Diaphragmatic Dysfunction Linked to Poorer Mechanical Ventilation Weaning Outcomes

Diaphragmatic dysfunction was associated with longer weaning times and reduced weaning success in patients on prolonged mechanical ventilation in long-term acute care hospitals (LTACHs).

To better understand the prevalence of undiagnosed diaphragmatic dysfunction and its impact on weaning, researchers conducted a retrospective cohort study with 451 patients on prolonged mechanical ventilation who were admitted to an LTACH.

Authors assessed 319 patients for diaphragmatic dysfunction using fluoroscopy, and 9 were diagnosed with the condition before admission.

In the group diagnosed with diaphragmatic dysfunction, 51 (31.9%) patients were successfully weaned off mechanical ventilation, and 109 (68.1%) patients failed to wean. By comparison, 80 (72.7%) patients were successfully weaned and 30 (27.3%) patients failed to wean in the group without diaphragmatic dysfunction (P<.001).

Patients with unilateral and bilateral diaphragmatic dysfunction took a median of 19 days and 28 days to wean, respectively. Patients without diaphragmatic dysfunction took a median of 13 days (P<.001) to wean.

Researchers concluded that diaphragmatic dysfunction was “strongly associated” with weaning outcomes, noting that very few patients were diagnosed with the condition before being admitted to an LTACH.

“Given this information, early diagnosis of [diaphragmatic dysfunction] amongst [prolonged mechanical ventilation] patients in the LTACH setting is paramount in preventing secondary complications associated with [mechanical ventilation].”

Reference:
Barchuk A, Barchuk SA, Roebken CK, Ahn J. Prevalence of diaphragmatic dysfunction in the long-term acute care setting and its effects on ventilator weaning outcomes: a retrospective cohort study. Am J Phys Med Rehabil. 2021. doi:10.1097/PHM.0000000000001863