Publication:
Duration of diaphragmatic inactivity after endotracheal intubation of critically ill patients

Issued Date

2021-12-01

Resource Type

Article

ISSN

1466609X
13648535

DOI

10.1186/s13054-020-03435-y

Other identifier(s)

2-s2.0-85099107610

Rights

Mahidol University

Rights Holder(s)

SCOPUS

Bibliographic Citation

Critical Care. Vol.25, No.1 (2021)

Suggested Citation

Michael Chaim Sklar, Fabiana Madotto, Annemijn Jonkman, Michela Rauseo, Ibrahim Soliman, L. Felipe Damiani, Irene Telias, Sebastian Dubo, Lu Chen, Nuttapol Rittayamai, Guang Qiang Chen, Ewan C. Goligher, Martin Dres, Remi Coudroy, Tai Pham, Ricard M. Artigas, Jan O. Friedrich, Christer Sinderby, Leo Heunks, Laurent Brochard Duration of diaphragmatic inactivity after endotracheal intubation of critically ill patients. Critical Care. Vol.25, No.1 (2021). doi:10.1186/s13054-020-03435-y Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/77646

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Title

Duration of diaphragmatic inactivity after endotracheal intubation of critically ill patients

Author(s)

Michael Chaim Sklar
 Fabiana Madotto
 Annemijn Jonkman
 Michela Rauseo
 Ibrahim Soliman
 L. Felipe Damiani
 Irene Telias
 Sebastian Dubo
 Lu Chen
 Nuttapol Rittayamai
 Guang Qiang Chen
 Ewan C. Goligher
 Martin Dres
 Remi Coudroy
 Tai Pham
 Ricard M. Artigas
 Jan O. Friedrich
 Christer Sinderby
 Leo Heunks
 Laurent Brochard

Other Contributor(s)

IRCCS Multimedica
 University of Toronto, Institute of Biomedical Engineering
 Keenan Research Centre for Biomedical Science
 Universite de Poitiers
 Toronto General Hospital
 University of Toronto
 Hôpital Universitaire Pitié Salpêtrière
 University Health Network University of Toronto
 Hopital de Bicetre
 Universidad de la Frontera
 Faculty of Medicine Siriraj Hospital, Mahidol University
 Facultad de Medicina
 Amsterdam UMC - Free University Amsterdam
 Universidad de Concepcion

Abstract

Background: In patients intubated for mechanical ventilation, prolonged diaphragm inactivity could lead to weakness and poor outcome. Time to resume a minimal diaphragm activity may be related to sedation practice and patient severity. Methods: Prospective observational study in critically ill patients. Diaphragm electrical activity (EAdi) was continuously recorded after intubation looking for resumption of a minimal level of diaphragm activity (beginning of the first 24 h period with median EAdi > 7 µV, a threshold based on literature and correlations with diaphragm thickening fraction). Recordings were collected until full spontaneous breathing, extubation, death or 120 h. A 1 h waveform recording was collected daily to identify reverse triggering. Results: Seventy-five patients were enrolled and 69 analyzed (mean age ± standard deviation 63 ± 16 years). Reasons for ventilation were respiratory (55%), hemodynamic (19%) and neurologic (20%). Eight catheter disconnections occurred. The median time for resumption of EAdi was 22 h (interquartile range 0–50 h); 35/69 (51%) of patients resumed activity within 24 h while 4 had no recovery after 5 days. Late recovery was associated with use of sedative agents, cumulative doses of propofol and fentanyl, controlled ventilation and age (older patients receiving less sedation). Severity of illness, oxygenation, renal and hepatic function, reason for intubation were not associated with EAdi resumption. At least 20% of patients initiated EAdi with reverse triggering. Conclusion: Low levels of diaphragm electrical activity are common in the early course of mechanical ventilation: 50% of patients do not recover diaphragmatic activity within one day. Sedatives are the main factors accounting for this delay independently from lung or general severity. Trial Registration ClinicalTrials.gov (NCT02434016). Registered on April 27, 2015. First patients enrolled June 2015.

Keyword(s)

Medicine

Availability

URI

https://repository.li.mahidol.ac.th/handle/123456789/77646

Collections

Scopus 2021