04 - ULTRASOUND ASSESSMENT OF VENTILATOR-INDUCED DIAPHRAGMATIC DYSFUNCTION IN PAEDIATRICS
Carla Pinto, Maria Teresa Dionísio, Armanda Rebelo · 2018
Background and AimsThe invasive mechanical ventilation (MV) contributes to ventilator-induced diaphragmatic dysfunction (VIDD), delaying extubation and increasing mortality in adults. Despite it may have a higher impact in paediatrics, it is not routinely monitored. Diaphragm ultrasound has been proposed as a safe and non-invasive technique for this purpose. The aim was to describe the evolution of diaphragmatic morphology and functionu2019s measurements by ultrasound in children requiring MV.MethodProspective exploratory study. Children admitted to PICU requiring MV>48 hours were included. The diaphragmatic thickness (Td), the excursion (Ed) and the thickening fraction (TFd) were assessed by ultrasound.ResultsSeventeen cases were included, with a median age of 42 months. Ten were male, seven had comorbidities and three had malnutrition at admission. The median time under MV was seven days. The median of initial Td was 2.3 mm and a median decrease of 13% under pressure-regulated volume control (PRVC) was observed. The median minimum Td was 1.9 mm, occurring on average at the fourth day of ventilation. Diaphragmatic atrophy was observed in 14/17 cases. Differences in the median thickness variation were found between patients with sepsis and without (0.70 vs. 0.25 mm, p=0.019). During pressure support (PS) a tendency to Td increase was noticed. Extubation failure occurred for TFdu226435%.ConclusionDuring PRVC Td decreased. In contrast, under PS, a tendency to increment was observed. Extubation failure occurred for TFdu226435%. The early recognition of diaphragmatic changes may encourage a targeted approach, namely titration of ventilation, in order to reduce VIDD and extubation failure.