Xue Yang, Yang Chun-Feng, Ao Yu, Qi Ji, Jia Fei-Yong
Department of Developmental and Behavioral Pediatrics, The First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, China.
Department of Pediatrics Intensive Care Unit, The First Hospital of Jilin University, Changchun, China.
BMC Pediatr. 2020 Sep 4;20(1):422. doi: 10.1186/s12887-020-02310-7.
Diaphragmatic dysfunction (DD) has a great negative impact on clinical outcomes, and it is a well-recognized complication in adult patients with critical illness. However, DD is largely unexplored in the critically ill pediatric population. The aim of this study was to identify risk factors associated with DD, and to investigate the effects of DD on clinical outcomes among critically ill children.
Diaphragmatic function was assessed by diaphragm ultrasound. According to the result of diaphragmatic ultrasound, all enrolled subjects were categorized into the DD group (n = 24) and the non-DD group (n = 46). Collection of sample characteristics in both groups include age, sex, height, weight, primary diagnosis, complications, laboratory findings, medications, ventilatory time and clinical outcomes.
The incidence of DD in this PICU was 34.3%. The level of CRP at discharge (P = 0.003) in the DD group was higher than the non-DD group, and duration of elevated C-reactive protein (CRP) (P < 0.001), sedative days (P = 0.008) and ventilatory treatment time (P < 0.001) in the DD group was significantly longer than the non-DD group. Ventilatory treatment time and duration of elevated CRP were independently risk factors associated with DD. Patients in the DD group had longer PICU length of stay, higher rate of weaning or extubation failure and higher mortality.
DD is associated with poorer clinical outcomes in critically ill childern, which include a longer PICU length of stay, higher rate of weaning or extubation failure and a higher mortality. The ventilatory treatment time and duration of elevated CRP are main risk factors of DD in critically ill children.
Current Controlled Trials ChiCTR1800020196 , Registered 01 Dec 2018.
膈肌功能障碍（DD）对临床结局有很大的负面影响，是成年危重症患者中公认的并发症。然而，在危重症儿童群体中，DD在很大程度上未被研究。本研究的目的是确定与DD相关的危险因素，并调查DD对危重症儿童临床结局的影响。
通过膈肌超声评估膈肌功能。根据膈肌超声结果，所有纳入的受试者被分为DD组（n = 24）和非DD组（n = 46）。两组样本特征的收集包括年龄、性别、身高、体重、初步诊断、并发症、实验室检查结果、用药情况、通气时间和临床结局。
该儿科重症监护病房（PICU）中DD的发生率为34.3%。DD组出院时的CRP水平（P = 0.003）高于非DD组，DD组C反应蛋白（CRP）升高的持续时间（P < 0.001）、镇静天数（P = 0.008）和通气治疗时间（P < 0.001）明显长于非DD组。通气治疗时间和CRP升高的持续时间是与DD相关的独立危险因素。DD组患者的PICU住院时间更长，脱机或拔管失败率更高，死亡率也更高。
DD与危重症儿童较差的临床结局相关，包括更长的PICU住院时间、更高的脱机或拔管失败率和更高的死亡率。通气治疗时间和CRP升高的持续时间是危重症儿童DD的主要危险因素。
当前受控试验ChiCTR1800020196，于2018年12月1日注册。
