Prevalence of Diaphragmatic Dysfunction in the Long-Term Acute Care Setting and Its Effects on Ventilator Weaning Outcomes

Abstract

Objective: To determine the prevalence of undiagnosed diaphragmatic dysfunction in a long-term acute care hospital setting in patients on prolonged mechanical ventilation and its association with weaning outcomes. Design: This is a single-center, retrospective cohort study including 451 patients on prolonged mechanical ventilation admitted to a longterm acute care hospital facility between 2012 and 2017. Diaphragmatic dysfunction was assessed using fluoroscopy. Results: Three hundred nineteen patients on prolonged mechanical ventilation were assessed for diaphragmatic dysfunction. Nine patients were diagnosed with diaphragmatic dysfunction before admission. Eighty (72.7%) without diaphragmatic dysfunction were successfully weaned and 30 (27.3%) failed to wean, whereas 51 participants (31.9%) with diaphragmatic dysfunction were successfully weaned and 109 (68.1%) failed to wean (P < 0.001). When analyzing days to wean, the median was 13 days for those with no diaphragmatic dysfunction, 19 days with unilateral diaphragmatic dysfunction, and 28 days with bilateral diaphragmatic dysfunction (P < 0.001). Weaning success was not statistically associated with generalized neuromuscular disorders, age, sex, body mass index, smoking history, or diabetes. Conclusions: Diaphragmatic dysfunction was found to be strongly associated with time to wean and weaning success in the long-term acute care hospital setting. Very few patients despite being on prolonged mechanical ventilation were diagnosed with diaphragmatic dysfunction before longterm acute care hospital admission. Given this information, early diagnosis of diaphragmatic dysfunction among prolonged mechanical ventilation patients in the long-term acute care hospital setting is paramount in preventing secondary complications associated with mechanical ventilation.

Diaphragm ultrasound in patients with prolonged weaning from mechanical ventilation

“…This pathophysiological complex condition results not only in an imbalance between diaphragmatic protein synthesis and degradation, but also in an impaired contractility due to changes in the intracellular calcium homoeostasis ( 7 ). Since the extent of VIDD correlates with the duration of MV, it is also strongly associated with weaning failure and increased mortality ( 8 - 12 ). A patient group, which can be considered as affected by VIDD by practically 100%, are patients in prolonged weaning from MV ( 13 ).…”