Diaphragm function in patients with sepsis and septic shock. A longitudinal ultrasound study

Abstract

Background: Sepsis is very common in the Intensive Care Unit (ICU) and is a major risk factor of muscle dysfunction. Limited previous literature studied determinants of diaphragm dysfunction in septic ICU patients. The goal of the study was to evidence the proper effect of sepsis on the diaphragm in ICU patients.

Methods: This prospective and observational study was conducted between June 2015 and July 2019. Ultrasound measures of diaphragm thickness were daily performed in septic patients. The primary outcome was the prevalence of diaphragm dysfunction at baseline and during ICU stay. Secondary outcomes were the diaphragm thickness and the diaphragm daily atrophy rate. Potential associated factors were prospectively recorded.

Results: Fifty patients were enrolled in the study. The prevalence of diaphragm dysfunction was 58% and was significantly higher in ventilated patients than in non-ventilated patients (71 vs. 37%, p=.04). No diaphragm atrophy during ICU stay was found. Diaphragm dysfunction was associated with the alteration of consciousness, intra-abdominal sepsis, hypnotics and opioids, and mechanical ventilation. Administration of hypnotics, opioids, and steroids was associated with a lower diaphragm thickening fraction. Diaphragm dysfunction had no impact on patients’ outcomes. Forty-five percent of patients with diaphragm dysfunction recovered from during ICU stay.

Conclusions: Our data show a high prevalence of diaphragm dysfunction in septic patients occurring at the onset of sepsis. Administration of hypnotics, opioids, and steroids was associated with alteration of diaphragm function as well as intra-abdominal sepsis.