The following is a summary of “Dyssynchronous diaphragm contractions impair diaphragm function in mechanically ventilated patients,” published in the April 2024 issue of Critical Care by Coiffard et al.
Researchers conducted a retrospective study investigating the link between variable diaphragm loading during mechanical ventilation and the development of diaphragm dysfunction due to dyssynchronous contractions.
They monitored airway flow, pressure, and diaphragm electrical activity (Edi) hourly for up to 7 days in patients undergoing invasive mechanical ventilation for pneumonia, septic shock, acute respiratory distress syndrome, or acute brain injury. Dysynchronous post-inspiratory diaphragm loading was determined based on the duration of neural inspiration following the ventilator’s expiratory cycling. Daily diaphragm function evaluations utilized neuromuscular coupling (NMC), determining the ratio of trans-diaphragmatic pressure to diaphragm electrical activity.
The results showed that 4,508 hourly recordings were obtained from 45 patients. Edi was ≤ 5 µV in 51% of study hours (median 71 h per patient, IQR 39–101 h). Dyssynchronous post-inspiratory loading occurred in 13% of study hours (median 7 h per patient, IQR 2–22 h). The likelihood of dyssynchronous post-inspiratory loading was higher with reverse triggering (OR 15, 95% CI 8–35) and premature cycling (OR 8, 95% CI 6–10). The duration and intensity of dyssynchronous post-inspiratory loading were linked to a gradual decrease in diaphragm NMC (P<0.01 for interaction with time).
Investigators concluded that dyssynchronous diaphragm contractions may have impaired diaphragm function during mechanical ventilation.
Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-04894-3
