Clearing the Air for Recovery

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New approach found that helps predict which patients will recover after being on a ventilator.
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Of the more than 230,000 patients annually admitted to intensive care units in Canada, around a third receive invasive ventilation.

Hospital intensive care units attend to patients with life-threatening or critical conditions. After a stay in the intensive care unit, patients who are released from the hospital are often severely weakened and may experience long-term disabilities.

“Identifying patients who will have serious difficulties recovering from illness is a challenge,” says Dr. Ewan Goligher, a Scientist with the Toronto General Hospital Research Institute.

Prompted by this challenge, Dr. Goligher and his team initiated a study that focused on patients being aided by a breathing machine—a procedure also known as invasive ventilation. In this procedure, a breathing tube is inserted into the throat so that air can be mechanically pumped into and out of the lungs to help the patient breathe.

In their study, the researchers examined patients who had received invasive ventilation at hospitals in Toronto and tracked their recovery. The researchers measured the thickness of patients’ diaphragms—the primary muscle used for breathing—using ultrasound imaging.

The study results revealed that the patients with more muscle mass in their diaphragms when first admitted had a lower risk of death in hospital. As well, they were less likely to develop complications and recovered from respiratory assistance significantly faster.

While the results may help identify the patients who are at risk for poor recovery, they could also enable the development of new, proactive approaches to reducing these risks. In cases where doctors can foresee a patient needing ventilation, such as following organ transplant or for serious illnesses like cancer, exercises aimed at strengthening the diaphragm could be prescribed.

This work was supported by the Canadian Institutes of Health Research and Toronto General & Western Hospital Foundation.

Sklar MC, Dres M, Fan E, Rubenfeld GD, Scales DC, Herridge MS, Rittayamai N, Harhay MO, Reid WD, Tomlinson G, Rozenberg D, McClelland W, Riegler S, Slutsky AS, Brochard L, Ferguson ND, Goligher EC. Association of Low Baseline Diaphragm Muscle Mass with Prolonged Mechanical Ventilation and Mortality Among Critically Ill Adults. JAMA Network Open. 2020 Feb 19. doi:10.1001/jamanetworkopen.2019.21520.

Dr. Ewan Goligher, Scientist with Toronto General Hospital Research Institute.