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Author Spotlight: Unraveling the Impact of Mechanical Ventilation on Diaphragm Function and Patient Outcomes
Published on: November 3, 2023
A prospective observational study on critically ill children with diaphragmatic dysfunction: clinical outcomes and
Yang Xue1, Chun-Feng Yang2, Yu Ao2
1Department of Developmental and Behavioral Pediatrics, The First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, China.
Insights
Diaphragmatic dysfunction (DD) in critically ill children is linked to longer hospital stays and higher mortality. Prolonged mechanical ventilation and elevated C-reactive protein are key risk factors for DD.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Physiology
- Diagnostic Ultrasound
Background:
- Diaphragmatic dysfunction (DD) significantly impacts clinical outcomes in adult critical illness but is understudied in children.
- Understanding DD in critically ill children is crucial for improving patient care and outcomes.
Purpose of the Study:
- To identify risk factors associated with diaphragmatic dysfunction (DD) in critically ill children.
- To investigate the impact of DD on clinical outcomes in this population.
Main Methods:
- Diaphragmatic function was assessed using diaphragm ultrasound.
- Patients were categorized into DD (n=24) and non-DD (n=46) groups.
- Data collected included demographics, diagnoses, lab findings, medications, and clinical outcomes.
Main Results:
- The incidence of DD in the pediatric intensive care unit (PICU) was 34.3%.
- Patients with DD had higher C-reactive protein (CRP) levels at discharge, longer duration of elevated CRP, more sedative days, and longer ventilatory treatment time.
- Ventilatory treatment time and duration of elevated CRP were independent risk factors for DD.
Conclusions:
- Diaphragmatic dysfunction is associated with poorer clinical outcomes in critically ill children, including longer PICU stays, increased weaning/extubation failure, and higher mortality.
- Prolonged ventilatory treatment and elevated CRP are significant risk factors for DD in critically ill children.
Background:
Diaphragmatic dysfunction (DD) has a great negative impact on clinical outcomes, and it is a well-recognized complication in adult patients with critical illness. However, DD is largely unexplored in the critically ill pediatric population. The aim of this study was to identify risk factors associated with DD, and to investigate the effects of DD on clinical outcomes among critically ill children.
Methods:
Diaphragmatic function was assessed by diaphragm ultrasound. According to the result of diaphragmatic ultrasound, all enrolled subjects were categorized into the DD group (n = 24) and the non-DD group (n = 46). Collection of sample characteristics in both groups include age, sex, height, weight, primary diagnosis, complications, laboratory findings, medications, ventilatory time and clinical outcomes.
Results:
The incidence of DD in this PICU was 34.3%. The level of CRP at discharge (P = 0.003) in the DD group was higher than the non-DD group, and duration of elevated C-reactive protein (CRP) (P < 0.001), sedative days (P = 0.008) and ventilatory treatment time (P < 0.001) in the DD group was significantly longer than the non-DD group. Ventilatory treatment time and duration of elevated CRP were independently risk factors associated with DD. Patients in the DD group had longer PICU length of stay, higher rate of weaning or extubation failure and higher mortality.
Conclusion:
DD is associated with poorer clinical outcomes in critically ill childern, which include a longer PICU length of stay, higher rate of weaning or extubation failure and a higher mortality. The ventilatory treatment time and duration of elevated CRP are main risk factors of DD in critically ill children.
Trial Registration:
Current Controlled Trials ChiCTR1800020196 , Registered 01 Dec 2018.
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