Methodological approaches for the determination of diaphragm atrophy and dysfunction during invasive ventilation

Background/ Objective: Ventilator-induced diaphragmatic dysfunction (VIDD) is associated with increased mortality, weaning failure and prolonged hospitalization. The aim of our study is, for the first time, to determine the decrease in diaphragmatic function and strength in invasively ventilated patients in a technically feasible way over time. Methods: Monocentric, prospective, longitudinal observational study in the intensive care unit of RWTH Aachen University Hospital (ClinicalTrials.gov Identifier: NCT05211661). A total of 12 ventilated patients will be included within 48 hours after intubation. While intubated, 8 following 2 additional measurements after extubation will be performed. In a multimodal approach neuromuscular and respiratory components will be determined. For this purpose, we will use the gold standard transdiaphragmatic pressure measurement after cervical magnetic stimulation (TwPDI), in combination with EMG recordings and ultrasound examinations. Results: Initial measurements of this technically sophisticated approach to determine diaphragm strength and have already been established in our ICU. Our study was able to examine factors that may contribute to the development of ventilator-induced diaphragmatic weakness over time in machine-ventilated patients. Preliminary data of the first patients will be presented. Conclusion: Initial human longitudinal measurements of diaphragm strength, thickness, and cortical controlare technically feasible and practical in intensive care ventilated patients.