Serial ultrasonographic evaluation of diaphragm thickness during mechanical ventilation in ICU patients

ABSTRACT

Objective: Serial ultrasonographic assessment of the effect of different modes of mechanical ventila-tion on diaphragmatic thickness and consequently its effect on weaning of mechanical ventilation, total ventilatory days, ICU stay and mortality.

Patients and methods: This study was carried out on 67 mechanically ventilated adult patients of both genders who were admitted to Critical Care Medicine Department in Alexandria main university hospital over a period from 1/4/2014 to 30\9\2014. All patients were subjected to complete medical and surgical history taking, complete physical examination and daily ultrasonographic assessment of diaphragmatic thickness.

Results: Diaphragmatic atrophy was detected in 15 patients (78.9%) of patients on CMV, 14 patients (60.9%) of patients on assisted MV in comparison to only one patient (4%) of patients on spontaneous MV (P<0.001). Patients who developed diaphragmatic atrophy had a mean total ventilatory days 7.23 ± 2.39 days, mean ICU stay 9.08 ± 2.91 days, mortality rate 16.7%, primary weaning failure rate 52% and secondary weaning failure rate 36% while Patients who did not develop diaphragmatic atrophy had a mean total ventilatory days 4.32 ± 2.44 days, mean ICU stay 7.59± 2.63 days, mortality rate 8.1%, primary weaning failure rate 5.4% and secondary weaning failure rate 5.4%. (P1 < 0.001 P2 = 0.03 P3 = 0.451 P4 <0.001     P5 <0.001 respectively).

Conclusion: Mechanical ventilation induces diaphragmatic atrophy which is significantly higher with controlled and assisted mechanical ventilation modes than spontaneous modes. Ventilator induced diaphragmatic atrophy is associated with higher rates of primary and secondary weaning failure, more ventilatory days, longer ICU stay.

Key Words: Mechanical Ventilation; Diaphragmatic atrophy; Weaning Failure

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