Reyes VAE, López MS, Vidal AER, Cerón DUW

Language: Spanish
References: 12
Page: 600-604
PDF size: 200.00 Kb.

ABSTRACT

Introduction: diaphragmatic muscle injury has been described in critically ill patients who require mechanical ventilation, as well as its effect on weaning failure. During this period of diaphragmatic dysfunction there is a recruitment effect on accessory muscles. Ultrasound is a low cost diagnostic tool, easily reproducible and can be used to assess diaphragmatic and accessory activity. Objective: determine the predictive value of the diaphragmatic (Tfdi) and intercostal thickening fraction (Tfic) for the failure or success of the spontaneous breathing trial (SBT). Material and methods: this is a transversal, observational and prospective trial in patients older than 18 years, requiring invasive mechanical ventilation, who were put on a SBT trial and in whom the Tfdi and Tfic were measured with ultrasound. Results: thirty two patients were recruited, SBT was considered successful in 93.7%, the mechanical ventilation hours median was 90.5 hours (IQR 40.7-164.2). We found a median Tfic of 7.54% (IQR 3.8-9.3), and a Tfdi median of 32.7% (IQR 24.1-40.9). The correlation between the diaphragm shortening fraction and the parasternal intercostal fraction was null (r = 0.076). We found four groups of patients with distinct diaphragmatic and intercostal shortening fraction patterns. A negative correlation between Tfdi and body mass index was found (r = 0.32), and a positive correlation between mechanical ventilation duration and Tfic (r = 0.28). We didn't find a statistically significant difference between patients who had a successful SBT and patients who failed, both for Tfdi (p = 0.52) and Tfic (p = 0.79). Conclusions: we cannot make a conclusion about the predictive capacity of the diaphragmatic and intercostal shortening fractions on the SBT success. The correlation analysis between diaphragmatic and intercostal thickening fraction suggests four groups of patients, in which both shortening fractions identify different respiratory muscle reserve patterns.

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