Diaphragm Dysfunction on Admission to the Intensive Care Unit. Prevalence, Risk Factors, and Prognostic Impact—A Prospective Study - Archive ouverte HAL Access content directly
Journal Articles American Journal of Respiratory and Critical Care Medicine Year : 2013

Diaphragm Dysfunction on Admission to the Intensive Care Unit. Prevalence, Risk Factors, and Prognostic Impact—A Prospective Study

(1, 2) , (3, 4) , (1) , (4, 3) , (3, 4) , (5) , (4, 3) , (6) , (7) , (3, 4)
1
2
3
4
5
6
7
Catherine Coirault

Abstract

Rationale: Diaphragmatic insults occurring during intensive care unit (ICU) stays have become the focus of intense research. However, diaphragmatic abnormalities at the initial phase of critical illness remain poorly documented in humans. Objectives: To determine the incidence, risk factors, and prognostic impact of diaphragmatic impairment on ICU admission. Methods: Prospective, 6-month, observational cohort study in two ICUs. Mechanically ventilated patients were studied within 24 hours after intubation (Day 1) and 48 hours later (Day 3). Seventeen anesthetized intubated control anesthesia patients were also studied. The diaphragm was assessed by twitch tracheal pressure in response to bilateral anterior magnetic phrenic nerve stimulation (Ptr,stim). Measurements and Main Results: Eighty-five consecutive patients aged 62 (54-75) (median [interquartile range]) were evaluated (medical admission, 79%; Simplified Acute Physiology Score II, 54 [44-68]). On Day 1, Ptr, stim was 8.2 (5.9-12.3) cm H2O and 64% of patients had Ptr, stim less than 11 cm H2O. Independent predictors of low Ptr, stim were sepsis (linear regression coefficient, -3.74; standard error, 1.16; P = 0.002) and Simplified Acute Physiology Score II (linear regression coefficient, -0.07; standard error, 1.69; P = 0.03). Compared with nonsurvivors, ICU survivors had higher Ptr, stim (9.7 [6.3-13.8] vs. 7.3 [5.5-9.7] cm H2O; P = 0.004). This was also true for hospital survivors versus nonsurvivors (9.7 [6.3-13.5] vs. 7.8 [5.5-10.1] cm H2O; P = 0.004). Day 1 and Day 3 Ptr, stim were similar. Conclusions: A reduced capacity of the diaphragm to produce inspiratory pressure (diaphragm dysfunction) is frequent on ICU admission. It is associated with sepsis and disease severity, suggesting that it may represent another form of organ failure. It is associated with a poor prognosis.
Embargoed file
Embargoed file
Ne sera jamais visible
Loading...

Dates and versions

inserm-02426547 , version 1 (02-01-2020)

Identifiers

Cite

Alexandre Demoule, Boris Jung, Hélène Prodanovic, Nicolas Molinari, Gerald Chanques, et al.. Diaphragm Dysfunction on Admission to the Intensive Care Unit. Prevalence, Risk Factors, and Prognostic Impact—A Prospective Study. American Journal of Respiratory and Critical Care Medicine, 2013, 188 (2), pp.213-219. ⟨10.1164/rccm.201209-1668OC⟩. ⟨inserm-02426547⟩
225 View
1 Download

Altmetric

Share

Gmail Facebook Twitter LinkedIn More