Sedation Exposure and Diaphragm Atrophy
Study Investigators
Dr. Jose Dianti (jose.dianti@uhn.ca)
Dr. Ewan Goligher (ext. 6810, ewan.goligher@uhn.ca)
Study Contact
Dr. Jose Dianti (jose.dianti@uhn.ca)
Study Summary
Post-hoc analysis of a prospective observational cohort evaluating diaphragm thickness and diaphragm thickening fraction. This study aims to characterize the differential effects of sedatives on diaphragm function over time.
Study Population
176 critically ill patients receiving mechanical ventilation for any cause.
Study Objectives
Our goal was to determine the association between the administration of different commonly used sedative drugs and the occurrence of diaphragm dysfunction evaluated by diaphragm ultrasound.
Evaluate the presence of “sedation clusters” (i.e. patterns of care) and its effect on diaphragm thickness.
Study Interventions
Post-hoc analysis of a prospective cohort of critically ill patients receiving invasive mechanical ventilation. The primary analysis examined the effect of the cumulative dose of each sedative (propofol, midazolam, fentanyl, morphine and dexmedetomidine) in the first 24 and 48 hours on the logarithm of daily Tdi using a linear mixed-effects model.
Why it Matters
Diaphragm dysfunction affects more than half of the patients receiving invasive mechanical ventilation and its presence is related to negative outcomes. Sedative drugs have a negative impact on diaphragm function both through direct adverse effects and by inducing disuse atrophy by decreasing respiratory effort and altering the normal breathing pattern. Although sedative drugs commonly used in the ICU exert their mechanisms of action through different pathways that lead to different effects, the distinct effect of these drugs (both type and dose) on diaphragm function in patients receiving mechanical ventilation has not been studied. Determine if different sedative drugs have a differential effect on diaphragmatic function could inform physicians on what type of sedative to choose in patients receiving mechanical ventilation.