• Tom Schepens, Walter Verbrugghe, Karolien Dams, Bob Corthouts, Paul M Parizel, and Philippe G Jorens.
• Department of Anesthesiology and Critical Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem, Belgium. tom.schepens@uza.be.
• Crit Care. 2015 Dec 7; 19: 422.

IntroductionMechanical ventilation and the effect of respiratory muscle unloading on the diaphragm cause ventilator-induced diaphragmatic dysfunction (VIDD). Atrophy of the diaphragmatic muscle is a major part of VIDD, and has a rapid onset in most animal models. We wanted to assess the clinical evolution and risk factors for VIDD in an adult intensive care unit (ICU) by measuring diaphragm thickness using ultrasound.MethodWe performed a single-centre observational cohort study, including 54 mechanically ventilated patients. The right hemidiaphragm was measured daily at the zone of apposition on the midaxillary line.ResultsMean baseline thickness was 1.9 mm (SD ± 0.4 mm), and mean nadir was 1.3 mm (SD ± 0.4 mm), corresponding with a mean change in thickness of 32 % (95 % CI 27-37 %). Length of mechanical ventilation (MV) was associated with the degree of atrophy, whereas other known risk factors for muscle atrophy in an ICU were not. The largest decrease in thickness occurred during the first 72 hours of MV.ConclusionsDiaphragm atrophy occurs quickly in mechanically ventilated patients and can accurately be monitored using ultrasound. Length of MV, as opposed to other variables, is associated with the degree of atrophy.Clinical Trial RegistrationClinicaltrials.gov NCT02299986 . Registered 10/11/2014.

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