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Objective: Ultrasonographic assessment of the effect of different modes of mechanical ventilation on diaphragmatic excursion and consequently its effect on weaning of mechanical ventilation, total ventilatory days, hospital stay and mortality. Patients and methods: This study was carried out on 61 mechanically ventilated adult patients of both genders who were admitted to Critical Care Medicine Department in Alexandria main university hospital over a period from 1/6/2014 to 30\11\2014. All patients were subjected to complete medical and surgical history taking, complete physical examination and daily ultrasonographic assessment of diaphragmatic excursion. Results: Diaphragmatic dysfunction was detected in 16 patients (72.2%) of patients on CMV, 12 patients (54.5%) of patients on assisted MV in comparison to only 2 patients (11.1%) of patients on spontaneous MV (P Conclusion: Mechanical ventilation induces diaphragmatic dysfunction which is significantly higher with controlled and assisted mechanical ventilation modes than spontaneous modes. Ventilator induced diaphragmatic dysfunction is associated with higher rates of primary and secondary weaning failure, more ventilatory days, longer hospital stay and higher mortality rate. Key words: Mechanical Ventilation; Diaphragmatic Dysfunction; Weaning Failure. Abbreviations: CMV=controlled mechanical ventilation, ICU= intensive care unit, VIDD= ventilator induced diaphragmatic dysfunction, CPAP=continuous positive airway pressure. REFERENCES Ayoub J, Milane J, Targhetta R. Diaphragm kinetics during pneumatic belt respiratory assistance: a sonographic study in Duchenne muscular dystrophy. Neuromuscular Disorders 2002; 12:569–75. Yoshioka Y, Ohwada A, Sekiya M. Ultrasonographic evaluation of the diaphragm in patients with amyotrophic lateral sclerosis. Respirology 2007; 12:304–7. Kim SH, Na S, Choi JS. An evaluation of diaphragmatic movement by M-mode sonography as a predictor of pulmonary dysfunction after upper abdominal surgery. Anesth Analg 2010; 110:1349–54. Diehl JL, Lofaso F, Deleuze P. Clinically relevant diaphragmatic dysfunction after cardiac operations. J Thoracic Cardiovasc Surg 1994; 107:487–98. Grosu HB, Lee YI, Lee J, Eden E, Eikermann M, Rose KM. Diaphragm muscle thinning in patients who are mechanically ventilated. Chest 2012; 142: 1455–60. Knebel AR, Janson-Bjerklie SL, Malley JD. Comparison of breathing comfort during weaning with two ventilatory modes. Am J Respir Care Med 1994; 149(1):14–8. Gerscovich EO, Cronan M, McGahan JP. Ultrasonographic evaluation of diaphragmatic motion. J Ultrasound Med 2001; 20:597-604. Boussuges A, Gole Y, Blanc P. Diaphragmatic motion studied by m-mode ultrasonography: methods, reproducibility, and normal values. Chest 2009; 135:391–400. Sassoon CS, Caiozzo VJ, Manka A, Sieck GC. Altered diaphragm contractile properties with controlled mechanical ventilation. J Appl Physiol 2002; 92: 2585–95. Mrozek S, Jung B, Petrof BJ, Pauly M, Roberge S, Lacampagne A, et al. Rapid onset of specific diaphragm weakness in a healthy murine model of ventilator-induced diaphragmatic dysfunction. Anesthesiology 2012; 117(3): 560-7. Jung B, Constantin JM, Rossel N, Le Goff C, Sebbane M, Coisel Y, et al. Adaptive support ventilation prevents ventilator-induced diaphragmatic dysfunction in piglet: an in vivo and in vitro study. Anesthesiology 2010;112(6):1435-43. Levine S, Nguyen T, Taylor N, Friscia ME, Budak MT, Rothenberg P, et al. Rapid disuse atrophy of diaphragm fibers in mechanically ventilated humans. N Engl J Med 2008; 358 (13): 1327–35. Sassoon CS, Zhu E, Caiozzo VJ. Assist-control mechanical ventilation attenuates ventilator-induced diaphragmatic dysfunction. Am J Respir Crit Care Med 2004; 170:626-32. |
