Diaphragmatic atrophy and dysfunction in critically ill mechanically ventilated children.

Area of Science:

• Pediatric Critical Care Medicine
• Respiratory Physiology
• Mechanical Ventilation

Background:

• Diaphragmatic atrophy and dysfunction are concerns in critically ill children, particularly in developing countries.
• The extent and progression of diaphragmatic changes during mechanical ventilation in this population are not well-established.

Purpose of the Study:

• To quantify changes in diaphragmatic thickness using ultrasound over the first week of mechanical ventilation in critically ill children.
• To determine the magnitude and identify risk factors associated with diaphragmatic atrophy.

Main Methods:

• An observational cohort study included children aged 1-18 years requiring mechanical ventilation.
• Ultrasound measurements of diaphragmatic thickness at end-expiration (DTe) and end-inspiration (DTi), and diaphragmatic thickening fraction (DTF) were recorded daily for the first week.
• Diaphragmatic atrophy percentage and daily atrophy rate were calculated.

Main Results:

• A significant reduction in DTe was observed over the first week of ventilation (p < .001).
• Median diaphragmatic atrophy was 9.91% with an atrophy rate of 2.01% per day.
• Pressure-targeted ventilation was associated with a lower diaphragmatic atrophy rate (1.79%/day) compared to volume-targeted ventilation (3.10%/day; p = .038).

Conclusions:

• The diaphragm undergoes progressive atrophy during the initial week of mechanical ventilation in critically ill children.
• Further research into ventilation strategies aimed at mitigating diaphragmatic atrophy is warranted.