Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.
Pediatr Pulmonol. 2020 Dec;55(12):3457-3464. doi: 10.1002/ppul.25076. Epub 2020 Oct 14.
The extent of diaphragmatic atrophy and dysfunction in critically ill children from developing countries is not established.
To estimate changes in ultrasound measurements of diaphragmatic thickness over the first week of mechanical ventilation. To assess magnitude and risk factors of diaphragmatic atrophy.
In an observational cohort study, children aged 1-18 years, requiring mechanical ventilation were included. Ultrasound measurements of diaphragmatic thickness at end-expiration (DTe) and end-inspiration (DTi), and diaphragmatic thickening fraction (DTF) were performed daily during the first week of admission, and pre- and post-extubation. Diaphragmatic atrophy (%) and atrophy rate (rate of decline in DTe, % per day) were calculated.
Of 55 children (74.6% boys) enrolled, 20 (36.4%) died. Of 35 children with planned extubation, 5 (14.3%) required reintubation. Baseline median (interquartile range [IQR]) DTe, DTi, and DTF were 1.27 mm (1, 1.6), 1.76 mm (1.35, 2.10), and 33.75% (26.90, 44.60), respectively. There was a significant reduction in DTe over the first week of mechanical ventilation (p < .001), median (IQR) diaphragmatic atrophy and atrophy rate of 9.91% (5.26, 17.35) and 2.01% (1.08, 3.04) per day, respectively. Diaphragmatic atrophy rate was lower in pressure targeted ventilation (n = 44; 1.79% [1.03, 2.87]) than volume targeted ventilation (n = 11; 3.10% [1.31, 5.49]), p = .038. There was no difference in diaphragmatic parameters (atrophy rate, and peri-extubation DTe and DTF) in extubation success versus failure.
The diaphragm undergoes progressive atrophy during the first week of mechanical ventilation in critically ill children. Future studies should evaluate ventilation strategies to reduce the diaphragmatic atrophy.
发展中国家危重症患儿的膈肌萎缩和功能障碍程度尚不清楚。
评估机械通气第 1 周时膈肌厚度的超声测量变化。评估膈肌萎缩的幅度和危险因素。
在一项观察性队列研究中，纳入了需要机械通气的 1-18 岁患儿。在入院第 1 周的每天以及预拔管和拔管后，进行膈肌呼气末（DTe）和吸气末（DTi）厚度以及膈肌增厚分数（DTF）的超声测量。计算膈肌萎缩（%）和萎缩率（DTe 每日下降率，%/天）。
共纳入 55 名患儿（74.6%为男性），其中 20 名（36.4%）死亡。在计划拔管的 35 名患儿中，有 5 名（14.3%）需要再次插管。基线时中位数（四分位距 [IQR]）DTe、DTi 和 DTF 分别为 1.27mm（1，1.6）、1.76mm（1.35，2.10）和 33.75%（26.90，44.60）。机械通气第 1 周 DTe 显著下降（p<.001），中位（IQR）膈肌萎缩和萎缩率分别为 9.91%（5.26，17.35）和 2.01%（1.08，3.04）/天。与容量目标通气（n=11）相比，压力目标通气（n=44）的膈肌萎缩率较低（1.79%[1.03，2.87]比 3.10%[1.31，5.49]，p=0.038）。在拔管成功与失败之间，膈肌参数（萎缩率和拔管时的 DTe 和 DTF）无差异。
在危重症患儿机械通气第 1 周，膈肌逐渐萎缩。未来的研究应评估通气策略以减少膈肌萎缩。
