Association of diaphragmatic dysfunction with duration of mechanical ventilation in patients in the pediatric intensive care unit: a prospective cohort study

• Published in: BMC pediatrics 2024-09, Vol.24 (1), p.607-11, Article 607
• Main Authors: Yao, Yelin, Guo, Xiaojing, Liu, Yuxin, Lu, Kai, Chen, Weiming, Yin, Huanhuan, Lu, Guoping, Wang, SuJuan, Tao, Jinhao
• Format: Article
• Language: English
• Subjects: Artificial respiration; Care and treatment; Child; Child, Preschool; Complications and side effects; Critical Illness; Critically ill children; Diaphragm; Diaphragm - diagnostic imaging; Diaphragm - physiopathology; Diaphragm thickening fraction; Diaphragmatic ultrasound; Female; Health aspects; Humans; Infant; Intensive Care Units, Pediatric; Length of Stay; Male; Pediatric critical care; Pediatric intensive care; Pediatric research; Prospective Studies; Respiration disorders; Respiration, Artificial - adverse effects; Risk factors; Time Factors; Ultrasonography; Ventilator induced diaphragmatic dysfunction
• ISSN: 1471-2431; 1471-2431
• DOI: 10.1186/s12887-024-05092-4

Mechanical ventilation (MV) can cause diaphragmatic injury and ventilator induced diaphragmatic dysfunction (VIDD). Diaphragm ultrasonography (DU) is increasingly used to assess diaphragmatic anatomy, function and pathology of patients receiving MV in the pediatric intensive care unit (PICU). We report the poor contractile ability of diaphragm during ventilation of critically ill patients in our PICU and the association to prolonged length of MV and PICU stay. Patients who received MV within 24 h of admission to the PICU, expected to undergo continuous MV for more than 48 h and succeeded to extubate were included in the study. DU monitoring was performed daily after the initiation of MV until extubation. Diaphragm thickening fraction (DTF) measured by DU was used as an indicator of diaphragmatic contractile activity. Patients with bilateral DTF = 0% during DU assessment were allocated into the severe VIDD group (n = 26) and the rest were into non-severe VIDD group (n = 29). The association of severe VIDD with individual length of MV, hospitalization and PICU stay were analyzed. With daily DU assessment, severe VIDD occurred on 2.9 ± 1.2 days after the initiation of MV, and lasted for 1.9 ± 1.7 days. Values of DTF of all patients recovered to > 10% before extubation. The severe VIDD group had a significantly longer duration (days) of MV [12.0 (8.0-19.3) vs. 5.0 (3.5-7.5), p