Asociación de la disminución de la fracción de engrosamiento diafragmático con resultados adversos en pacientes bajo ventilación mecánica invasiva

Abstract

Background

Diaphragmatic dysfunction is a severity marker for patients under mechanical ventilation and is associated with higher mortality rates. The diaphragmatic thickening fraction, an ultrasound measurement, has been employed as a mechanical ventilation weaning predictor; its impact on adverse outcomes, such as tracheostomy and mortality rates, are still undetermined.

Objective

To evaluate the association of diaphragmatic thickening fraction decrease with adverse outcomes in patients under invasive mechanical ventilation.

Material and methods

Prospective cohort study. The diaphragmatic thickening fraction was measured by ultrasound on the third day of enrollment, with a follow-up observation on day 14. A ROC curve was computed in search of an optimal cut-off point for sensitivity and specificity. Relative risk was calculated for adverse outcomes with 95% confidence interval.

Results

One hundred and eleven patients were analyzed. Sixty-seven patients (74.37%) had a normal diaphragmatic thickening fraction, and forty-four patients (25.63%) had a low diaphragmatic thickening fraction. In the low diaphragmatic thickening fraction group, 37 deaths were documented at day 14 (82.2%), and four cases sustained tracheostomy (14.8%); the incidence of adverse effects was 56.2% (relative risk, 1.79; 95% CI, 1.3–2.45; p > 0.001).

Conclusion

The diaphragmatic thickening fraction is a novel parameter for clinical monitorization and surveillance for patients under mechanical ventilation, as well as a promising tracheostomy and mortality predictor.