Background Corticosteroids are widely used in critical care settings for different indications. Their use is associated with steroid-induced myopathy that can affect the diaphragm. Among those affected are mechanically ventilated patients who are also subjected to ventilator-induced diaphragmatic dysfunction. The underlying pathogenesis entails different inflammatory processes. Aim The present study aimed to evaluate the impact of acute administration of intravenous corticosteroids on diaphragmatic thickness and functions using ultrasonography. Research design and methods A single-center prospective observational study. Children who required mechanical ventilation for more than 24 h and who received systemic corticosteroids were included. Diaphragmatic measurements taken on the final day included: diaphragmatic excursion (DE), diaphragmatic contraction velocity, diaphragmatic thickness reduction from baseline, diaphragmatic thickening fraction, and diaphragmatic thickness at maximum inspiration. The cumulative corticosteroid dose was calculated until the final day of mechanical ventilation and converted to hydrocortisone equivalents. Results Fifty-one mechanically ventilated children were included in the study. There was a significant correlation between cumulative corticosteroid dose and final-day diaphragmatic thickness reduction from baseline (rs = 0.379, P = 0.006 for the right side; rs = 0.429, P = 0.002 for the left side). There was a significant correlation with DE (rs = 0.510, P = 0.002 for the right side; rs = 0.531, P = 0.001 for the left side). Conclusion Acutely administered intravenous corticosteroids in pediatric mechanically ventilated patients were associated with significant reductions in diaphragmatic thickness from baseline and a significant proportionate increase in DEs.
Fahim et al. (Thu,) studied this question.