Nobile Stefano, Sbordone Annamaria, Salce Nicola, Patti Maria Letizia, Perri Alessandro, Fattore Simona, Prontera Giorgia, Giordano Lucia, Tana Milena, Vento Giovanni
Department of Mother, Child and Public Health, Division of Neonatology, Neonatal Unit, Fondazione Policlinico Universitario "A. Gemelli", Rome, Italy.
Division of Neonatology, Neonatal Unit, Policlinico Casilino, Rome, Italy.
Pediatr Pulmonol. 2024 Apr;59(4):855-862. doi: 10.1002/ppul.26818. Epub 2024 Feb 14.
Diaphragm dysfunction is associated with poor outcomes in critically ill patients. Ventilator-induced diaphragmatic dysfunction (VIDD), including diaphragm atrophy (DA), is poorly studied in newborns. We aimed to assess VIDD and its associations in newborns.
Single-center prospective study. Diaphragm thickness was measured at end-inspiration (TDI) and end-expiration (TDE) on the right midaxillary line. DA was defined as decrease in TDE ≥ 10%. Daily measurements were recorded in preterm newborns on invasive mechanical ventilation (IMV) for ≥2 days. Clinical characteristics of patients and extubation failure were recorded. Univariate analysis, logistic regression, and mixed models were performed to describe VIDD and associated factors.
We studied 17 patients (median gestational age 27 weeks) and 22 IMV cycles (median duration 9 days). Median TDE decreased from 0.118 cm (interquartile range [IQR] 0.094-0.165) on the first IMV day to 0.104 cm (IQR 0.083-0.120) on the last IMV day (p = .092). DA occurred in 11 IMV cycles (50%) from 10 infants early during IMV (median: second IMV day). Mean airway pressure (MAP) and lung ultrasound score (LUS) on the first IMV day were significantly higher in patients who developed DA. DA was more frequent in patients with extubation failure than in those with extubation success within 7 days (83.3 vs. 33.3%, p = .038).
DA, significantly associated with extubation failure, occurred in 58.8% of the study infants on IMV. Higher MAP and LUS at IMV start were associated with DA. Our results suggest a potential role of diaphragm ultrasound to assess DA and predict extubation failure in clinical practice.
膈肌功能障碍与危重症患者的不良预后相关。呼吸机诱导的膈肌功能障碍（VIDD），包括膈肌萎缩（DA），在新生儿中的研究较少。我们旨在评估新生儿中的VIDD及其关联因素。
单中心前瞻性研究。在右侧腋中线吸气末（TDI）和呼气末（TDE）测量膈肌厚度。DA定义为TDE降低≥10%。对接受有创机械通气（IMV）≥2天的早产儿进行每日测量记录。记录患者的临床特征和拔管失败情况。进行单因素分析、逻辑回归和混合模型分析以描述VIDD及其相关因素。
我们研究了17例患者（中位胎龄27周）和22个IMV周期（中位持续时间9天）。TDE中位数从IMV第1天的0.118厘米（四分位间距[IQR]0.094 - 0.165）降至IMV最后一天的0.104厘米（IQR 0.083 - 0.120）（p = 0.092）。10例婴儿在IMV早期的11个IMV周期（50%）出现DA（中位时间：IMV第2天）。发生DA的患者在IMV第1天的平均气道压（MAP）和肺部超声评分（LUS）显著更高。与7天内拔管成功的患者相比，拔管失败的患者DA更常见（83.3%对33.3%，p = 0.038）。
在接受IMV的研究婴儿中，58.8%出现了与拔管失败显著相关的DA。IMV开始时较高的MAP和LUS与DA相关。我们的结果表明膈肌超声在临床实践中评估DA和预测拔管失败方面可能具有潜在作用。
