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