Evolution of inspiratory muscle function in children during mechanical ventilation

Critical Care

Basil J. Petrof¹  Jean-Paul Praud²  Guillaume Emeriaud³  Benjamin Crulli³  Karen Harrington³  Atsushi Kawaguchi⁴ 

[1] Meakins-Christie Laboratories and Translational Research in Respiratory Diseases Program, McGill University Health Centre and Research Institute, 1001 Boulevard Décarie, H4A 3J1, Montreal, QC, Canada;Neonatal Respiratory Research Unit, Departments of Pediatrics and Pharmacology-Physiology, Université de Sherbrooke, 3001 12e Avenue Nord, J1H 5N4, Sherbrooke, QC, Canada;Pediatric Intensive Care Unit, CHU Sainte-Justine, Université de Montréal, 3175 chemin de la Côte-Sainte-Catherine, H3T 1C5, Montreal, QC, Canada;Pediatric Intensive Care Unit, CHU Sainte-Justine, Université de Montréal, 3175 chemin de la Côte-Sainte-Catherine, H3T 1C5, Montreal, QC, Canada;Pediatric Intensive Care Unit, Children’s Hospital of Eastern Ontario, University of Ottawa, 401 Smyth Road, K1H 8L1, Ottawa, ON, Canada;Department of Intensive Care Medicine, Tokyo Women’s Medical University, Tokyo, Japan;

关键词: Mechanical ventilation;    Diaphragm;    Inspiratory muscle dysfunction;    Electrical activity of the diaphragm;    Children;    Intensive care;   

DOI  :  10.1186/s13054-021-03647-w

来源: Springer

【 摘 要 】

BackgroundThere is no universally accepted method to assess the pressure-generating capacity of inspiratory muscles in children on mechanical ventilation (MV), and no study describing its evolution over time in this population.MethodsIn this prospective observational study, we have assessed the function of the inspiratory muscles in children on various modes of MV. During brief airway occlusion maneuvers, we simultaneously recorded airway pressure depression at the endotracheal tube (ΔPaw, force generation) and electrical activity of the diaphragm (EAdi, central respiratory drive) over five consecutive inspiratory efforts. The neuro-mechanical efficiency ratio (NME, ΔPaw/EAdimax) was also computed. The evolution over time of these indices in a group of children in the pediatric intensive care unit (PICU) was primarily described. As a secondary objective, we compared these values to those measured in a group of children in the operating room (OR).ResultsIn the PICU group, although median NMEoccl decreased over time during MV (regression coefficient − 0.016, p = 0.03), maximum ΔPawmax remained unchanged (regression coefficient 0.109, p = 0.50). Median NMEoccl at the first measurement in the PICU group (after 21 h of MV) was significantly lower than at the only measurement in the OR group (1.8 cmH2O/µV, Q1–Q3 1.3–2.4 vs. 3.7 cmH2O/µV, Q1–Q3 3.5–4.2; p = 0.015). Maximum ΔPawmax in the PICU group was, however, not significantly different from the OR group (35.1 cmH2O, Q1–Q3 21–58 vs. 31.3 cmH2O, Q1–Q3 28.5–35.5; p = 0.982).ConclusionsThe function of inspiratory muscles can be monitored at the bedside of children on MV using brief airway occlusions. Inspiratory muscle efficiency was significantly lower in critically ill children than in children undergoing elective surgery, and it decreased over time during MV in critically ill children. This suggests that both critical illness and MV may have an impact on inspiratory muscle efficiency.

【 授权许可】

CC BY