Duration of mechanical ventilation and diaphragm functioning in children with acute respiratory failure

O.V. Filyk

Abstract


Background. Children with combination of restrictive and obstructive types of respiratory failure often have a long-lasting or difficult weaning from mechanical ventilation. The aim of this study was to compare the duration of ventilation and diaphragm function in children ventilated in pressure-synchronized intermittent mandatory ventilation (P-SIMV) and bilevel positive airway pressure (BIPAP) modes during the weaning from mechanical ventilation. Materials and methods. It was a prospective, observational, cohort, non-randomized study. Twenty seven children with acute respiratory failure were included in this study. All patients were divided in two groups. During weaning process, group I patients were ventilated in P-SIMV mode, and group II — in BIPAP mode. The primary outcome was the duration of mechanical ventilation; secondary outcomes were amplitude of movements of both hemidiaphragms, fraction of diaphragm thickening, presence of decompensated respiratory or mixed acidosis. Results. During this study, 3 out of 27 patients were excluded after verifying neuromuscular disease or bronchopulmonary dysplasia. Twenty four persons were ready for weaning from mechanical ventilation via the P-SIMV or BIPAP modes, however, 4 patients were excluded from the study due to severe desynchronization and the need to continue the controlled mechanical ventilation with sedation and muscle relaxation. As a result, 20 patients were included in the data analysis (evaluation of primary and secondary outcomes). The duration of mechanical ventilation in patients of group I was 14.14 ± 1.83 days, in group II — 13.20 ± 2.56 days (p = 0.32). The amplitude of diaphragm movements in the first day of the study was 7.2 ± 1.8 mm in group I, and 6.8 ± 1.5 — in group II (p = 0.42); on day 5, these data did not significantly differ in two groups, and increased to 8.1 ± 2.1 mm in group I, to 8.4 ± 1.9 mm — in group II (p = 0.12, and p = 0.89). On day 9, the amplitude of the right hemidiaphragm movements was significantly better in the patients of both groups — 9.0 ± 2.1 mm and 10.0 ± 1.3 mm in groups I and II, respectively, and differences were statistically significant compare to day 5 (p = 0.05, and p = 0.04). The amplitude of the right hemidiaphragm movement was more than 10 mm on day 13 in group II of patients and only on day 17 — in group I. Conclusions. The duration of mechanical ventilation was not significantly different in both groups of patients. Spontaneous respiratory efforts were significantly higher from days 9 to 17 in patients of group II.


Keywords


diaphragm function; children; weaning from mechanical ventilation

References


Bellani G, Grasselli G, Teggia-Droghi M et al. Do spontaneous and mechanical breathing have similar effects on average transpulmonary and alveolar pressure? A clinical crossover study. Critical Care. 2016; 20: 142. doi 10.1186/s13054-016-1290-9

Hraiech S, Yoshida T, Papazian L. Balancing neuromuscular blockade versus preserved muscle activity. Curr Opin Crit Care. 2015; 21(1): 26–33. doi: 10.1097/MCC.0000000000000175.

Kneyber MC, De Luca D, Calderini E, Jarreau P-H, Javouhey E, Lopez-Herce J. Recommendations for mechanical ventilation of critically ill children from the Paediatric Mechanical Ventilation Consensus Conference (PEMVECC). Intensive Care Medicine.2017; 43 (12): 1764–1780. doi: https://doi.org/10.1007/s00134-017-4920-z

Goligher EC, Dres M, Fan E et al. Mechanical Ventilation-induced Diaphragm Atrophy Strongly Impacts Clinical Outcomes. American Journal of Respiratory and Critical Care Medicine. 2018; 2. DOI: 10.1164/rccm.201703-0536OC

Brochard L. Measurement of esophageal pressure at bedside: pros and cons. Curr Opin Crit Care. 2014; 20:39 – 46. DOI:10.1097/MCC.0000000000000050

Aduen JF, Zisman A, Jolles SI, Keller CA. Retrospective Study of Pulmonary Function Tests in Patients Presenting With Isolated Reduction in Single-Breath Diffusion Capacity: Implications for the Diagnosis of Combined Obstructive and Restrictive Lung Disease. Mayo Clinic Proceedings. 2007; 82 (1): 48-54.https://doi.org/10.4065/82.1.48

Gardner ZS, Ruppel GL, Kaminsky DA. Grading the Severity of Obstruction in Mixed Obstructive-Restrictive Lung Disease. CHEST. 2011; 140(3):598–60. DOI: 10.1378/chest.10-2860

Diaz-Guzman E, McCarthy K, Siu A, Stoller JK. Frequency and Causes of Combined Obstruction and Restriction Identified in Pulmonary Function Tests in Adults. Respir Care. 2010; 55(3): 310 –316




DOI: https://doi.org/10.22141/2224-0586.3.90.2018.129490

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