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Open Access Highly Accessed Research

Diaphragm weakness in mechanically ventilated critically ill patients

Gerald S Supinski* and Leigh Ann Callahan

Author Affiliations

Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky, 740 South Limestone Room L-543, Lexington, KY 40536-0284, USA

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Critical Care 2013, 17:R120  doi:10.1186/cc12792

Published: 20 June 2013

Abstract

Introduction

Studies indicate that mechanically ventilated patients develop significant diaphragm muscle weakness, but the etiology of weakness and its clinical impact remain incompletely understood. We assessed diaphragm strength in mechanically ventilated medical ICU patients, correlated the development of diaphragm weakness with multiple clinical parameters, and examined the relationship between the level of diaphragm weakness and patient outcomes.

Methods

Transdiaphragmatic twitch pressure (PdiTw) in response to bilateral magnetic stimulation of the phrenic nerves was measured. Diaphragm weakness was correlated with the presence of infection, blood urea nitrogen, albumin, and glucose levels. The relationship of diaphragm strength to patient outcomes, including mortality and the duration of mechanical ventilation for successfully weaned patients, was also assessed.

Results

We found that infection is a major risk factor for diaphragm weakness in mechanically ventilated medical ICU patients. Outcomes for patients with severe diaphragm weakness (PdiTw <10 cmH2O) were poor, with a markedly increased mortality (49%) compared to patients with PdiTw ≥10 cmH2O (7% mortality, P = 0.022). In addition, survivors with PdiTw <10 cmH2O required a significantly longer duration of mechanical ventilation (12.3 ± 1.7 days) than those with PdiTw ≥10 cmH2O (5.5 ± 2.0 days, P = 0.016).

Conclusions

Infection is a major cause of severe diaphragm weakness in mechanically ventilated patients. Moreover, diaphragm weakness is an important determinant of poor outcomes in this patient population.