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VOLUME 13 , ISSUE 2 ( April-June, 2024 ) > List of Articles

Original Article

Reduced Diaphragmatic Thickness Index in Mechanically Ventilated Patients: Incidence, Risk Factors, and Impact on Weaning Outcome

Debasish Panda, Suresh Kumar Sundaramurthy, Lakshmi Ranganathan, Ramesh Venkataraman, Nagarajan Ramakrishnan, Raymond Dominic Savio

Keywords : Diaphragmatic dysfunction, Diaphragmatic thickness index, Diaphragmatic weakness, Mechanical ventilation, Spontaneous breathing trial, Weaning

Citation Information : Panda D, Sundaramurthy SK, Ranganathan L, Venkataraman R, Ramakrishnan N, Savio RD. Reduced Diaphragmatic Thickness Index in Mechanically Ventilated Patients: Incidence, Risk Factors, and Impact on Weaning Outcome. Indian J Respir Care 2024; 13 (2):95-100.

DOI: 10.5005/jp-journals-11010-1111

License: CC BY-NC 4.0

Published Online: 18-06-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Background: Diaphragmatic weakness (DW) is common in an intensive care unit (ICU) and diaphragmatic thickness index (DTI) using ultrasound is used as a surrogate marker for DW despite many limitations. This study aims to identify the incidence and risk factors of reduced DTI (≤30%) among patients ventilated for >48 hours and its impact on outcome of first spontaneous breathing trial (SBT). Materials and methods: Single-center, prospective, observational study, conducted in a tertiary care ICU, over 4 months. Consecutive, eligible patients initiated on mechanical ventilation (MV) upon hospitalization and continued for >48 hours were included. Serial measurements of DTI were done once every 3 days until first SBT. Data pertaining to risk factors for DW and outcome of first SBT were documented. Results: Ninety-two patients were included in the final analysis of the study. DTI ≤30% was identified in 43.5% of patients. Sepsis on admission (p = 0.02) and use of neuromuscular blocking (NMB) agent infusion (p = 0.028) were significantly associated with reduced DTI. Failure of first SBT was observed in 82.5% of the patients with DTI ≤30%, whereas only 25% of those with DTI ≥31% were unsuccessful [relative risk (RR)—3.3; confidence interval (CI)—2.47–1.34]. Mean DTI was significantly higher among those who succeeded their first SBT (32.9 ± 8.9) vs those who failed (19.32 ± 11.89). Conclusion: Reduced DTI (≤30%) is common among patients mechanically ventilated for greater than 48 hours. Sepsis on admission and use of NMB agent infusion were identified as significant risk factors. DTI ≤30% was significantly associated with a failed first SBT.

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