Ventilator-induced diaphragmatic dysfunction in extremely preterm infants: a pilot ultrasound study
Ventilator-induced diaphragmatic dysfunction in extremely preterm infants: a pilot ultrasound study
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DOI：
10.1007/s00431-023-04846-z
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发表时间：
2023-01-31
影响因子：
3.6
通讯作者：
Hinata，Ayako
中科院分区：
文献类型：
--
作者：
Hoshino，Yusuke;Arai，Junichi;Hinata，Ayako
目的：应用横膈膜超声（DU）研究通气极早产儿（EPI）膈功能障碍的发展。EPI小于28周龄且在出生6小时内需要机械通气的患者纳入了这项前瞻性观察性研究。每天进行1次DU，直至生命第4天。测量膈肌吸气末和呼气末厚度，计算膈肌增厚分数。共纳入20例EPI。插管后，从基线到第1天，膈肌吸气末厚度逐渐减少（P< 0.001），但从第1天到第2天（P= 0.092）、第2天到第3天（P= 1.0）或第3天到第4天（P= 1.0）没有减少。从基线到第1天膈肌增厚分数也有显著降低（P< 0.001），但从第1天到第2天（P= 1.0）、第2天到第3天（P= 1.0）或第3天到第4天（P= 1.0）没有显著降低。结论：本研究首次提供了通气EPI患者膈肌功能障碍的证据。我们证明了呼吸机诱发的膈功能障碍的快速进展，在通气24小时内膈厚度和增厚分数显著减少。注意事项：•呼吸机的过度辅助抑制呼吸努力，诱发膈肌卸载，导致膈肌萎缩或功能障碍。•膈功能障碍导致呼吸机依赖时间延长和临床结果不佳。最新进展：•大多数极早产儿在插管后24小时内出现膈肌功能障碍。•超声测量的隔膜厚度和收缩能力将是呼吸恶化或呼吸结果的重要指标。
To investigate the development of diaphragmatic dysfunction in ventilated extremely preterm infants (EPI) using diaphragm ultrasound (DU). EPI of less than 28 weeks’ gestational age who required mechanical ventilation within six hours of birth were included in this prospective, observational study. DU was performed once a day until four days of life. End-inspiratory and end-expiratory thicknesses of the diaphragm were measured, and the diaphragm thickening fraction was calculated. A total of 20 EPI were enrolled. After intubation, there was a progressive reduction in end-inspiratory thickness of the diaphragm from baseline to day 1 (P< 0.001), but not from day 1 to day 2 (P= 0.092), day 2 to day 3 (P= 1.0), or day 3 to day 4 (P= 1.0). There was also a significant reduction in the diaphragm thickening fraction from baseline to day 1 (P< 0.001), but not from day 1 to day 2 (P= 1.0), day 2 to day 3 (P= 1.0), or day 3 to day 4 (P= 1.0).Conclusions: This study provides the first evidence of diaphragmatic dysfunction in ventilated EPI. We demonstrated a rapid progression of ventilator-induced diaphragmatic dysfunction, with a significant reduction in diaphragm thickness and thickening fraction within 24 h of ventilation.What is Known:• Over-assistance of the ventilator suppresses respiratory effort and induces diaphragm unloading, resulting in diaphragm atrophy or dysfunction.• Diaphragmatic dysfunction contributes to prolonged ventilator dependence and poor clinical outcomes.What is New:• Most extremely preterm infants develop diaphragmatic dysfunction after intubation within 24 hours.• Diaphragm thickness and contraction ability measured by ultrasound would be important indicators of worsening breathing or respiratory outcomes.