Scripties UMCG - Rijksuniversiteit Groningen
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Diaphragm muscle thinning in mechanically ventilated patients admitted to the ICU

(2018) Coenen, N.M.O.

Background: Thirty-nine percent of all patients admitted to the Intensive Care Unit (ICU) receive mechanical ventilation (MV) at some point. Due to prolonged MV, muscle weakness and atrophy may develop in patients admitted to the ICU. Atrophy possibly cause change in diaphragmatic thickness over time. The aim of this study was to determine whether decrease in diaphragm muscle thickness, measured by ultrasonography (US), occurs over time in mechanically ventilated adult patients admitted to the ICU and if there is a correlation with extubation failure (EF).
Materials and methods: For this study, the diaphragmatic thickness was measured by US in patients receiving MV. Thickness was measured within 24 hours after intubation and repeated every day, with an interval of 24 hours between each individual measurement, until the patient was liberated from MV. As thinning is most pronounced in the first seven days after intubation, final analyses were conducted over these days.
Results: Of the 21 subjects 18 (86%) showed diaphragm thickness decrease during MV, with duration of MV as a significant effect (P = 0.019). Only two (10%) subjects failed extubation. No correlation was observed between diaphragmatic thickness and EF, nor was it demonstrated that the development of thinning started early after intubation.
Conclusions: Almost all intubated patients admitted to the ICU requiring MV showed decrease in diaphragmatic muscle. Thinning of the diaphragmatic muscle couldn’t be associated with extubation outcome, most likely as a result of the small sample size. More research is necessary to evaluate the added value of US in predicting EF.

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