Critical Care and Shock

Diaphragm dysfunction and weaning failure in the ventilated critically ill patient: A systematic review and meta-analysis

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Introduction: Diaphragm dysfunction following mechanical ventilation is associated with weaning failure from the ventilator in critically ill patients, resulting in a bad prognosis and increased mortality. We conducted a systematic review and meta-analysis to measure the risk of diaphragm dysfunction on weaning failure.

Methods: We searched Pubmed, Embase, Cochrane, and Scopus databases without restriction to publication date. The clinical question was “is diaphragm dysfunction associated with weaning failure and increased weaning time in patients with >24 hours positive pressure mechanical ventilation?” The primary outcome was weaning failure, and the secondary outcome was weaning time. Risk Of Bias In Non-randomised Studies – of Interventions (ROBINS-I) was used to assess study quality and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach was used to assess the certainty of evidence.

Results: The search string yielded 164 studies. Twenty-one studies were collected for full text and appraised thoroughly following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Four studies with similar clinical questions were included in the systematic review. ROBINS-I showed that the studies have a low to medium risk of bias. GRADE showed a moderate to a high level of certainty evidence. Pooled odds ratio (OR) showed diaphragm dysfunction was closely associated with weaning failure (156 patients), OR 3.27 (CI95% 1.34-8.02) but loosely associated with weaning time (188 patients), mean weaning time difference of 3.12 (CI95% -0.09-6.33) hours.

Conclusion: Diaphragm dysfunction as a complication of mechanical ventilation should be addressed carefully in critically ill patients since it is associated with weaning failure.