الفهرس 
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Abstract
Invasive mechanical ventilation (MV) is a life-saving procedure applied to critically ill patients to achieve adequate pulmonary gas exchange and unload excessive respiratory muscle work. However, mechanical ventilation itself can cause ventilator-induced diaphragmatic dysfunction (VIDD). It is also commonly attributed to critical illness polyneuropathy and myopathy.
It is well known that muscle dysfunction in critically ill patients, defined as ICU-acquired weakness, is associated with weaning failure and unfavorable outcomes in critically ill patients. However, it remains unclear whether the specific changes in the diaphragm caused by mechanical ventilation significantly impact clinical outcomes.
Theophylline has been shown to have various pharmacologic actions, such as bronchodilation and anti-inflammation. It also increases heart muscle contractility and efficiency, and increases respiratory muscle activity such as intercostal muscle, transversus abdominis muscle, and diaphragm.
This study was an interventional study that was conducted in the Critical Care Unit, Internal Medicine Department, Assiut University, aiming to assess the response of critically ill patients with diaphragmatic dysfunction to theophylline treatment whether they are mechanically ventilated or not and to Assess the impact of diaphragmatic function on hospital stay and mortality.
The study included 46 patients who were divided randomly and equally into two groups: the study group that received theophylline and the control group that received only their usual medications.
All the patients included in this study were subjected to the following: Medical history taking, thorough physical examination, laboratory investigations in the form of (CBC, arterial blood gases, creatinine, urea, sodium and potassium), APACHE II score calculation, diaphragmatic US prior to and after theophylline treatment and follow up of the patients regarding diaphragmatic function (excursion and thickening fraction measured by ultrasonography), duration of mechanical ventilation, ICU stay, and mortality.
Results showed that:
After theophylline therapy, there was a significant increase in each thickening fraction and excursion.
In the control group (patients who didn’t receive theophylline), there were no significant changes in excursion and thickening fraction.
Patients who received theophylline treatment had a significantly shorter duration of ICU’s stay.
Both groups had insignificant differences as regards frequency of mechanical ventilation and duration of mechanical ventilation.
It was found that dead patients had a significantly higher frequency of diabetes mellitus, mean APACHE-II, lower baseline thickening fraction, and excursion in comparison to live patients.
This was the first study that assessed the accuracy of diaphragmatic function in the prediction of mortality at a cutoff point < 12.5% for thickening fraction with (a specificity of 75% and sensitivity of 67%) and at a cutoff point < 8 mm for an excursion with (a specificity of 79% and sensitivity 70%).