Abstract
Background
Previous literature on the determinants of diaphragm dysfunction in septic patients
is limited. The goal of this study is to assess diaphragm dysfunction in terms of
its prevalence and its potential associated factors in septic intensive care unit
(ICU) patients.
Methods
This prospective and observational study was conducted between June 2015 and July
2019. Ultrasound measures of diaphragm thickness were performed daily on septic patients.
The primary outcome was the prevalence of diaphragm dysfunction at baseline and during
the ICU stay. The secondary outcome was the diaphragm thickness. Possible associated
factors were prospectively recorded.
Results
Fifty patients were enrolled in the study. The prevalence of diaphragm dysfunction
was 58%. No diaphragm atrophy was found during the ICU stay. Diaphragm dysfunction
was associated with the alteration of consciousness, intra-abdominal sepsis, hypnotics
and opioids, and mechanical ventilation. Administration of hypnotics, opioids, and
steroids was associated with a decreased diaphragm thickening fraction. Diaphragm
dysfunction had no impact on patient outcomes.
Conclusions
Our data reveal a high prevalence of diaphragm dysfunction in septic patients at the
onset of sepsis. Administration of hypnotics, opioids, and steroids was associated
with the alteration of diaphragm function as well as intra-abdominal sepsis.
Keywords
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References
- Intensive care unit-acquired weakness: risk factors and prevention.Crit Care Med. 2009; 37: S309-S315https://doi.org/10.1097/CCM.0b013e3181b6e64c
- Sepsis-induced myopathy.Crit Care Med. 2009; 37: S354-S367https://doi.org/10.1097/CCM.0b013e3181b6e439
- Diaphragm dysfunction on admission to the intensive care unit. Prevalence, risk factors, and prognostic impact—a prospective study.Am J Respir Crit Care Med. 2013; 188: 213-219https://doi.org/10.1164/rccm.201209-1668OC
- Sepsis is associated with a preferential diaphragmatic atrophy: a critically ill patient study using tridimensional computed tomography.Anesthesiology. 2014; 120: 1182-1191https://doi.org/10.1097/ALN.0000000000000201
- Rapidly progressive diaphragmatic weakness and injury during mechanical ventilation in humans.Am J Respir Crit Care Med. 2011; 183: 364-371https://doi.org/10.1164/rccm.201004-0670OC
- Alterations in respiratory and limb muscle strength and size in patients with sepsis who are mechanically ventilated.Phys Ther. 2014; 94: 68-82https://doi.org/10.2522/ptj.20130048
- Critical illness-associated diaphragm weakness.Intensive Care Med. 2017; 43: 1441-1452https://doi.org/10.1007/s00134-017-4928-4
- The third international consensus definitions for sepsis and septic shock (Sepsis-3).JAMA. 2016; 315: 801-810https://doi.org/10.1001/jama.2016.0287
- Measuring diaphragm thickness with ultrasound in mechanically ventilated patients: feasibility, reproducibility and validity.Intensive Care Med. 2015; 41: 734https://doi.org/10.1007/s00134-015-3687-3
- Monitoring recovery from diaphragm paralysis with ultrasound.Chest. 2008; 133: 737-743https://doi.org/10.1378/chest.07-2200
- Mechanical ventilation-induced diaphragm atrophy strongly impacts clinical outcomes.Am J Respir Crit Care Med. 2018; 197: 204-213https://doi.org/10.1164/rccm.201703-0536OC
- Focused principal component analysis: looking at a correlation matrix with a particular interest in a given variable.J Comput Graph Stat. 1999; 8: 906-912https://doi.org/10.1080/10618600.1999.10474855
- Early development of critical illness myopathy and neuropathy in patients with severe sepsis.Neurology. 2006; 67: 1421-1425https://doi.org/10.1212/01.wnl.0000239826.63523.8e
- The critical illness polyneuropathy in septic patients with prolonged weaning from mechanical ventilation: is the diaphragm also affected? A pilot study.Respir Care. 2012; 57: 1594-1601https://doi.org/10.4187/respcare.01396
- Rapid disuse atrophy of diaphragm fibers in mechanically ventilated humans.N Engl J Med. 2008; 358: 1327-1335https://doi.org/10.1056/NEJMoa070447
- Alteration in diaphragmatic function induced by acute necrotizing pancreatitis in a rodent model.Am J Respir Crit Care Med. 1999; 160: 1623-1628https://doi.org/10.1164/ajrccm.160.5.9806004
- The course of diaphragm atrophy in ventilated patients assessed with ultrasound: a longitudinal cohort study.Crit Care. 2015; 19: 422https://doi.org/10.1186/s13054-015-1141-0
- Assisted mechanical ventilation promotes recovery of diaphragmatic thickness in critically ill patients: a prospective observational study.Crit Care. 2020; 24: 85https://doi.org/10.1186/s13054-020-2761-6
- Diaphragm muscle thinning in patients who are mechanically ventilated.Chest. 2012; 142: 1455-1460https://doi.org/10.1378/chest.11-1638
- Atrophy of diaphragm and pectoral muscles in critically ill patients.Anesthesiology. 2019; https://doi.org/10.1097/ALN.0000000000002737
- Alterations in diaphragmatic function assessed by ultrasonography in mechanically ventilated patients with sepsis.J Clin Ultrasound. 2019; https://doi.org/10.1002/jcu.22690
- Quantitative neuromuscular ultrasound in the intensive care unit.Muscle Nerve. 2013; 47: 255-259https://doi.org/10.1002/mus.23525
- Diaphragmatic fatigue during sepsis and septic shock.Intensive Care Med. 2005; 31: 1611-1617https://doi.org/10.1007/s00134-005-2748-4
- Diaphragm thickening in cardiac surgery: a perioperative prospective ultrasound study.Ann Intensive Care. 2019; 9: 50https://doi.org/10.1186/s13613-019-0521-z
- Diaphragm ultrasonography to estimate the work of breathing during non-invasive ventilation.Intensive Care Med. 2012; 38: 796-803https://doi.org/10.1007/s00134-012-2547-7
- Respective contribution of intensive care unit-acquired limb muscle and severe diaphragm weakness on weaning outcome and mortality: a post hoc analysis of two cohorts.Crit Care. 2019; 23: 370https://doi.org/10.1186/s13054-019-2650-z
- Sedation with sufentanil in patients receiving pressure support ventilation has no effects on respiration: a pilot study.Can J Anaesth. 2004; 51: 494-499https://doi.org/10.1007/BF03018315
- Remifentanil effects on respiratory drive and timing during pressure support ventilation and neurally adjusted ventilatory assist.Respir Physiol Neurobiol. 2017; 244: 10-16https://doi.org/10.1016/j.resp.2017.06.007
- Paresis acquired in the intensive care unit: a prospective multicenter study.JAMA. 2002; 288: 2859-2867https://doi.org/10.1001/jama.288.22.2859
- Interactive effects of corticosteroid and mechanical ventilation on diaphragm muscle function.Muscle Nerve. 2011; 43: 103-111https://doi.org/10.1002/mus.21821
- Corticosteroid effects on ventilator-induced diaphragm dysfunction in anesthetized rats depend on the dose administered.Respir Res. 2010; 11: 178https://doi.org/10.1186/1465-9921-11-178
- Neutralization of receptor for advanced glycation end-products and high mobility group box-1 attenuates septic diaphragm dysfunction in rats with peritonitis.Crit Care Med. 2009; 37: 2619-2624https://doi.org/10.1097/CCM.0b013e3181a930f7
- Association of low baseline diaphragm muscle mass with prolonged mechanical ventilation and mortality among critically ill adults.JAMA Netw Open. 2020; 3e1921520https://doi.org/10.1001/jamanetworkopen.2019.21520
- Ultrasound evaluation of diaphragm function in mechanically ventilated patients: comparison to phrenic stimulation and prognostic implications.Thorax. 2017; 72: 811-818https://doi.org/10.1136/thoraxjnl-2016-209459
- Mechanical ventilation and diaphragmatic atrophy in critically ill patients: an ultrasound study.Crit Care Med. 2016; https://doi.org/10.1097/CCM.0000000000001657
- Change in diaphragm and intercostal muscle thickness in mechanically ventilated patients: a prospective observational ultrasonography study.J Intensive Care. 2019; 7: 56https://doi.org/10.1186/s40560-019-0410-4
- Inspiratory muscle training for intensive care patients: a multidisciplinary practical guide for clinicians.Aust Crit Care. 2019; 32: 249-255https://doi.org/10.1016/j.aucc.2018.06.001
Article info
Publication history
Published online: March 08, 2022
Accepted:
January 13,
2022
Received in revised form:
December 23,
2021
Received:
August 28,
2021
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.
