DIAPHRAGM-PROTECTIVE MECHANICAL VENTILATION IN CHILDREN

Abstract

Background . Mechanical ventilation can lead to diaphragm injury. The aim of the study was to investigate thickness of diaphragm, it thicknening fraction and to compare the results of treatment in group of patients with lung-protective mechanical ventilation and in group where we used the combination of lung-protective and diaphragm-protective mechanical ventilation. Materials and methods. We conduct prospective, randomized, non-interventional, single-center controlled trial among patients 1 month to 18 years old. In the data analysis 31 patients of control group (lung-protective mechanical ventilation) and 27 patients of study group (lung-protective and diaphragm-protective mechanical ventilation) were included in data analysis. The primary outcome was the 28-day mortality rate. Secondary outcomes were duration of weaning from mechanical ventilation, frequency of complications (reintubation, tracheostomy), dynamics of thicknening fraction of diaphragm. Results . It was tendency to decreasing the fraction of thickening of right hemidiaphragm from 31.1% to 28.6% during the d1 - d3 stages of study in control group, while in study group this fraction increased from 25% to 32.65%. Fraction of thickening of left hemidiaphragm in control group at stage d1 was 22.5 [16.7; 35]; at stage d3 increased up to 24.55 [10.8; 53.33], and at stage d5 - up to 39.3 [24.73; 52,98]. In study group of patients it was 19 [11; 41,45] at stage d1 (p = 0,311 for control and study groups); increased up to 27.3 [14.3; 38.7] (p = 0.329) at stage d3; and exceeded the recommended by diaphragm-protective strategy of mechanical ventilation values at stage d5 and was 64 [36; 78,9] (p = 0.049), what we can be interpreted as a marker of diaphragm overload. The duration of weaning from mechanical ventilation in control group was 8 days [4 days; 19.5 days], in study group - 9 days [5.5 days; 19.75 days], (p = 0.77). Conclusion . The 28-day mortality rate was higher in control group in comparison with study group (9.7% and 3.7%, respectively, p = 0.29). The incidence of complications in control group of patients was lower in comparison with study group (7.1% and 26.9%, respectively, p = 0.06). There were no significant differences in the duration of mechanical ventilation in both groups. Trial registration : ISRCTN registry. Identifier: ISRCTN84734652.