Evaluation of Diaphragmatic Thickness in Patients Undergoing Controlled and Assisted Mechanical Ventilation, as Assessed by Ultrasonography
CCCF ePoster library. Grassi A. Nov 8, 2018; 234200
Disclosure(s): Nothing to disclose
Dr. Alice Grassi
Dr. Alice Grassi
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Abstract
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Introduction: Changes in diaphragmatic thickness are common during mechanical ventilation. Such changes (both in terms of decreased and increased thickness) are associated with diaphragmatic dysfunction  which is known to be correlated with difficult weaning and increased risk of mechanical-ventilation related complications1,2.



Objective: The aim of this study is to evaluate by ultrasound (US) the change in diaphragm thickness  in patients undergoing controlled and assisted mechanical ventilation (MV) and to correlate these changes with clinical variables and patients’ outcome.



Methods: We enrolled patients who underwent controlled MV (CMV) for at least 48 cumulative hours and then were switched to  assisted mechanical ventilation (AMV). Patients < 18 years old, with neuromuscular diseases, phrenic nerve injury, abdominal vacuum dressing system and poor acoustic window were excluded. Diaphragm thickness was measured with US as described by Goligher3. Clinical data and mechanical ventilation parameters were collected every 48 hours until ICU discharge. Clinical outcomes were recorded (ICU length of stay, CMV and AMV duration, ICU mortality). We named as day 0 the first day of AMV. We analyzed separately the CMV period and the AMV period, dividing the patients in 2 groups, based on a change in diaphragmatic thickness of more or less than 10% in comparison  to day 0. Data are expressed as mean (SEM) or median [IQR] based on normality analysis and were compared with T-test if normally distributed and with Mann-Whitney test if not-normally distributed.


 

Results: We enrolled 67 patients who had more than 4 diaphragm measurements, 4 were excluded for low quality images. Among these patients, 54 were switched from CMV to AMV, the remaining 9 died during the CMV period. Diaphragmatic thickness decreased during CMV and went back to baseline during AMV (Fig. 1A). Figure 1B and 1C show patients’ stratification based on change in diaphragmatic thickness during CMV (1B) and AMV (1C). A decrease in diaphragmatic thickness during CMV was associated with more neuromuscular blockers (NMB) use, with a more severe lung disease, as indicated by higher Plateau Pressure and lower Respiratory System Compliance and with longer ICU stay (Table 1). An increase in diaphragmatic thickness during AMV was associated with a higher p0.1 and a better oxygenation (Table 2). No correlation was found between change of diaphragmatic thickness during AMV and clinical outcomes.



Conclusion: Decreased diaphragmatic thickness is associated with more severe lung disease, more NMB use and longer ICU stay. In some patients AMV promotes an increase in diaphragm thickness in some patients.


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