PREVENTION OF RESPIRATORY MUSCLE DYSFUNCTION DUE TO DIAPHRAGM ATROPHY IN CHILDREN WITH RESPIRATORY FAILURE

The aim of the study was to determine whether diaphragm-protective mechanical ventilation can prevent diaphragm atrophy in children with respiratory failure.

Materials and methods. We complete the prospective single-center cohort study. Data analysis included 82 patients 1 month – 18 years old, divided into I group (lung-protective MV) and II group (diaphragm-protective in addition to lung-protective MV).

Patients were divided into age subgroups. Stages of the study: 1^st day (d₁), 3^rd (d₃), 5^th (d₅), 7^th (d₇), 9^th (d₉), 28^th (d₂₈). We studied changes in diaphragm thickness at the end of exhalation and compared them with these indicators at patient`s admission to the study (baseline). Primary endpoint was length of stay in ICU, secondary endpoints were complications (prolonged MV). Results are described as arithmetic mean (X) and standard deviation (σ) with level of significance p.

Results. There were significant differences in length of stay in ICU among patients of the 1^st and 5^th age subgroups: in 1^st age subgroup this data was in 1.3 times lower in II group, compared with I group (p <0,05); in 5^th age subgroup the situation was the opposite – length of stay in ICU was in 1.4 times higher in II group, compared with I group (p<0.05). There were no patients who required lifelong mechanical ventilation in any of the groups.

Changes in the thickness of the diaphragm, which indicate its atrophy, were the most significant among patients of the first, second, third and fourth age subgroups and the severity of atrophy was higher among patients of group I, compared with patients of group II.

Conclusions. Diaphragm-protective mechanical ventilation significantly prevents diaphragm atrophy in children with respiratory failure in 2^nd, 4^th, and 5^th age subgroups. Providing goal-directed diaphragm-protective MV might reduce the length of stay in ICU among patients of 1^st and 5^th age subgroups. There were no observed complications like lifelong mechanical ventilation in both patient`s group.