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Master Thesis

Atrophie diaphragmatique séquellaire du sepsis : étude tomodensitométrique rétrospective

Abstract : In addition of the aftereffects associated with a critical illness and the aggressive intensive care management, diaphragm is affected by sepsis as well as other muscles such as psoas. Its mechanism and duration remain unclear but atrophic sequelae is a major factor of difficulties to ventilator withdrawal in ICU and long term physical rehabilitation. We tried to observe the importance of the diaphragm and psoas atrophy after ICU discharge comparing to anterior data. Methods: we retrospectively included 41 patients admitted in our ICU for a sepsis or a septic shock, and for whom CT-scans have been performed in the course of an oncological follow-up. We used a segmentation software to compare volumetric measurements of the diaphragmatic and the psoas before, and after the ICU stay. The primary endpoint was to the observable atrophy in this period. Results: between 2 CTs, 102±62 days apart, we found a significant loss of volume of 12,1% (that is 26±25 cm³, p<0.01) for the psoas and 10,70% (that is 21±2 5 cm³, p<0.01) for the diaphragm, with no correlation between each other, but a significantly link between initial volume of the diaphragm ant its loss of volume after ICU (p<0.01). Atrophy of psoas was associated with an history of arteriopathy (p<0.01) and age >59 years (p=0.01), whereas the atrophy of diaphragm was associated with height >166 cm (p=0.023) and absence of metastasis (p=0.031). Conclusion: the diaphragm and psoas are concurrently but independently affected by a loss of muscular mass, in case of severe infection admitted in ICU. We were able to be bring to light differential associated factors, giving reasons to believe that the pathophysiology behind the sepsis-linked atrophy of the diaphragm and psoas is not equivalent and comparable in all points.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03451423
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Submitted on : Friday, November 26, 2021 - 2:28:37 PM
Last modification on : Friday, August 5, 2022 - 10:57:55 AM
Long-term archiving on: : Sunday, February 27, 2022 - 7:20:38 PM

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Simon Légère. Atrophie diaphragmatique séquellaire du sepsis : étude tomodensitométrique rétrospective. Human health and pathology. 2021. ⟨dumas-03451423⟩

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