膈肌功能障碍与儿科重症监护病房患者机械通气时间的关系：一项前瞻性队列研究。

Association of diaphragmatic dysfunction with duration of mechanical ventilation in patients in the pediatric intensive care unit: a prospective cohort study.

机构信息

Department of Rehabilitation, Children's Hospital of Fudan University, Shanghai, China.

NHC Key Laboratory of Neonatal Diseases, Fudan University, Shanghai, China.

出版信息

BMC Pediatr. 2024 Sep 28;24(1):607. doi: 10.1186/s12887-024-05092-4.

DOI:10.1186/s12887-024-05092-4

PMID:39342241

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11438377/

Abstract

BACKGROUND

Mechanical ventilation (MV) can cause diaphragmatic injury and ventilator induced diaphragmatic dysfunction (VIDD). Diaphragm ultrasonography (DU) is increasingly used to assess diaphragmatic anatomy, function and pathology of patients receiving MV in the pediatric intensive care unit (PICU). We report the poor contractile ability of diaphragm during ventilation of critically ill patients in our PICU and the association to prolonged length of MV and PICU stay.

METHODS

Patients who received MV within 24 h of admission to the PICU, expected to undergo continuous MV for more than 48 h and succeeded to extubate were included in the study. DU monitoring was performed daily after the initiation of MV until extubation. Diaphragm thickening fraction (DTF) measured by DU was used as an indicator of diaphragmatic contractile activity. Patients with bilateral DTF = 0% during DU assessment were allocated into the severe VIDD group (n = 26) and the rest were into non-severe VIDD group (n = 29). The association of severe VIDD with individual length of MV, hospitalization and PICU stay were analyzed.

RESULTS

With daily DU assessment, severe VIDD occurred on 2.9 ± 1.2 days after the initiation of MV, and lasted for 1.9 ± 1.7 days. Values of DTF of all patients recovered to > 10% before extubation. The severe VIDD group had a significantly longer duration (days) of MV [12.0 (8.0-19.3) vs. 5.0 (3.5-7.5), p < 0.001] and PICU stay (days) [30.5 (14.9-44.5) vs. 13.0 (7.0-24.5), p < 0.001]. The occurrence of severe VIDD, first day of severe VIDD and length of severe VIDD were significantly positively associated with the duration of MV and PICU stay. The occurrence of severe VIDD on the second and third days after initiation of MV significantly associated to longer PICU stay (days) [43.0 (9.0-70.0) vs. 13.0 (3.0-40.0), p = 0.009; 36.0 (17.0-208.0) vs. 13.0 (3.0-40.0), p = 0.005, respectively], and the length of MV (days) was significantly longer in those with severe VIDD on the third day after initiation of MV [16.5 (7.0-29.0) vs. 5.0 (2.0-22.0), p = 0.003].

CONCLUSIONS

Daily monitoring of diaphragmatic function with bedside ultrasonography after initiation of MV is necessary in critically ill patients in PICU and the influences and risk factors of severe VIDD need to be further studied. (355 words).

摘要

背景

机械通气（MV）可导致膈肌损伤和呼吸机诱导的膈肌功能障碍（VIDD）。膈肌超声（DU）越来越多地用于评估接受儿科重症监护病房（PICU）MV 的患者的膈肌解剖结构、功能和病理。我们报告了我们的 PICU 中危重症患者在通气期间膈肌收缩能力差，与 MV 和 PICU 住院时间延长有关。

方法

我们纳入了在 PICU 入院后 24 小时内接受 MV、预计需要持续 MV 超过 48 小时并成功拔管的患者。在开始 MV 后每天进行 DU 监测，直到拔管。通过 DU 测量的膈肌增厚分数（DTF）被用作膈肌收缩活动的指标。在 DU 评估中双侧 DTF=0%的患者被分配到严重 VIDD 组（n=26），其余患者被分到非严重 VIDD 组（n=29）。分析严重 VIDD 与个体 MV 时间、住院时间和 PICU 住院时间的关系。

结果

通过每日 DU 评估，严重 VIDD 在 MV 开始后 2.9±1.2 天发生，持续 1.9±1.7 天。所有患者的 DTF 值在拔管前均恢复至>10%。严重 VIDD 组的 MV 时间[12.0（8.0-19.3）vs. 5.0（3.5-7.5），p<0.001]和 PICU 住院时间[30.5（14.9-44.5）vs. 13.0（7.0-24.5），p<0.001]明显更长。严重 VIDD 的发生、严重 VIDD 的第一天和严重 VIDD 的持续时间与 MV 和 PICU 住院时间呈显著正相关。MV 开始后第二天和第三天出现严重 VIDD 与 PICU 住院时间延长显著相关[43.0（9.0-70.0）vs. 13.0（3.0-40.0），p=0.009；36.0（17.0-208.0）vs. 13.0（3.0-40.0），p=0.005]，MV 持续时间（天）在 MV 开始后第三天出现严重 VIDD 的患者中明显更长[16.5（7.0-29.0）vs. 5.0（2.0-22.0），p=0.003]。