Ventilator-induced diaphragmatic dysfunction in extremely preterm infants: a pilot ultrasound study

Abstract

Purpose: To investigate the development of diaphragmatic dysfunction in ventilated extremely preterm infants (EPI) using diaphragm ultrasound (DU). Methods: EPI of less than 28 weeks' gestational age who required mechanical ventilation within six hours of birth were included in this prospective, observational study. The DU was performed once a day until four days of life. End-inspiratory and end-expiratory thicknesses of the diaphragm were measured and the diaphragm thickening fraction was calculated.Results: A total of 20 EPI were enrolled. After intubation, there was a progressive reduction in endinspiratory thicknesses of the diaphragm from baseline to day 1 (P < 0.001), but not from day 1 to day 2 (P = 0.078), day 2 to day 3 (P = 1.0), or day 3 to day 4 (P = 1.0). There was also a signi cant reduction in the diaphragm thickening fraction from baseline to day 1 (P < 0.001), but not from day 1 to day 2 (P = 1.0), day 2 to day 3 (P = 1.0), or day 3 to day 4 (P = 1.0).Conclusions: This study provides the rst evidence of diaphragmatic dysfunction in ventilated EPI. We demonstrated a rapid progression of ventilator-induced diaphragmatic dysfunction, with a signi cant reduction in diaphragm thickness and thickening fraction within 24 hours of ventilation.

Diaphragm atrophy during invasive mechanical ventilation is related to extubation failure in preterm infants: An ultrasound study

“…DA and VIDD have been reported in 41% of adults 47% of children undergoing IMV and has been associated with adverse outcomes 8,10,21,22 . In a recent study with 20 extremely preterm infants, 90% of them were found to have VIDD, however, the incidence of DA was not reported 15 . Moreover, the authors of this study only provided data on TDI and diaphragm thickening fraction (DTF) change but not on TDE change.…”

“…8,10,21,22 In a recent study with 20 extremely preterm infants, 90% of them were found to have VIDD, however, the incidence of DA was not reported. 15 Moreover, the authors of this study only provided data on TDI and diaphragm thickening fraction (DTF) change but not on TDE change. In our experience, and based on pathophysiologic considerations, TDI reflects the individual's ability to contract the diaphragm and is therefore influenced by multiple factors such as sleep state, agitation (and level of sedation), time from last meal, drugs (i.e., caffeine).…”

“…[8][9][10][11][12] There is paucity of studies about VIDD in newborns: authors mainly investigated on the role of diaphragm ultrasound for the prediction of successful extubation 13,14 and only one recent study assessed the development of DA in preterm infants born <28 weeks but did not report DA-associated outcomes. 15 We therefore aimed to describe the changes in diaphragm thickness during IMV and the prevalence and associations of DA, particularly regarding the relationship between DA and extubation failure.…”

“…There is paucity of studies about VIDD in newborns: authors mainly investigated on the role of diaphragm ultrasound for the prediction of successful extubation 13,14 and only one recent study assessed the development of DA in preterm infants born <28 weeks but did not report DA‐associated outcomes 15 …”

Diagnostic Accuracy of Lung Ultrasound in Neonatal Diseases: A Systematized Review

“…In fact, invasive mechanical ventilation (MV) leads to the rapid development of diaphragmatic weakness due to the onset of muscle atrophy and contractile dysfunction. This condition has been defined as ventilator-induced diaphragmatic dysfunction and has been associated with extubation failure [ 48 , 49 ]. Other authors reported that the LUS score but not diaphragmatic excursion parameters could predict extubation failure [ 50 ].…”