The following is a summary of “Diaphragm function in patients with Covid-19-related acute respiratory distress syndrome on venovenous extracorporeal membrane oxygenation,” published in the September 2023 issue of Critical Care by Gautier et al.

Diaphragm dysfunction is a common complication of Venovenous extracorporeal membrane oxygenation (VV ECMO), but its prevalence, risk factors, and evolution are unknown. Researchers started a retrospective study to investigate the prevalence of diaphragm dysfunction and its association with diaphragm activity in patients with VV ECMO.

They included patients with acute respiratory distress syndrome (ARDS) requiring VV ECMO in two centers. Diaphragm function was assessed sequentially by recording tracheal pressure in response to phrenic nerve stimulation (Ptr,stim) from the start of ECMO (Day 1) until weaning off ECMO. Diaphragm activity was determined by calculating the percentage of spontaneous breathing ventilation and by measuring the diaphragm thickening fraction (TFdi) using ultrasound.

The results showed 63 patients with a median of 4 days (range: 3–6) of invasive mechanical ventilation. Diaphragm dysfunction, defined by Ptr, stim ≤ 11 cmH₂O, was observed in 39 patients (62%) on Day 1 of ECMO. Diaphragm function remained unchanged throughout the one-week study period and was not affected by the percentage of spontaneous breathing ventilation or the TFdi. Out of the 63 patients enrolled, 24 (38%) were alive at the end of the 60-day study period.

They concluded that diaphragm dysfunction is common in COVID-19 ARDS patients on VV ECMO, but it is stable over time and not associated with spontaneous breathing.

Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-023-01179-w