Evidence map›Paper›PMID 28930478›Full record

ArticleAmerican journal of respiratory and critical care medicine2018

Mechanical Ventilation-induced Diaphragm Atrophy Strongly Impacts Clinical Outcomes.

Ewan C Goligher, Martin Dres, Eddy Fan, Gordon D Rubenfeld, Damon C Scales, Margaret S Herridge, Stefannie Vorona, Michael C Sklar, Nuttapol Rittayamai, Ashley Lanys and 9 more

12 registry-linked trialsAbstract readComparative Study
PubMed Publisher
In one paragraph

Article in American journal of respiratory and critical care medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 12 registered trials, which are not on this map. Cited by 352 papers, 10 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
352citing papers in PubMed, 10 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03768232 unknown statusnot on this mapstarted 2019, after this paper: background citation

Ventilator Induced Diaphragm Dysfunction in Pediatric Critically Ill Patients

TypeobservationalSponsorBambino Gesù Hospital and Research InstituteRan2019 to 2020Enrolled80ConditionsRespiratory Failure, Respiratory Distress Syndrome, Mechanical Ventilation ComplicationArmsultrasound asessment
NCT04026217 suspendednot on this mapstarted 2019, after this paper: background citation

Evaluation of Diaphragmatic Function in Hematological Patients With Acute Hypoxemic Respiratory Failure

TypeobservationalSponsorAzienda Sanitaria-Universitaria Integrata di UdineRan2019 to 2024Enrolled30ConditionsRespiratory Failure, Diaphragm Injury, Ultrasound, Mechanical Ventilation Complication
NCT04534296 narecruitingnot on this mapstarted 2021, after this paper: background citation

A Randomized Control Trial Comparing the Effects of Early Mobilization and Routine Care on Diaphragmatic Thickness

TypeinterventionalSponsorChildren's Hospital of Fudan UniversityRan2021 to 2025Enrolled160ConditionsMechanical Ventilation Complication, Ventilator-induced Diaphragm DysfunctionArmsearly mobilization, routine care
NCT04550143 completednot on this mapstarted 2020, after this paper: background citation

Diaphragm Dysfunction and Peripheral Muscle Wasting in Septic Shock Patients: Exploring Their Relationship Over Time Using Ultrasound Technology

TypeobservationalSponsorUniversity Hospital, GenevaRan2020 to 2024Enrolled30ConditionsSeptic ShockArmsDiaphragm ultrasound (DUS), Peripheral Muscle Ultrasound (PMUS), Airway occlusion pressure (P0.1), Medical Research Council (MRC) sum score
NCT05063214 unknown statusnot on this mapstarted 2021, after this paper: background citation

Muscle Evaluation of Patients Infected by the Coronavirus Requiring Mechanical Ventilation

Typeobservational_patient_registrySponsorHospital Israelita Albert EinsteinRan2021 to 2022Enrolled138ConditionsSARS-CoV-2 Acute Respiratory DiseaseArmsMuscle ultrasound evaluation
NCT05191433 unknown statusnot on this mapstarted 2020, after this paper: background citation

Effects of Mechanical Ventilation on the Diaphragm in COVID-19 Intensive Care Patients. A Post-mortem Pathology Study.

TypeobservationalSponsorAzienda Sanitaria-Universitaria Integrata di UdineRan2020 to 2022Enrolled41ConditionsDiaphragm Injury, Pathology, COVID-19 Acute Respiratory Distress Syndrome, Ventilation Therapy
NCT05241002 terminatednot on this mapstarted 2020, after this paper: background citation

The Application and Analysis of Diaphragm Electrical Impulse in Adult Patients With Spontaneous Breathing Trial: Before and After Tracheostomy

TypeobservationalSponsorFu Jen Catholic UniversityRan2020 to 2022Enrolled4ConditionsTracheostomy
NCT05710432 narecruitingnot on this mapstarted 2023, after this paper: background citation

Muscle Recruitment During Neck Flexion and Inspiratory Muscle Training in Difficult and Prolonged Weaning Patients: a Physiological Study - The FLEX Study

TypeinterventionalSponsorUnity Health TorontoRan2023 to 2025Enrolled10ConditionsMechanical Ventilator Weaning, Respiratory Muscle TrainingArmsQuasi-Isometric Neck Flexion, Inspiratory Muscle Training
NCT05802745 completednot on this mapstarted 2023, after this paper: background citation

Airway Occlusion Pressure (P0.1) to Predict Extubation Failure in Critically Ill Patients: A Prospective Cohort Study

TypeobservationalSponsorCleveland Clinic Abu DhabiRan2023 to 2025Enrolled120ConditionsWeaning Failure, Mechanical Ventilation, Critically IllArmsReintubation
NCT06242236 nacompletednot on this mapstarted 2023, after this paper: background citation

Comparison of Guiding Sedation Level by Respiratory Effort Versus Usual Care in Mechanically Ventilated Patients: A Randomized Controlled Trial (EFFORT-GUIDE Trial 2)

TypeinterventionalSponsorRamathibodi HospitalRan2023 to 2025Enrolled156ConditionsARDS, Respiratory Effort, Mechanical Ventilation Complication, SedationArmsThe respiratory effort parameters guide sedative dosage.
NCT06433076 completednot on this mapstarted 2022, after this paper: background citation

The Association Between Respiratory Effort Parameters During the First 48 Hours With Clinical Outcomes in Mechanically Ventilated Patients: A Prospective Observational Study.

TypeobservationalSponsorRamathibodi HospitalRan2022 to 2024Enrolled163ConditionsRespiratory Effort, Respiratory Distress Syndrome, Lung Mechanics
NCT06490523 completednot on this mapstarted 2020, after this paper: background citation

Analysis of Advanced Physiological Ventilatory Parameters During Spontaneous Breathing Effort in Patients with Acute Hypoxemic Respiratory Failure

TypeobservationalSponsorHospital del Mar Research Institute (IMIM)Ran2020 to 2022Enrolled31ConditionsAcute Hypoxic Respiratory Failure
3 · Its place in the literature

Who cites it

352 citing papers in PubMed, 10 syntheses or guidelines pooled it.

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292 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

19 authors.

Ewan C Goligher1 Interdepartmental Division of Critical Care Medicine.
Martin Dres5 Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
Eddy Fan1 Interdepartmental Division of Critical Care Medicine.
Gordon D Rubenfeld1 Interdepartmental Division of Critical Care Medicine.
Damon C Scales1 Interdepartmental Division of Critical Care Medicine.
Margaret S Herridge1 Interdepartmental Division of Critical Care Medicine.
Stefannie Vorona2 Division of Respirology, Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, Canada.
Michael C Sklar10 Department of Anesthesia, and.
Nuttapol Rittayamai5 Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
Ashley Lanys5 Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
Alistair Murray2 Division of Respirology, Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, Canada.
Deborah Brace2 Division of Respirology, Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, Canada.
Cristian Urrea2 Division of Respirology, Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, Canada.
W Darlene Reid11 Department of Physical Therapy, University of Toronto, Toronto, Canada.
George Tomlinson2 Division of Respirology, Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, Canada.
Arthur S Slutsky1 Interdepartmental Division of Critical Care Medicine.
Brian P Kavanagh1 Interdepartmental Division of Critical Care Medicine.
Laurent J Brochard1 Interdepartmental Division of Critical Care Medicine.
Niall D Ferguson1 Interdepartmental Division of Critical Care Medicine.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

rationaleDiaphragm dysfunction worsens outcomes in mechanically ventilated patients, but the clinical impact of potentially preventable changes in diaphragm structure and function caused by mechanical ventilation is unknown.

objectivesTo determine whether diaphragm atrophy developing during mechanical ventilation leads to prolonged ventilation.

methodsDiaphragm thickness was measured daily by ultrasound in adults requiring invasive mechanical ventilation; inspiratory effort was assessed by thickening fraction. The primary outcome was time to liberation from ventilation. Secondary outcomes included complications (reintubation, tracheostomy, prolonged ventilation, or death). Associations were adjusted for age, severity of illness, sepsis, sedation, neuromuscular blockade, and comorbidity. MEASUREMENTS AND MAIN

resultsOf 211 patients enrolled, 191 had two or more diaphragm thickness measurements. Thickness decreased more than 10% in 78 patients (41%) by median Day 4 (interquartile range, 3-5). Development of decreased thickness was associated with a lower daily probability of liberation from ventilation (adjusted hazard ratio, 0.69; 95% confidence interval [CI], 0.54-0.87; per 10% decrease), prolonged ICU admission (adjusted duration ratio, 1.71; 95% CI, 1.29-2.27), and a higher risk of complications (adjusted odds ratio, 3.00; 95% CI, 1.34-6.72). Development of increased thickness (n = 47; 24%) also predicted prolonged ventilation (adjusted duration ratio, 1.38; 95% CI, 1.00-1.90). Decreasing thickness was related to abnormally low inspiratory effort; increasing thickness was related to excessive effort. Patients with thickening fraction between 15% and 30% (similar to breathing at rest) during the first 3 days had the shortest duration of ventilation.

conclusionsDiaphragm atrophy developing during mechanical ventilation strongly impacts clinical outcomes. Targeting an inspiratory effort level similar to that of healthy subjects at rest might accelerate liberation from ventilation.

Indexed as

Hospital MortalityAdultAgedAtrophyCritical IllnessDiaphragmFemaleFollow-Up StudiesHumansIntensive Care UnitsLength of StayMaleMiddle AgedRespiration, ArtificialRespiratory InsufficiencyRisk Assessmentacute respiratory failureartificial respirationdiaphragmweaning

Identifiers

PMID28930478

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.