An observational study to assess diaphragmatic muscle inactivity in mechanically ventilated ICU patients
CCCF ePoster library. Soliman I. Oct 28, 2015; 117380; P97
Dr. Ibrahim Soliman
Dr. Ibrahim Soliman
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Abstract
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P97


Topic: Clinical Trial


An observational study to assess diaphragmatic muscle inactivity in mechanically ventilated ICU patients



Ibrahim Soliman, M. RAUSEO, L. Chen, N. Rittayamai, G. Chen, E. Goligher, J. Friedrich, C. Sinderby, L. Heunks, L. Brochard

Critical Care, St. Michael's hospital, Toronto, Canada | Critical care, St. Michael's Hospital, Toronto, Canada | Critical Care, St. Michael's Hospital, Toronto, Canada | Critical care, St. Michael's Hospital, Toronto, Canada | Critical care, St. Michael's hospital, toronto, Canada | Critical care, University of toronto, toronto, Canada | Critical care, St. Michael's Hospital, Toronto, Canada | critical care, St. Michael's Hospital, Toronto, Canada | Critical Care, University of Netherlands, Nijmegn, Netherlands | Critical Care, St. Michael's Hospital, Toronto, Canada

Introduction: Respiratory muscle dysfunction is frequent in ICU patients and isassociated with adverse outcomes, including prolonged mechanical ventilation1,2. Assisted modes ofmechanical ventilation may prevent the development of disuse associateddiaphragm dysfunction but it is unclear when their use really starts in the ICU3. In addition, it should be acknowledged thateven in assisted modes such as pressure support, over-assist may occur,resulting in very low diaphragm muscle activity. Tools to monitor activity ofthe respiratory muscles are seldom used in daily clinical care and thereforeprolonged periods of diaphragm muscle disuse may occur without being identifiedby the clinician. Diaphragm EMG (EAdi) could be considered as the state of theart technique to monitor respiratory muscle activity in the acutely ventilatedpatient4,5 and we wereinterested to see how fast it could identify a sufficient level of diaphragmactivity (continuously above 5 microvolts).

Objectives:

To determinethe time from endotracheal intubation and of diaphragm activity monitoring to theonset of diaphragm activity in ventilated ICU patients with EAdi catheter insitu.



Methods: observationalstudy of newly admitted ICU patients and intubated with expected duration ofmechanical ventilation of > 48 h, andhaving an EAdi monitoring and feeding tube catheter inserted within 12hrs.Ventilator data were collected every 24 h for a maximum of 5 days, until 24 hof continuous EAdi >5mv was observed. Ventilator setting and continuous trendsof EAdi, airway pressure, tidal volume and minute ventilation were collected.

Results:

Table 1 showsthe characteristics of the first 15 patients enrolled in the study. The averagedata collection lasted 2.9 days. These Preliminary results show that theaverage time from start of EAdi monitoring till onset of the first significantEAdi (defined as > 5 mv for 5 or more min) occurred after 6h and 47 min fromintubation on average. A continuous EAdi >5mv for 24 h occurred in 9 patients(60%) after 2.6 days (see figure 1); 6 patients(40%) did not reach thisendpoint (3 extubated, 1 patient with his EAdi catheter removed, 1 patientdied, and 1 patient didn’t have continuous EAdi after 5 days). The amplitude ofEAdi was affected by the dose of sedation and the mode of ventilation used.



Conclusion: Thispreliminary results on 15 patients showed that an early monitoring of EAdi identifiessubstantial periods of diaphragm inactivity.

References:

1. De Jonghe B, Bastuji-Garin S, DurandMC, et al. Respiratoryweakness is associated with limb weakness and delayed weaning in criticalillness. Crit Care Med 2007;35:2007-15.

2. EstebanA, Anzueto A, Frutos F, et al. Characteristics and outcomes in adult patientsreceiving mechanical ventilation: a 28-day international study. JAMA2002;287:345-55.

3. SassoonCS, Zhu E, Caiozzo VJ. Assist-control mechanical ventilation attenuatesventilator-induced diaphragmatic dysfunction. Am J Respir Crit Care Med2004;170:626-32.

4. DoorduinJ, van Hees HW, van der Hoeven JG, Heunks LM. Monitoring of the respiratorymuscles in the critically ill. Am J Respir Crit Care Med 2013;187:20-7.

5. Heunks LM, Doorduin J, van der HoevenJG. Monitoring and preventing diaphragm injury. Curr Opin Crit Care2015;21:34-41.

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