Andrea Bruni1, Eugenio Garofalo1, Laura Pasin2, Giuseppe Filiberto Serraino3, Gianmaria Cammarota4, Federico Longhini1, Giovanni Landoni5, Rosalba Lembo5, Pasquale Mastroroberto3, Paolo Navalesi6. 1. Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy. 2. Department of Anesthesia and Intensive Care, Azienda Ospedialiera di Padova, Padova, Italy. 3. Cardiac Surgery Unit, Department of Clinical and Experimental Medicine, Magna Graecia University, Catanzaro, Italy. 4. Department of Anesthesia and Intensive Care, Maggiore della Carità University Hospital, Novara, Italy. 5. Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy. 6. Anesthesia and Intensive Care, Padua Hospital, Department of Medicine - DIMED, University of Padua, Padua, Italy. Electronic address: paolo.navalesi@unipd.it.
Abstract
OBJECTIVES: To determine the incidence of postoperative diaphragm dysfunction as diagnosed by ultrasonography. DESIGN: Explorative prospective observational study. SETTING: University intensive care unit. PARTICIPANTS: One hundred consecutive patients undergoing elective cardiac surgery. INTERVENTIONS: Diaphragm ultrasound was performed the day before surgery during unassisted breath (D-1), at the first spontaneous breathing trial attempt (DSBT), 24 hours after surgery (D+1), and at intensive care unit (ICU) discharge (DICU). Diaphragm displacement, inspiratory and expiratory thickness, and the thickening fraction were measured at all timepoints. MEASUREMENTS AND MAIN RESULTS: Primary outcome was assessing the rate of postoperative diaphragm dysfunction, defined as a thickening fraction <20% at DSBT. Secondary outcomes were the number of difficult-to-wean patients, the need for rescue noninvasive ventilation, the reintubation rate, and the ICU length of stay. Thirty-eight patients showed diaphragm dysfunction at DSBT, which resolved over time. No differences in preoperative characteristics and comorbidities were found between patients who developed postoperative diaphragm dysfunction and patients without postoperative disorders. The duration of cardiopulmonary bypass (103 ± 34 v 55 ± 34 min; P < 0.001) was significantly associated with the development of postoperative diaphragm dysfunction. When compared with patients without postoperative diaphragm disorders, patients with diaphragm dysfunction were characterized by a higher rate of difficult weaning (32% v 5%; P < 0.001), lower extubation rate at 24 hours after surgery (50% v 92%; P < 0.001), and longer ICU length of stay (19 [16; 88] v 16 [15; 18] hours; P < 0.001). CONCLUSIONS: The incidence of postoperative diaphragm dysfunction after elective cardiac surgery is high and might contribute to prolonging ICU length of stay.
OBJECTIVES: To determine the incidence of postoperative diaphragm dysfunction as diagnosed by ultrasonography. DESIGN: Explorative prospective observational study. SETTING: University intensive care unit. PARTICIPANTS: One hundred consecutive patients undergoing elective cardiac surgery. INTERVENTIONS: Diaphragm ultrasound was performed the day before surgery during unassisted breath (D-1), at the first spontaneous breathing trial attempt (DSBT), 24 hours after surgery (D+1), and at intensive care unit (ICU) discharge (DICU). Diaphragm displacement, inspiratory and expiratory thickness, and the thickening fraction were measured at all timepoints. MEASUREMENTS AND MAIN RESULTS: Primary outcome was assessing the rate of postoperative diaphragm dysfunction, defined as a thickening fraction <20% at DSBT. Secondary outcomes were the number of difficult-to-wean patients, the need for rescue noninvasive ventilation, the reintubation rate, and the ICU length of stay. Thirty-eight patients showed diaphragm dysfunction at DSBT, which resolved over time. No differences in preoperative characteristics and comorbidities were found between patients who developed postoperative diaphragm dysfunction and patients without postoperative disorders. The duration of cardiopulmonary bypass (103 ± 34 v 55 ± 34 min; P < 0.001) was significantly associated with the development of postoperative diaphragm dysfunction. When compared with patients without postoperative diaphragm disorders, patients with diaphragm dysfunction were characterized by a higher rate of difficult weaning (32% v 5%; P < 0.001), lower extubation rate at 24 hours after surgery (50% v 92%; P < 0.001), and longer ICU length of stay (19 [16; 88] v 16 [15; 18] hours; P < 0.001). CONCLUSIONS: The incidence of postoperative diaphragm dysfunction after elective cardiac surgery is high and might contribute to prolonging ICU length of stay.
Authors: Abdallah Fayssoil; Nicolas Mansencal; Lee S Nguyen; David Orlikowski; Hélène Prigent; Jean Bergounioux; Djillali Annane; Frédéric Lofaso Journal: Medicines (Basel) Date: 2022-01-11