RT Journal Article
SR Electronic
T1 Identifying Subjects at Risk for Diaphragm Atrophy During Mechanical Ventilation Using Routinely Available Clinical Data
JF Respiratory Care
FD American Association for Respiratory Care
SP 551
OP 558
DO 10.4187/respcare.08223
VO 66
IS 4
A1 Martin Urner
A1 Nicholas Mitsakakis
A1 Stefannie Vorona
A1 Lu Chen
A1 Michael C Sklar
A1 Martin Dres
A1 Gordon D Rubenfeld
A1 Laurent J Brochard
A1 Niall D Ferguson
A1 Eddy Fan
A1 Ewan C Goligher
YR 2021
UL http://rc.rcjournal.com/content/66/4/551.abstract
AB BACKGROUND: Diaphragmatic respiratory effort during mechanical ventilation is an important determinant of patient outcome, but direct measurement of diaphragmatic contractility requires specialized instrumentation and technical expertise. We sought to determine whether routinely collected clinical variables can predict diaphragmatic contractility and stratify the risk of diaphragm atrophy.METHODS: We conducted a secondary analysis of a prospective cohort study on diaphragm ultrasound in mechanically ventilated subjects. Clinical variables, such as breathing frequency, ventilator settings, and blood gases, were recorded longitudinally. Machine learning techniques were used to identify variables predicting diaphragm contractility and stratifying the risk of diaphragm atrophy (> 10% decrease in thickness from baseline). Performance of the variables was evaluated in mixed-effects logistic regression and random-effects tree models using the area under the receiver operating characteristic curve.RESULTS: Measurements were available for 761 study days in 191 subjects, of whom 73 (38%) developed diaphragm atrophy. No routinely collected clinical variable, alone or in combination, could accurately predict either diaphragm contractility or the development of diaphragm atrophy (model area under the receiver operating characteristic curve 0.63–0.75). The risk of diaphragm atrophy was not significantly different according to the presence or absence of patient-triggered breaths (38.3% vs 38.6%; odds ratio 1.01, 95% CI 0.05–2.03). Diaphragm thickening fraction < 15% during either of the first 2 d of the study was associated with a higher risk of atrophy (44.6% vs 26.1%; odds ratio 2.28, 95% CI 1.05–4.95).CONCLUSIONS: Diaphragmatic contractility and the risk of diaphragm atrophy could not be reliably determined from routinely collected clinical variables and ventilator settings. A single measurement of diaphragm thickening fraction measured within 48 h of initiating mechanical ventilation can be used to stratify the risk of diaphragm atrophy during mechanical ventilation.