Effeciency of trigger sensitivity adjustment on patient with ventilator induced diaphragmatic dysfunction / Ahmed Refaat Abdelaziz Taha Malik ; Supervised Nagwa Mohamed Badr , Heba Ali Abdelghaffar , Soliman Belal Soliman

Thesis (M.Sc.) - Cairo University - Faculty of Physical Therapy - Department Physical Therapy for Cardiopulmonary and Geriatric Disorder

Background: Ventilator-induced diaphragmatic dysfunction (VIDD) is a loss of diaphragmatic force-generating capacity that is specifically related to the use of mechanical ventilation. This occurs in a time-dependent manner, with the force decline becoming evident quite early and worsening as mechanical ventilation is prolonged. Within a few days of instituting controlled mandatory ventilation (CMV), the pressure-generating capacity of the diaphragm has declined by 40{u2013}50%. Endurance of the diaphragm is also adversely affected, as indicated by a reduced ability to sustain diaphragmatic force in the face of an inspiratory resistive load. Objective: to investigate if trigger sensitivity adjustment may improve the diaphragmatic function and weaning outcome from mechanical ventilation. Patients and Methods: 60 patients with ventilator induced diaphragmatic dysfunction are divided into two equal groups; A (Study group) and B (controlled group); the controlled group followed their plan of weaning from mechanical ventilation, and the study group practiced trigger sensitivity adjustment beside their plan of weaning. Treatment session was gradually increased from 5 minutes to 30 minutes, 2 sessions per day, implemented daily for one week. Diaphragmatic US was used to assess the diaphragmatic thickening fraction and diaphragmatic excursion. Negative inspiratory force and rapid shallow breathing index was determined by mechanical ventilation. Also, the successful weaning was monitored among the patients. All patients were assessed pre and post the study. Results: There was a significant thickening fraction increase with percentage about 42.00% and 17.90% for group A and group B respectively (with P value=0.0001; P<0.05). Regarding the diaphragmatic excursion, there was a significant improve with percentage about 51.57% for the study group and 12.78% for the controlled group (with P value=0.0001; P<0.05). Also, the negative inspiratory force was significantly improved with percentage about 67.42% and 32.38% for group A and group B respectively (with P value=0.0001; P<0.05)

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