RT Journal Article
SR Electronic
T1 Diaphragmatic Dysfunction Is Characterized by Increased Duration of Mechanical Ventilation in Subjects With Prolonged Weaning
JF Respiratory Care
FD American Association for Respiratory Care
SP 1316
OP 1322
DO 10.4187/respcare.04746
VO 61
IS 10
A1 Lu, Zhihua
A1 Xu, Qiuping
A1 Yuan, Yuehua
A1 Zhang, Ge
A1 Guo, Feng
A1 Ge, Huiqing
YR 2016
UL http://rc.rcjournal.com/content/61/10/1316.abstract
AB BACKGROUND: Diaphragmatic dysfunction is often underdiagnosed and is among the risk factors for failed weaning. The purpose of this study was to determine the prevalence of diaphragmatic dysfunction diagnosed by B-mode ultrasonography and to determine whether prolonged weaning subjects with diaphragmatic dysfunction have increased duration of mechanical ventilation compared with those without diaphragmatic dysfunction.METHODS: This was a prospective observational study in mechanically ventilated subjects who failed ≥3 spontaneous breathing trials or required >7 d of weaning after the first spontaneous breathing trial. Diaphragm thickness was measured in the zone of apposition using a 6–13-MHz ultrasound transducer during a spontaneous breathing trial. The diaphragmatic thickening fraction was calculated as a percentage from the formula: (Thickness at peak inspiration − thickness at end expiration)/thickness at end expiration. Intra-observer and inter-observer reliability were also evaluated.RESULTS: Forty-one subjects (24 males; 62.2 ± 15.9 y old) were included in the study. Of these, the prevalence of ultrasonographic diaphragmatic dysfunction (defined as diaphragmatic thickening fraction of <20% with inspiration) was 34.1% (n = 14). Subjects with diaphragmatic dysfunction had longer ventilation time after inclusion (293.4 ± 194.8 vs 145.1 ± 101.3 h, P = .02) and ICU stay (29.2 ± 11.4 vs 22.4 ± 7.7 d, P = .03) than subjects without diaphragmatic dysfunction.CONCLUSIONS: Diaphragmatic dysfunction as assessed by B-mode ultrasonography is common in subjects with prolonged weaning. Subjects with such diaphragmatic dysfunction show longer mechanical ventilation durations and ICU stays.