Mechanical ventilation and diaphragmatic atrophy in critically ill patients: An ultrasound study

Massimo Zambon, Paolo Beccaria, Jun Matsuno, Marco Gemma, Elena Frati, Sergio Colombo, Luca Cabrini, Giovanni Landoni, Alberto Zangrillo

Research output: Contribution to journalArticle

Abstract

Objective: Mechanical ventilation contributes to diaphragmatic atrophy and dysfunction, and few techniques exist to assess diaphragmatic function: the purpose of this study was to quantify diaphragm atrophy in a population of critically ill mechanically ventilated patients with ultrasound and to identify risk factors that can worsen diaphragmatic activity. Design: Prospective observational study. Setting: ICU of a 1,200-bed university hospital. Patients: Newly intubated adult critically ill patients. Interventions: Diaphragm thickness in the zone of apposition was measured daily with ultrasound, from the first day of mechanical ventilation till discharge to the main ward. Measurements and Main Results: Daily atrophy rate (ΔTdi/d) was calculated as the reduction in percentage from the previous measurement. To analyze the difference in atrophy rate (ΔTdi/d), ventilation was categorized into four classes: spontaneous breathing or continuous positive airway pressure; pressure support ventilation 5-12 cm H2O (low pressure support ventilation); pressure support ventilation greater than 12 cm H2O (high pressure support ventilation); and controlled mechanical ventilation. Multivariate analysis with ventilation support and other clinical variables was performed to identify risk factors for atrophy. Forty patients underwent a total of 153 ultrasonographic evaluations. Mean (sd) ΔTdi/d was -7.5% (12.3) during controlled mechanical ventilation, -5.3% (12.9) at high pressure support ventilation, -1.5% (10.9) at low pressure support ventilation, +2.3% (9.5) during spontaneous breathing or continuous positive airway pressure. At multivariate analysis, only the ventilation support was predictive of diaphragm atrophy rate. Pressure support predicted diaphragm thickness with coefficient -0.006 (95% CI, -0.010 to -0.002; p = 0.006). Conclusions: In critically ill mechanically ventilated patients, there is a linear relationship between ventilator support and diaphragmatic atrophy rate.
Original languageEnglish
Pages (from-to)1347 - 1352
Number of pages6
JournalCritical Care Medicine
Volume44
Issue number7
DOIs
Publication statusPublished - Jul 1 2016

Keywords

  • critically ill
  • diaphragm
  • diaphragmatic dysfunction
  • respiratory monitoring
  • thoracic ultrasound
  • ultrasonography

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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