Diaphragm Function Assessment During Spontaneous Breathing Trial in Patients with Neuromuscular Diseases
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ORIGINAL WORK
Diaphragm Function Assessment During Spontaneous Breathing Trial in Patients with Neuromuscular Diseases Mathangi Krishnakumar* , Radhakrishnan Muthuchellappan and Dhritiman Chakrabarti © 2020 Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society
Abstract Introduction: The optimal time to discontinue patients from mechanical ventilation is critical as premature discontinuation as well as delayed weaning can result in complications. The literature on diaphragm function assessment during the weaning process in the intriguing subpopulation of critically ill neuromuscular disease patients is lacking. Methods: Patients with neuromuscular diseases, on mechanical ventilation for more than 7 days, and who were ready for weaning were studied. During multiple T-piece trials over days, diaphragm function using ultrasound and diaphragm electrical activity (Edi peaks using NAVA catheter) was measured every 30 min till a successful 2 h weaning. Results: A total of 18 patients were screened for eligibility over 5-month period and eight patients fulfilled the inclusion criteria. Sixty-three data points in these 8 subjects were available for analysis. A successful breathing trial was predicted by Edi reduction (1.22 μV for every 30 min increase in weaning duration; 0.69 μV for every day of weaning) and increase in diaphragm excursion (2.81 mm for every 30 min increase in weaning duration; 2.18 mm for every day of weaning). Conclusion: The Edi and diaphragm excursion changes can be used as additional objective tools in the decisionmaking of the weaning trials in neuromuscular disease. Keywords: Diaphragm ultrasound, Diaphragm excursion, Diaphragm thickening fraction, Neuromuscular disease, NAVA, Weaning Introduction The optimal time to discontinue patients from mechanical ventilation (MV) is critical. Premature liberation from MV may be followed by reinstitution of ventilator support in up to 25% of patients. On the other hand, delayed weaning may be associated with ventilator-induced diaphragm dysfunction [1, 2]. In fact, even a shorter duration of mechanical ventilation (18–96 h) has been shown, by histological examination, to induce disuse atrophy of diaphragm muscle fibers [3]. Both premature and delayed *Correspondence: [email protected] Department of Neuroanaesthesia and Neurocritical Care, III Floor, Neurosciences Faculty Centre, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka 560029, India
liberation from mechanical ventilation have been associated with increased mortality up to 36%, assuming that reintubation is not related to upper-airway obstruction [4, 5]. Early identification of patients who can successfully breathe spontaneously results in a shorter duration of mechanical ventilation and lower complication rate [1, 2]. Mechanical ventilation can be discontinued in the majority of the patients when the disease process that caused acute respiratory failure improves. However, a cohort of patients (20–30%) remai
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