Diaphragm-protective mechanical ventilation in children during weaning from respiratory support
Keywords:diaphragm-protective mechanical ventilation, weaning from mechanical ventilation, children
AbstractBackground. Mechanical ventilation (MV) can cause diaphragm dysfunction in a significant proportion of patients, which is associated with adverse outcomes, prolonged weaning from MV, and prolonged stay at the intensive care unit (ICU). The purpose of the study was to determine the effectiveness of the diaphragm-protective strategy in addition to the lung-protective strategy during weaning from MV in children. The study hypothesis was that the implementation of diaphragm-protective strategy in addition to lung-protective strategy will not affect the level of dyspnea, the duration of weaning from MV, the length of stay in the ICU. Materials and methods. We conducted a prospective cohort single-center study at the Department of Anesthesiology and Intensive Care at Lviv Regional Children’s Clinical Hospital “OHMATDYT”. The study included 89 patients aged 1 month — 18 years. All patients were randomly divided into 2 groups (using random.org). Group I included people who received lung-protective ventilation strategy, group II — those who received diaphragm-protective in addition to lung-protective ventilation strategy. Eighty-two patients were included in the data analysis. We studied indicators of diaphragm function (thickening fraction and amplitude of movements), parameters of acid-base balance. We analyzed the level of dyspnea according to the visual analogue scale for dyspnea in patients aged 6–18 years, frequency of successful weaning from MV (no need in MV for more than 48 h from the time of patient’s extubation and stopping any ventilation support), as well as the duration of MV and duration of stay in the ICU. Results. Our study found that 72.1 % of patients in the group I were successfully weaned from MV, while in the group II only 86.8 % were weaned (p = 0.05). The duration of MV was higher in group II compared to group I and was 19.4 ± 2.6 days and 23.1 ± 2.2 days, respectively (p = 0.12). Such an increase in the duration of MV in patients of group II should be interpreted together with the rate of successful weaning from MV, which was higher in this group of patients. It can be assumed that the fact of successful weaning is more clinically valuable for the patient than the duration of MV itself; however, such interpretation of the research results requires further studies. The duration of stay in the ICU was higher in group I compared to group II and was 29.2 ± 3.1 days and 26.5 ± 3.6 days, respectively (p = 0.06). Conclusions. A comprehensive approach at the stage of weaning from MV, which includes the diaphragm-protective strategy in addition to the lung-protective strategy, might reduce the incidence of dyspnea in patients, increase the likelihood of successful weaning and reduce the length of stay in the ICU.
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