Prevalence of Diaphragmatic Dysfunction in the Long-Term Acute Care Setting and Its Effects on Ventilator Weaning Outcomes

Objective To determine the prevalence of undiagnosed diaphragmatic dysfunction (DD) in a long term acute care hospital (LTACH) setting in patients on prolonged mechanical ventilation (PMV) and its association with weaning outcomes. Design A single-center, retrospective cohort study including 451 patients on PMV admitted to an LTACH facility between 2012 and 2017. DD was assessed using fluoroscopy. Results 319 patients on PMV were assessed for DD. Nine patients were diagnosed with DD prior to admission. Eighty (72.7%) without DD were successfully weaned and 30 (27.3%) failed to wean, while 51 (31.9%) participants with DD were successfully weaned and 109 (68.1%) failed to wean (p < 0.001). When analyzing days to wean, the median was 13 days for those with no DD, 19 days with unilateral DD and 28 days with bilateral DD (p < 0.001). Weaning success was not statistically associated with generalized neuromuscular disorders, age, gender, body mass index (BMI), smoking history or diabetes. Conclusion DD was found to be strongly associated with time to wean and weaning success in the LTACH setting. Very few patients despite being on PMV were diagnosed with DD prior to LTACH admission. Given this information, early diagnosis of DD amongst PMV patients in the LTACH setting is paramount in preventing secondary complications associated with MV.