Duration of diaphragmatic inactivity after endotracheal
intubation of critically ill patients
by Michael Chaim Sklar, Fabiana Madotto, Annemijn Jonkman,
Michela Rauseo, Ibrahim Soliman, L. Felipe Damiani, Irene Telias, Sebastian
Dubo, Lu Chen, Nuttapol Rittayamai, Guang-Qiang Chen, Ewan C. Goligher, Martin
Dres, Remi Coudroy, Tai Pham, Ricard M. Artigas…
Critical Care volume 25,
Article number: 26 (2021)
Background
In patients intubated for mechanical ventilation, prolonged
diaphragm inactivity could lead to weakness and poor outcome. Time to resume a
minimal diaphragm activity may be related to sedation practice and patient
severity.
Methods
Prospective observational study in critically ill patients.
Diaphragm electrical activity (EAdi) was continuously recorded after intubation
looking for resumption of a minimal level of diaphragm activity (beginning of
the first 24 h period with median EAdi > 7 µV, a threshold based
on literature and correlations with diaphragm thickening fraction). Recordings
were collected until full spontaneous breathing, extubation, death or
120 h. A 1 h waveform recording was collected daily to identify
reverse triggering.
Results
Seventy-five patients were enrolled and 69 analyzed (mean
age ± standard deviation 63 ± 16 years). Reasons for ventilation were
respiratory (55%), hemodynamic (19%) and neurologic (20%). Eight catheter
disconnections occurred. The median time for resumption of EAdi was 22 h
(interquartile range 0–50 h); 35/69 (51%) of patients resumed activity
within 24 h while 4 had no recovery after 5 days. Late recovery was
associated with use of sedative agents, cumulative doses of propofol and
fentanyl, controlled ventilation and age (older patients receiving less
sedation). Severity of illness, oxygenation, renal and hepatic function, reason
for intubation were not associated with EAdi resumption. At least 20% of
patients initiated EAdi with reverse triggering.
Conclusion
Low levels of diaphragm electrical activity are common in
the early course of mechanical ventilation: 50% of patients do not recover
diaphragmatic activity within one day. Sedatives are the main factors
accounting for this delay independently from lung or general severity.
