparing first and last measurements.
Main Results:
- A high incidence of DD was observed, with 79% of patients developing it during their ICU stay.
- Over half (53%) of patients presented with DD upon initiation of MV, with 33% having persistent DD.
- ICU-acquired DD developed in 26% of patients who initially had normal diaphragm function; DD was associated with higher mortality and longer MV duration.
Conclusions:
- Diaphragmatic dysfunction (DD) is highly prevalent in mechanically ventilated (MV) patients requiring prolonged ICU stays (≥5 days).
- DD manifests in various patterns, including onset at MV initiation and development during the ICU stay (ICU-acquired DD).
- The presence and timing of DD significantly impact patient outcomes, including mortality and duration of mechanical ventilation.
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