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Mu H, Zhang Q. The Application of Diaphragm Ultrasound in Chronic Obstructive Pulmonary Disease: A Narrative Review. COPD 2024; 21:2331202. [PMID: 38634575 DOI: 10.1080/15412555.2024.2331202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/11/2024] [Indexed: 04/19/2024]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a prevalent condition that poses a significant burden on individuals and society due to its high morbidity and mortality rates. The diaphragm is the main respiratory muscle, its function has a direct impact on the quality of life and prognosis of COPD patients. This article aims to review the structural measurement and functional evaluation methods through the use of diaphragmatic ultrasound and relevant research on its application in clinical practice for COPD patients. Thus, it serves to provide valuable insights for clinical monitoring of diaphragm function in COPD patients, facilitating early clinical intervention and aiding in the recovery of diaphragm function.
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Affiliation(s)
- Heng Mu
- Department of Ultrasound, Second Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
- State Key Laboratory of Ultrasound in Medicine and Engineering of Chongqing Medical University, Chongqing, PR China
| | - Qunxia Zhang
- Department of Ultrasound, Second Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
- State Key Laboratory of Ultrasound in Medicine and Engineering of Chongqing Medical University, Chongqing, PR China
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Nascimento MS, Leite FS, Silva PAL, Zamberlan GC, de Souza PM, Eid RAC, Zacharias RSB, do Prado C, Batista CL. Reliability and reference values for diaphragmatic excursion, thickness, and thickening fraction and quadriceps femoris muscle thickness in full-term newborns evaluated by ultrasound. Eur J Pediatr 2024; 183:3453-3460. [PMID: 38771374 DOI: 10.1007/s00431-024-05608-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/06/2024] [Accepted: 05/11/2024] [Indexed: 05/22/2024]
Abstract
To determine the diaphragm thickness, thickening fraction, and excursion and thickness of the quadriceps femoris muscle in full-term newborns and to evaluate the intra- and interrater reliability of these measurements. This was a prospective, observational clinical study including full-term newborns born within the first 48 h after birth. Serial measurements of the thickness, thickening fraction, and mobility of the diaphragm muscles and the thickness of the quadriceps muscle were obtained using ultrasound images. A total of 69 newborns with a mean gestational age of 39 weeks were included. The following measurements were obtained and are expressed as the mean (standard deviation): inspiratory diaphragm thickness, 0.19 cm (0.04); expiratory diaphragm thickness, 0.16 cm (0.04); diaphragm thickness fraction, 16.70 cm (10.27); diaphragmatic excursion, 0.68 cm (0.22); and quadriceps thickness, 0.99 cm (0.14). Intrarater reliability was assessed using intraclass correlation coefficients (ICCs). Excellent intrarater agreement was observed for the two groups of operators (ICC > 0.86, p < 0.001) for all measurements except for the diaphragm thickening fraction, which showed good agreement for both operator groups (ICC = 0.70, p < 0.001). Regarding interrater reliability, moderate agreement between the raters was observed in the means of all measures (ICC > 0.49, p < 0.001), except for the diaphragm thickening fraction, which showed poor agreement. Conclusion: Good intrarater and moderate interrater reliability were achieved in ultrasound evaluations of the thickness and mobility of the diaphragm and quadriceps femoris muscles in full-term newborns, demonstrating the feasibility of this technique for clinical use. This pioneering study offers reference values for these muscles in a single study, allowing comparisons between different clinical conditions. What is Known: • Ultrasound is a highly reliable tool for muscle assessment that can be used to assess muscular atrophy in critically ill patients. • Muscle atrophy worsens the patient's condition and has been associated with worse outcomes. What is New: • To our knowledge, this is the first study to jointly evaluate the diaphragm and quadriceps muscle thickness and evaluate the reliability of all measurements. • Our study presents reference values for both muscles, enabling comparisons between different clinical conditions.
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Affiliation(s)
- Milena Siciliano Nascimento
- Departamento de Práticas Assistenciais, Hospital Israelita Albert Einstein, Avenue Albert Einstein, 627-701, 05651-901, São Paulo, Brazil.
| | - Flávia Sales Leite
- Departamento de Pacientes Graves, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | | | - Priscila Monteiro de Souza
- Departamento de Práticas Assistenciais, Hospital Israelita Albert Einstein, Avenue Albert Einstein, 627-701, 05651-901, São Paulo, Brazil
- Corpo Discente da Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil
| | | | | | - Cristiane do Prado
- Departamento Materno-infantil, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Carla Luciana Batista
- Departamento de Pacientes Graves, Hospital Israelita Albert Einstein, São Paulo, Brazil
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Demoule A, Fossé Q, Mercat A, Bergum D, Virolle S, Bureau C, Mellemseter M, Guichou R, Similowski T, Dres M, Mortaza S. Operator independent continuous ultrasound monitoring of diaphragm excursion predicts successful weaning from mechanical ventilation: a prospective observational study. Crit Care 2024; 28:245. [PMID: 39014512 PMCID: PMC11253384 DOI: 10.1186/s13054-024-05003-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 06/24/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND In mechanically ventilated patients, diaphragm ultrasound can identify diaphragm weakness and predict weaning failure. We evaluated whether a novel operator-independent ultrasound-based medical device allowing continuous monitoring of the diaphragm (CUSdi) could reliably (1) measure diaphragm excursion (EXdi) and peak contraction velocity (PCVdi), (2) predict weaning outcome, and (3) approximate transdiaphragmatic pressure (Pdi). METHODS In 49 mechanically ventilated patients, CUSdi was recorded during a 30-min spontaneous breathing trial (SBT), and EXdi and PCVdi were measured. In subgroups of patients, standard ultrasound measurement of EXdi and PCVdi was performed (n = 36), and Pdi derived parameters (peak and pressure time product, n = 30) were measured simultaneously. RESULTS The agreement bias between standard ultrasound and CUSdi for EXdi was 0.1 cm (95% confidence interval -0.7-0.9 cm). The regression of Passing-Bablok indicated a lack of systematic difference between EXdi measured with standard ultrasound and CUSdi, which were positively correlated (Rho = 0.84, p < 0.001). Weaning failure was observed in 54% of patients. One, two and three minutes after the onset of the SBT, EXdi was higher in the weaning success group than in the failure group. Two minutes after the onset of the SBT, an EXdi < 1.1 cm predicted weaning failure with a sensitivity of 0.83, a specificity of 0.68, a positive predictive value of 0.76, and a negative predictive value of 0.24. There was a weak correlation between EXdi and both peak Pdi (r = 0.22, 95% confidence interval 0.15 - 0.28) and pressure time product (r = 0.13, 95% confidence interval 0.06 - 0.20). Similar results were observed with PCVdi. CONCLUSIONS Operator-independent continuous diaphragm monitoring quantifies EXdi reliably and can predict weaning failure with an identified cut-off value of 1.1 cm. Trial registration clinicaltrial.gov, NCT04008875 (submitted 12 April 2019, posted 5 July 2019) and NCT03896048 (submitted 27 March 2019, posted 29 March 2019).
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Affiliation(s)
- Alexandre Demoule
- Service de Médecine Intensive - Réanimation (Département R3S), AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, 47-83 Boulevard de L'Hôpital, 75651 Paris Cedex 13, 75013, Paris, France.
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, 75005, Paris, France.
| | - Quentin Fossé
- Service de Médecine Intensive - Réanimation (Département R3S), AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, 47-83 Boulevard de L'Hôpital, 75651 Paris Cedex 13, 75013, Paris, France
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, 75005, Paris, France
| | - Alain Mercat
- Service de Réanimation Médicale et Médecine Hyperbare, Centre Hospitalier Régional Universitaire, Angers, France
| | - Daniel Bergum
- Department of Intensive Care Medicine, St. Olav University Hospital, Trondheim, Norway
| | - Sara Virolle
- Service de Médecine Intensive - Réanimation (Département R3S), AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, 47-83 Boulevard de L'Hôpital, 75651 Paris Cedex 13, 75013, Paris, France
| | - Côme Bureau
- Service de Médecine Intensive - Réanimation (Département R3S), AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, 47-83 Boulevard de L'Hôpital, 75651 Paris Cedex 13, 75013, Paris, France
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, 75005, Paris, France
| | | | | | - Thomas Similowski
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, 75005, Paris, France
- Département R3S, AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, 75013, Paris, France
| | - Martin Dres
- Service de Médecine Intensive - Réanimation (Département R3S), AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, 47-83 Boulevard de L'Hôpital, 75651 Paris Cedex 13, 75013, Paris, France
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, 75005, Paris, France
| | - Satar Mortaza
- Service de Réanimation Médicale et Médecine Hyperbare, Centre Hospitalier Régional Universitaire, Angers, France
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Oliveira BE, Canola PA. Ultrasonographic measurement of diaphragm muscle activity for assessment of respiratory function in horses. J Equine Vet Sci 2024; 138:105100. [PMID: 38763366 DOI: 10.1016/j.jevs.2024.105100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 05/21/2024]
Abstract
Ultrasonographic imaging of the diaphragm is a non-invasive alternative for respiratory function evaluation in horses. This study aimed to measure diaphragm thickness, thickening (change in thickness with contraction) and thickening fraction in healthy adult horses during tidal breathing and forced vital capacity. Correlation between body weight (≤400 kg and >400 kg) and diaphragm thickness was investigated. To that purpose, 20 adult horses, weight 409±50 kg, height 1.47±0.05 m, and age 16±6 years were included in the study. Diaphragm thickness was measured at end-inspiration and end-expiration using B-mode and M-mode. The transducer was placed in the 10th, 11th and 12th intercostal spaces of both hemithoraces. Measurements obtained at end inspiration using M-mode during forced vital capacity were greater than for tidal breathing for diaphragm thickness (P=0.006), diaphragm thickening (P<0.001) and thickening fraction (P<0.001). The same was found for thickening (P<0.001) and thickening fraction (P<0.001). Diaphragm thickness at end-inspiration was greater in horses weighing >400kg than those ≤400kg at the inspiration (0.93±0.2 cm and 0.74±0 0.02 cm, P<0.001) and at the end of expiration (0.77±0.02 cm and 0.63±0, 02 cm, P<0.001). There was no difference in thickening fraction between horses weighing ≤400kg and >400kg (tidal breathing: 18±2 % and 16±2 %, P=0.609; forced vital capacity: 39±6 % and 31±5 %, P=0.301). Diaphragm assessment in horses is possible using both B-mode and M-mode. Breathing workload has a positive correlation between breathing workload and diaphragm contraction. Due to the relationship demonstrated between diaphragm thickness and weight, it is recommended that diaphragm thickening fraction is used to compare diaphragm measurements between horses.
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Affiliation(s)
- B E Oliveira
- Department of Veterinary Medicine and Surgery, SCIEN - Large Animal Surgery Lab, São Paulo State University (Unesp), School of Agricultural and Veterinary Sciences, Jaboticabal, Via de Acesso Prof. Paulo Donato Castellane s/n, Jaboticabal/São Paulo, 14884-900 Brazil
| | - P A Canola
- Department of Veterinary Medicine and Surgery, SCIEN - Large Animal Surgery Lab, São Paulo State University (Unesp), School of Agricultural and Veterinary Sciences, Jaboticabal, Via de Acesso Prof. Paulo Donato Castellane s/n, Jaboticabal/São Paulo, 14884-900 Brazil.
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Colaianni-Alfonso N, Castro I, Cáceres V, Montiel G, Maggiore SM, Vetrugno L. Effect of high-flow nasal cannula at different flow rates on diaphragmatic function in subjects recovering from an acute exacerbation of COPD: a physiological prospective pilot study. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2024; 4:37. [PMID: 38915126 PMCID: PMC11197175 DOI: 10.1186/s44158-024-00173-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 06/17/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND Noninvasive ventilation (NIV) is widely employed as the initial treatment for patients with chronic acute exacerbation of obstructive pulmonary disease (AECOPD). Nevertheless, high-flow nasal cannula (HFNC) has been increasingly utilized and investigated to mitigate the issues associated with NIV. Flow rate may play a significant role in diaphragmatic function among subjects recovering from AECOPD. Based on these observations, we conducted a physiological study to assess the impact of HFNC therapy on diaphragmatic function, as measured by US, respiratory rate (RR), gas exchange, and patient comfort at various flow rates. METHODS A prospective physiological pilot study enrolled subjects with a diagnosis of AECOPD who required NIV for more than 24 h. After stabilization, these subjects underwent a 30-min trial using NIV and HFNC at different sequential flow rates (30-60 L/min). At the end of each trial, diaphragmatic displacement (DD, cm) and diaphragmatic thickness fraction (DTF, %) were measured using ultrasound. Additionally, other physiological variables, such as RR, gas exchange, and patient comfort, were recorded. RESULTS A total of 20 patients were included in the study. DD was no different among trials (p = 0.753). DTF (%) was significantly lower with HFNC-30 L/min compared to HFNC-50 and 60 L/min (p < 0.001 for all comparisons). No significant differences were found in arterial pH and PaCO2 at discontinuation of NIV and at the end of HFNC trials (p > 0.050). During HFNC trials, RR remained unchanged without statistically significant differences (p = 0.611). However, we observed that HFNC improved comfort compared to NIV (p < 0.001 for all comparisons). Interestingly, HFNC at 30 and 40 L/min showed greater comfort during trials. CONCLUSIONS In subjects recovering from AECOPD and receiving HFNC, flows above 40 L/min may not offer additional benefits in terms of comfort and decreased respiratory effort. HFNC could be a suitable alternative to COT during breaks off NIV.
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Affiliation(s)
- Nicolás Colaianni-Alfonso
- Respiratory Intermediate Care Unit, Hospital Juan A. Fernández, Ciudad Autónoma de Buenos Aires, Buenos Aires, C1425, Argentina.
| | - Iván Castro
- Respiratory Intermediate Care Unit, Hospital Juan A. Fernández, Ciudad Autónoma de Buenos Aires, Buenos Aires, C1425, Argentina
| | - Vanesa Cáceres
- Respiratory Intermediate Care Unit, Hospital Juan A. Fernández, Ciudad Autónoma de Buenos Aires, Buenos Aires, C1425, Argentina
| | - Guillermo Montiel
- Respiratory Intermediate Care Unit, Hospital Juan A. Fernández, Ciudad Autónoma de Buenos Aires, Buenos Aires, C1425, Argentina
| | - Salvatore Maurizio Maggiore
- Department of Anesthesiology, Critical Care Medicine and Emergency, Department of Innovative Technologies in Medicine and Dentistry, "G. d'Annunzio" University Chieti-Pescara, Chieti, Italy
| | - Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, University of G. d' Annunzio, Chieti-Pescara, Italy
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Yao XY, Li HM, Sun BW, Zhang YY, Feng JG, Jia J, Liu L. Ultrasound assessment of diaphragmatic dysfunction in non-critically ill patients: relevant indicators and update. Front Med (Lausanne) 2024; 11:1389040. [PMID: 38957305 PMCID: PMC11217340 DOI: 10.3389/fmed.2024.1389040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 06/03/2024] [Indexed: 07/04/2024] Open
Abstract
Diaphragm dysfunction (DD) can be classified as mild, resulting in diaphragmatic weakness, or severe, resulting in diaphragmatic paralysis. Various factors such as prolonged mechanical ventilation, surgical trauma, and inflammation can cause diaphragmatic injury, leading to negative outcomes for patients, including extended bed rest and increased risk of pulmonary complications. Therefore, it is crucial to protect and monitor diaphragmatic function. Impaired diaphragmatic function directly impacts ventilation, as the diaphragm is the primary muscle involved in inhalation. Even unilateral DD can cause ventilation abnormalities, which in turn lead to impaired gas exchange, this makes weaning from mechanical ventilation challenging and contributes to a higher incidence of ventilator-induced diaphragm dysfunction and prolonged ICU stays. However, there is insufficient research on DD in non-ICU patients, and DD can occur in all phases of the perioperative period. Furthermore, the current literature lacks standardized ultrasound indicators and diagnostic criteria for assessing diaphragmatic dysfunction. As a result, the full potential of diaphragmatic ultrasound parameters in quickly and accurately assessing diaphragmatic function and guiding diagnostic and therapeutic decisions has not been realized.
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Affiliation(s)
- Xin-Yu Yao
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, China
| | - Hong-Mei Li
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Department of Anesthesiology, Chengdu Fifth People’s Hospital, Chengdu, China
| | - Bo-Wen Sun
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, China
| | - Ying-Ying Zhang
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, China
| | - Jian-Guo Feng
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, China
| | - Jing Jia
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, China
| | - Li Liu
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, China
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Yang X, Zhang B, Liu Y, Lv Q, Guo J. Automatic Quantitative Assessment of Muscle Strength Based on Deep Learning and Ultrasound. ULTRASONIC IMAGING 2024:1617346241255590. [PMID: 38881032 DOI: 10.1177/01617346241255590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Skeletal muscle is a vital organ that promotes human movement and maintains posture. Accurate assessment of muscle strength is helpful to provide valuable insights for athletes' rehabilitation and strength training. However, traditional techniques rely heavily on the operator's expertise, which may affect the accuracy of the results. In this study, we propose an automated method to evaluate muscle strength using ultrasound and deep learning techniques. B-mode ultrasound data of biceps brachii of multiple athletes at different strength levels were collected and then used to train our deep learning model. To evaluate the effectiveness of this method, this study tested the contraction of the biceps brachii under different force levels. The classification accuracy of this method for grade 4 and grade 6 muscle strength reached 98% and 96%, respectively, and the overall average accuracy was 93% and 87%, respectively. The experimental results confirm that the innovative methods in this paper can accurately and effectively evaluate and classify muscle strength.
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Affiliation(s)
- Xiao Yang
- Key Laboratory of Ultrasound of Shaanxi Province, School of Physics and Information Technology, Shaanxi Normal University, Xi'an, China
| | - Beilei Zhang
- Key Laboratory of Ultrasound of Shaanxi Province, School of Physics and Information Technology, Shaanxi Normal University, Xi'an, China
| | - Ying Liu
- Key Laboratory of Ultrasound of Shaanxi Province, School of Physics and Information Technology, Shaanxi Normal University, Xi'an, China
| | - Qian Lv
- Key Laboratory of Ultrasound of Shaanxi Province, School of Physics and Information Technology, Shaanxi Normal University, Xi'an, China
| | - Jianzhong Guo
- Key Laboratory of Ultrasound of Shaanxi Province, School of Physics and Information Technology, Shaanxi Normal University, Xi'an, China
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Sahin ME, Sahin E, Kirlangic MM, Ak M, Daglıtuncezdi Cam S, Cundubey CR, Col Madendag I, Madendag Y. Fetal Diaphragmatic Excursion Is Decreased in Hospitalized Pregnant Women Infected with COVID-19 during the Second and Third Trimesters. Am J Perinatol 2024; 41:e1384-e1389. [PMID: 36724872 DOI: 10.1055/a-2024-0907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE In the present study, we aimed to evaluate coronavirus disease 2019 (COVID-19) infection effects on fetal diaphragm thickness and diaphragmatic excursion, which together show the quality of diaphragmatic contractions. STUDY DESIGN One hundred and ninety-two pregnant women were included in this prospective case-control study. Patients were divided into four groups according to their COVID-19 infection history in their second or third trimester: hospitalized COVID-19-infected pregnant women group (n = 48), outpatient COVID-19-infected pregnant women group (n = 48), common cold (COVID-19 polymerase chain reaction negative) pregnant women group (n = 48), and noninfected healthy controls (n = 48). The number of patients was determined by power analysis following the pilot study. All participants underwent an ultrasound examination to determine fetal diaphragm parameters at 32 to 37 weeks of gestation. RESULTS Demographic characteristics were similar among the four groups. The gestational age at ultrasound examination and gestational age at delivery were similar among the groups. Neonatal intensive care unit (NICU) admission rate was significantly higher in the hospitalized COVID-19-infected pregnant women group than the other groups. The fetal diaphragm thickness during inspiration and expiration, and fetal costophrenic angles at inspiration and expiration were similar among the groups. Fetal diaphragmatic excursion was significantly decreased in the hospitalized COVID-19-infected pregnant women group compared with the other groups. CONCLUSION Our results indicated that moderate maternal COVID-19 infection decreased fetal diaphragmatic excursion, and ultrasonographic evaluation of fetal diaphragmatic excursion before delivery can provide critical information to predict whether infants will require NICU admission. KEY POINTS · Diaphragm ultrasound as a new technique for characterizing the diaphragm's structure and function.. · Fetal diaphragmatic excursion is decreased in the presence of moderate COVID-19 infection.. · Ultrasonographic evaluation of fetal diaphragmatic excursion provides critical information to predict NICU admission..
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Affiliation(s)
| | - Erdem Sahin
- Department of Obstetrics and Gynecology, Kayseri City Hospital, Kayseri, Turkey
| | - Mehmet M Kirlangic
- Department of Obstetrics and Gynecology, Kartal Dr. Lutfu Kirdar City Hospital, Istanbul, Turkey
| | - Mehmet Ak
- Department of Obstetrics and Gynecology, Kayseri City Hospital, Kayseri, Turkey
| | | | - Cevat R Cundubey
- Department of Obstetrics and Gynecology, Kayseri City Hospital, Kayseri, Turkey
| | - Ilknur Col Madendag
- Department of Obstetrics and Gynecology, Kayseri City Hospital, Kayseri, Turkey
| | - Yusuf Madendag
- Department of Obstetrics and Gynecology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
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Song J, Luo Q, Lai X, Hu W, Yu Y, Wang M, Yang K, Chen G, Chen W, Li Q, Hu C, Gong S. Combined cardiac, lung, and diaphragm ultrasound for predicting weaning failure during spontaneous breathing trial. Ann Intensive Care 2024; 14:60. [PMID: 38641687 PMCID: PMC11031537 DOI: 10.1186/s13613-024-01294-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 04/10/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Weaning from invasive mechanical ventilation (MV) is a complex and challenging process that involves multiple pathophysiological mechanisms. A combined ultrasound evaluation of the heart, lungs, and diaphragm during the weaning phase can help to identify risk factors and underlying mechanisms for weaning failure. This study aimed to investigate the accuracy of lung ultrasound (LUS), transthoracic echocardiography (TTE), and diaphragm ultrasound for predicting weaning failure in critically ill patients. METHODS Patients undergoing invasive MV for > 48 h and who were readied for their first spontaneous breathing trial (SBT) were studied. Patients were scheduled for a 2-h SBT using low-level pressure support ventilation. LUS and TTE were performed prospectively before and 30 min after starting the SBT, and diaphragm ultrasound was only performed 30 min after starting the SBT. Weaning failure was defined as failure of SBT, re-intubation, or non-invasive ventilation within 48 h. RESULTS Fifty-one patients were included, of whom 15 experienced weaning failure. During the SBT, the global, anterior, and antero-lateral LUS scores were higher in the failed group than in the successful group. Receiver operating characteristic curve analysis showed that the areas under the curves for diaphragm thickening fraction (DTF) and global and antero-lateral LUS scores during the SBT to predict weaning failure were 0.678, 0.719, and 0.721, respectively. There was no correlation between the LUS scores and the average E/e' ratio during the SBT. Multivariate analysis identified antero-lateral LUS score > 7 and DTF < 31% during the SBT as independent predictors of weaning failure. CONCLUSION LUS and diaphragm ultrasound can help to predict weaning failure in patients undergoing an SBT with low-level pressure support. An antero-lateral LUS score > 7 and DTF < 31% during the SBT were associated with weaning failure.
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Affiliation(s)
- Jia Song
- Department of Critical Care Medicine, Zhejiang Hospital, No. 12, Lingyin Road, Xihu District, Hangzhou, Zhejiang, 310013, China
| | - Qiancheng Luo
- Department of Critical Care Medicine, Shanghai Pudong New Area Gongli Hospital, No. 219, Miaopu Road, Pudong New Area, Shanghai, 200135, China
| | - Xinle Lai
- Department of Critical Care Medicine, Zhejiang Hospital, No. 12, Lingyin Road, Xihu District, Hangzhou, Zhejiang, 310013, China
| | - Weihang Hu
- Department of Critical Care Medicine, Zhejiang Hospital, No. 12, Lingyin Road, Xihu District, Hangzhou, Zhejiang, 310013, China
| | - Yihua Yu
- Department of Critical Care Medicine, Zhejiang Hospital, No. 12, Lingyin Road, Xihu District, Hangzhou, Zhejiang, 310013, China
| | - Minjia Wang
- Department of Critical Care Medicine, Zhejiang Hospital, No. 12, Lingyin Road, Xihu District, Hangzhou, Zhejiang, 310013, China
| | - Kai Yang
- The 2nd Clinical Medical College, Zhejiang Chinese Medical University, No. 548, Binwen Road, Binjiang District, Hangzhou, 310053, China
| | - Gongze Chen
- The 2nd Clinical Medical College, Zhejiang Chinese Medical University, No. 548, Binwen Road, Binjiang District, Hangzhou, 310053, China
| | - Wenwei Chen
- The 2nd Clinical Medical College, Zhejiang Chinese Medical University, No. 548, Binwen Road, Binjiang District, Hangzhou, 310053, China
| | - Qian Li
- The 2nd Clinical Medical College, Zhejiang Chinese Medical University, No. 548, Binwen Road, Binjiang District, Hangzhou, 310053, China
| | - Caibao Hu
- Department of Critical Care Medicine, Zhejiang Hospital, No. 12, Lingyin Road, Xihu District, Hangzhou, Zhejiang, 310013, China.
| | - Shijin Gong
- Department of Critical Care Medicine, Zhejiang Hospital, No. 12, Lingyin Road, Xihu District, Hangzhou, Zhejiang, 310013, China.
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Huebner L, Warmbein A, Scharf C, Schroeder I, Manz K, Rathgeber I, Gutmann M, Biebl J, Mehler-Klamt A, Huber J, Eberl I, Kraft E, Fischer U, Zoller M. Effects of robotic-assisted early mobilization versus conventional mobilization in intensive care unit patients: prospective interventional cohort study with retrospective control group analysis. Crit Care 2024; 28:112. [PMID: 38582934 PMCID: PMC10999075 DOI: 10.1186/s13054-024-04896-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/29/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND Approximately one in three survivors of critical illness suffers from intensive-care-unit-acquired weakness, which increases mortality and impairs quality of life. By counteracting immobilization, a known risk factor, active mobilization may mitigate its negative effects on patients. In this single-center trial, the effect of robotic-assisted early mobilization in the intensive care unit (ICU) on patients' outcomes was investigated. METHODS We enrolled 16 adults scheduled for lung transplantation to receive 20 min of robotic-assisted mobilization and verticalization twice daily during their first week in the ICU (intervention group: IG). A control group (CG) of 13 conventionally mobilized patients after lung transplantation was recruited retrospectively. Outcome measures included the duration of mechanical ventilation, length of ICU stay, muscle parameters evaluated by ultrasound, and quality of life after three months. RESULTS During the first week in the ICU, the intervention group received a median of 6 (interquartile range 3-8) robotic-assisted sessions of early mobilization and verticalization. There were no statistically significant differences in the duration of mechanical ventilation (IG: median 126 vs. CG: 78 h), length of ICU stay, muscle parameters evaluated by ultrasound, and quality of life after three months between the IG and CG. CONCLUSION In this study, robotic-assisted mobilization was successfully implemented in the ICU setting. No significant differences in patients' outcomes were observed between conventional and robotic-assisted mobilization. However, randomized and larger studies are necessary to validate the adequacy of robotic mobilization in other cohorts. TRIAL REGISTRATION This single-center interventional trial was registered in clinicaltrials.gov as NCT05071248 on 27/08/2021.
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Affiliation(s)
- Lucas Huebner
- Department of Anaesthesiology, LMU University Hospital, LMU Munich, Munich, Germany.
| | - Angelika Warmbein
- Clinical Nursing Research and Quality Management Unit, LMU University Hospital, LMU Munich, Munich, Germany
| | - Christina Scharf
- Department of Anaesthesiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Ines Schroeder
- Department of Anaesthesiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Kirsi Manz
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Munich, Germany
| | - Ivanka Rathgeber
- Clinical Nursing Research and Quality Management Unit, LMU University Hospital, LMU Munich, Munich, Germany
| | - Marcus Gutmann
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Munich, Germany
| | - Johanna Biebl
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Munich, Germany
| | - Amrei Mehler-Klamt
- Professorship for Nursing Science, Faculty of Social Work, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Jana Huber
- Professorship for Nursing Science, Faculty of Social Work, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Inge Eberl
- Professorship for Nursing Science, Faculty of Social Work, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Eduard Kraft
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Munich, Germany
| | - Uli Fischer
- Clinical Nursing Research and Quality Management Unit, LMU University Hospital, LMU Munich, Munich, Germany
| | - Michael Zoller
- Department of Anaesthesiology, LMU University Hospital, LMU Munich, Munich, Germany
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Lytra E, Kokkoris S, Poularas I, Filippiadis D, Cokkinos D, Exarhos D, Zakynthinos S, Routsi C. The effect of high-flow oxygen via tracheostomy on respiratory pattern and diaphragmatic function in patients with prolonged mechanical ventilation: A randomized, physiological, crossover study. JOURNAL OF INTENSIVE MEDICINE 2024; 4:202-208. [PMID: 38681788 PMCID: PMC11043636 DOI: 10.1016/j.jointm.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/08/2023] [Accepted: 11/14/2023] [Indexed: 05/01/2024]
Abstract
Background Compared to conventional oxygen devices, high-flow oxygen treatment (HFOT) through the nasal cannulae has demonstrated clinical benefits. Limited data exist on whether such effects are also present in HFOT through tracheostomy. Hence, we aimed to examine the short-term effects of HFOT through tracheostomy on diaphragmatic function and respiratory parameters in tracheostomized patients on prolonged mechanical ventilation. Methods A randomized, crossover, physiological study was conducted in our ICU between December 2020 and April 2021, in patients with tracheostomy and prolonged mechanical ventilation. The patients underwent a 30-min spontaneous breathing trial (SBT) and received oxygen either via T-piece or by HFOT through tracheostomy, followed by a washout period of 15-min breathing through the T-piece and receipt of 30-min oxygen with the other modality in a randomized crossover manner. At the start and end of each session, blood gasses, breathing frequency (f), and tidal volume (VT) via a Wright's spirometer were measured, along with diaphragm ultrasonography including diaphragm excursion and diaphragmatic thickening fraction, which expressed the inspiratory muscle effort. Results Eleven patients were enrolled in whom 19 sessions were uneventfully completed; eight patients were studied twice on two different days with alternate sessions; and three patients were studied once. Patients were randomly assigned to start the SBT with a T-piece (n=10 sessions) or with HFOT (n=9 sessions). With HFOT, VT and minute ventilation (VE) significantly increased during SBT (from [465±119] mL to [549±134] mL, P <0.001 and from [12.4±4.3] L/min to [13.1±4.2] L/min, P <0.05, respectively), but they did not change significantly during SBT with T-piece (from [495±132] mL to [461±123] mL and from [12.8±4.4] mL to [12.0±4.4] mL, respectively); f/VT decreased during HFOT (from [64±31] breaths/(min∙L) to [49±24] breaths/(min∙L), P <0.001), but it did not change significantly during SBT with T-piece (from [59±28] breaths/(min∙L) to [64±33] breaths/(min∙L)); partial pressure of arterial oxygen increased during HFOT (from [99±39] mmHg to [132±48] mmHg, P <0.001), but it decreased during SBT with T-piece (from [124±50] mmHg to [83±22] mmHg, P <0.01). In addition, with HFOT, diaphragmatic excursion increased (from [12.9±3.3] mm to [15.7±4.4] mm, P <0.001), but it did not change significantly during SBT with T-piece (from [13.4±3.3] mm to [13.6±3.3] mm). The diaphragmatic thickening fraction did not change during SBT either with T-piece or with HFOT. Conclusion In patients with prolonged mechanical ventilation, HFOT through tracheostomy compared with T-piece improves ventilation, pattern of breathing, and oxygenation without increasing the inspiratory muscle effort. Trial Registration Clinicaltrials.gov ldentifer: NCT04758910.
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Affiliation(s)
- Elena Lytra
- 1st Department of Intensive Care, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
- Radiology Department, Evangelismos Hospital, Athens, Greece
| | - Stelios Kokkoris
- 1st Department of Intensive Care, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Ioannis Poularas
- 1st Department of Intensive Care, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Dimitrios Filippiadis
- 2nd Radiology Department, Medical School, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
| | | | | | - Spyros Zakynthinos
- 1st Department of Intensive Care, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Christina Routsi
- 1st Department of Intensive Care, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
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12
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Moury PH, Béhouche A, Bailly S, Durand Z, Dessertaine G, Pollet A, Jaber S, Verges S, Albaladejo P. Diaphragm thickness modifications and associated factors during VA-ECMO for a cardiogenic shock: a cohort study. Ann Intensive Care 2024; 14:38. [PMID: 38457010 PMCID: PMC10923772 DOI: 10.1186/s13613-024-01264-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 02/16/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND The incidence, causes and impact of diaphragm thickness evolution in veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for cardiogenic shock are unknown. Our study investigates its evolution during the first week of VA-ECMO and its relationship with sweep gas flow settings. METHODS We conducted a prospective monocentric observational study in a 12-bed ICU in France, enrolling patients on the day of the VA-ECMO implantation. The diaphragm thickness and the diaphragm thickening fraction (as index of contractile activity, dTF; dTF < 20% defined a low contractile activity) were daily measured for one week using ultrasound. Factors associated with diaphragm thickness evolution (categorized as increased, stable, or atrophic based on > 10% modification from baseline to the last measurement), early extubation role (< day4), and patients outcome at 60 days were investigated. Changes in diaphragm thickness, the primary endpoint, was analysed using a mixed-effect linear model (MLM). RESULTS Of the 29 included patients, seven (23%) presented diaphragm atrophy, 18 remained stable (60%) and 4 exhibited an increase (17%). None of the 13 early-extubated patients experienced diaphragm atrophy, while 7 (46%) presented a decrease when extubated later (p-value = 0.008). Diaphragm thickness changes were not associated with the dTF (p-value = 0.13) but with sweep gas flow (Beta = - 3; Confidence Interval at 95% (CI) [- 4.8; - 1.2]. p-value = 0.001) and pH (Beta = - 2; CI [- 2.9; - 1]. p-value < 0.001) in MLM. The dTF remained low (< 20%) in 20 patients (69%) at the study's end and was associated with sweep gas flow evolution in MLM (Beta = - 2.8; 95% CI [- 5.2; - 0.5], p-value = 0.017). Odds ratio of death at 60 days in case of diaphragm atrophy by day 7 was 8.50 ([1.4-74], p = 0.029). CONCLUSION In our study, diaphragm thickness evolution was frequent and not associated with the diaphragm thickening fraction. Diaphragm was preserved from atrophy in case of early extubation with ongoing VA-ECMO assistance. Metabolic disorders resulting from organ failures and sweep gas flow were linked with diaphragm thickness evolution. Preserved diaphragm thickness in VA-ECMO survivors emphasizes the importance of diaphragm-protective strategies, including meticulous sweep gas flow titration.
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Affiliation(s)
- Pierre-Henri Moury
- Pôle Anesthésie-Réanimation, Grenoble Alpes University, Grenoble, France.
- Univ. Grenoble Alpes, Inserm, Grenoble Alpes University Hospital, HP2 Laboratory, Grenoble, France.
| | - Alexandre Béhouche
- Pôle Anesthésie-Réanimation, Grenoble Alpes University, Grenoble, France
| | - Sébastien Bailly
- Univ. Grenoble Alpes, Inserm, Grenoble Alpes University Hospital, HP2 Laboratory, Grenoble, France
| | - Zoé Durand
- Pôle Anesthésie-Réanimation, Grenoble Alpes University, Grenoble, France
| | | | - Angelina Pollet
- Pôle Anesthésie-Réanimation, Grenoble Alpes University, Grenoble, France
| | - Samir Jaber
- Intensive Care Unit, Anaesthesiology and Critical Care Department B, Saint Eloi Teaching Hospital, Université Montpellier 1, Centre Hospitalier Universitaire Montpellier, Montpellier, France
| | - Samuel Verges
- Univ. Grenoble Alpes, Inserm, Grenoble Alpes University Hospital, HP2 Laboratory, Grenoble, France
| | - Pierre Albaladejo
- Pôle Anesthésie-Réanimation, Grenoble Alpes University, Grenoble, France
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Xue S, Wang D, Tu HQ, Gu XP, Ma ZL, Liu Y, Zhang W. The effects of robot-assisted laparoscopic surgery with Trendelenburg position on short-term postoperative respiratory diaphragmatic function. BMC Anesthesiol 2024; 24:92. [PMID: 38443828 PMCID: PMC10913577 DOI: 10.1186/s12871-024-02463-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 02/18/2024] [Indexed: 03/07/2024] Open
Abstract
OBJECTIVE To study how Pneumoperitoneum under Trendelenburg position for robot-assisted laparoscopic surgery impact the perioperative respiratory parameters, diagrammatic function, etc. METHODS: Patients undergoing robot-assisted laparoscopic surgery in the Trendelenburg position and patients undergoing general surgery in the supine position were selected. The subjects were divided into two groups according to the type of surgery: robot-assisted surgery group and general surgery group. ① Respiratory parameters such as lung compliance, oxygenation index, and airway pressure were recorded at 5 min after intubation, 1 and 2 h after pneumoperitoneum. ② Diaphragm excursion (DE) and diaphragm thickening fraction (DTF) were recorded before entering the operating room (T1), immediately after extubation (T2), 10 min after extubation (T3), and upon leaving the postanesthesia care unit (T4). ③ Peripheral venous blood (5 ml) was collected before surgery and 30 min after extubation and was analyzed by enzyme-linked immunosorbent assay to determine the serum concentration of Clara cell secretory protein 16 (CC16) and surfactant protein D (SP-D). RESULT ① Compared with the general surgery group (N = 42), the robot-assisted surgery group (N = 46) presented a significantly higher airway pressure and lower lung compliance during the surgery(P < 0.001). ② In the robot-assisted surgery group, the DE significantly decreased after surgery (P < 0.001), which persisted until patients were discharged from the PACU (P < 0.001), whereas the DTF only showed a transient decrease postoperatively (P < 0.001) and returned to its preoperative levels at discharge (P = 0.115). In the general surgery group, the DE showed a transient decrease after surgery(P = 0.011) which recovered to the preoperative levels at discharge (P = 1). No significant difference in the DTF was observed among T1, T2, T3, and T4. ③ Both the general and robot-assisted surgery reduced the postoperative serum levels of SP-D (P < 0.05), while the robot-assisted surgery increased the postoperative levels of CC16 (P < 0.001). CONCLUSION Robot-assisted laparoscopic surgery significantly impairs postoperative diaphragm function, which does not recover to preoperative levels at PACU discharge. Elevated levels of serum CC16 after surgery suggest potential lung injury. The adverse effects may be attributed to the prolonged Trendelenburg position and pneumoperitoneum during laparoscopic surgery.
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Affiliation(s)
- Shuo Xue
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No.321 of Zhongshan Road, Nanjing, 210008, Jiangsu Province, China
| | - Dan Wang
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No.321 of Zhongshan Road, Nanjing, 210008, Jiangsu Province, China
| | - Hong-Qin Tu
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No.321 of Zhongshan Road, Nanjing, 210008, Jiangsu Province, China
| | - Xiao-Ping Gu
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No.321 of Zhongshan Road, Nanjing, 210008, Jiangsu Province, China
| | - Zheng-Liang Ma
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No.321 of Zhongshan Road, Nanjing, 210008, Jiangsu Province, China
| | - Yue Liu
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No.321 of Zhongshan Road, Nanjing, 210008, Jiangsu Province, China
| | - Wei Zhang
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No.321 of Zhongshan Road, Nanjing, 210008, Jiangsu Province, China.
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14
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Wu H, Chasteen B. Rapid review of ventilator-induced diaphragm dysfunction. Respir Med 2024; 223:107541. [PMID: 38290603 DOI: 10.1016/j.rmed.2024.107541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 02/01/2024]
Abstract
Ventilator-induced diaphragm dysfunction is gaining increased recognition. Evidence of diaphragm weakness can manifest within 12 h to a few days after the initiation of mechanical ventilation. Various noninvasive and invasive methods have been developed to assess diaphragm function. The implementation of diaphragm-protective ventilation strategies is crucial for preventing diaphragm injuries. Furthermore, diaphragm neurostimulation emerges as a promising and novel treatment option. In this rapid review, our objective is to discuss the current understanding of ventilator-induced diaphragm dysfunction, diagnostic approaches, and updates on strategies for prevention and management.
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Affiliation(s)
- Huimin Wu
- Pulmonary, Critical Care and Sleep Medicine Section, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, United States; Department of Adult Respiratory Care, University of Oklahoma Medical Center, Oklahoma City, OK, 73104, United States.
| | - Bobby Chasteen
- Department of Adult Respiratory Care, University of Oklahoma Medical Center, Oklahoma City, OK, 73104, United States.
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15
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Cheong I, Imbelloni MI, Gómez RA, Álvarez Vilariño FM, Baiona GA, Tamagnone FM. Non-invasive diagnosis of diaphragmatic paralysis in botulism using ultrasound. Toxicon 2024; 239:107609. [PMID: 38216093 DOI: 10.1016/j.toxicon.2024.107609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/26/2023] [Accepted: 01/08/2024] [Indexed: 01/14/2024]
Abstract
This case study explores foodborne botulism, a severe illness caused by botulinum neurotoxin-contaminated food. It leads to bilateral descending paralysis, involving the diaphragm. We highlight diaphragmatic ultrasound as a non-invasive diagnostic tool. A 50-year-old obese male developed diplopia and weakness after consuming contaminated food, rapidly progressing to severe symptoms. Mechanical ventilation became necessary due to respiratory failure. Diaphragmatic ultrasound confirmed bilateral diaphragm paralysis despite early antitoxin treatment. The patient experienced complications, requiring tracheostomy and rehabilitation. After five months, he fully recovered diaphragmatic function. This study underscores botulism's life-threatening nature and the vital role of supportive care. Diaphragmatic ultrasound is a safe and effective method for assessing diaphragmatic function in such cases, obviating ionizing radiation exposure. We recommend its routine use for evaluating botulism-induced paralysis.
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Affiliation(s)
- Issac Cheong
- Department of Critical Care Medicine, Sanatorio de Los Arcos, Buenos Aires, Argentina; Argentinian Critical Care Ultrasonography Association (ASARUC), Argentina.
| | - Mariano Iván Imbelloni
- Department of Critical Care, Clínica de Internación Aguda en Rehabilitación y Cirugía (CIAREC), Buenos Aires, Argentina
| | - Raúl Alejandro Gómez
- Department of Critical Care Medicine, Sanatorio de Los Arcos, Buenos Aires, Argentina
| | | | - Gastón Adrián Baiona
- Department of Critical Care Medicine, Sanatorio de Los Arcos, Buenos Aires, Argentina; Department of Critical Care, Clínica de Internación Aguda en Rehabilitación y Cirugía (CIAREC), Buenos Aires, Argentina
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16
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Xirouchaki N, Bolaki M, Psarologakis C, Pediaditis E, Proklou A, Papadakis E, Kondili E, Georgopoulos D. Thoracic ultrasound use in hospitalized and ambulatory adult patients: a quantitative picture. Ultrasound J 2024; 16:11. [PMID: 38383809 PMCID: PMC10881936 DOI: 10.1186/s13089-024-00359-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 01/26/2024] [Indexed: 02/23/2024] Open
Abstract
INTRODUCTION AND OBJECTIVES Thoracic ultrasound (TUS) has been established as a powerful diagnostic and monitoring tool in the Intensive Care Unit (ICU). However, studies outside the critical care setting are scarce. The aim of this study was to investigate the value of TUS for hospitalized or ambulatory community patients. MATERIALS AND METHODS This was a retrospective study conducted from 2016 to 2020 in the TUS clinic at Heraklion University Hospital. TUS examination was performed using a standard ultrasound machine (EUB HITACHI 8500), and a high-frequency microconvex probe (5-8 MHz). Patients had been referred by their primary physician to address a range of different questions. The various respiratory system entities were characterised according to internationally established criteria. RESULTS 762 TUS studies were performed on 526 patients due to underlying malignancy (n = 376), unexplained symptoms/signs (n = 53), pregnancy related issues (n = 42), evaluation of abnormal findings in X-ray (n = 165), recent surgery/trauma (n = 23), recent onset respiratory failure (n = 12), acute respiratory infection (n = 66) and underlying non-malignant disease (n = 25). Pleural effusion was the commonest pathologic entity (n = 610), followed by consolidation (n = 269), diaphragmatic dysfunction/paradox (n = 174) and interstitial syndrome (n = 53). Discrepancies between chest X-ray and ultrasonographic findings were demonstrated in 96 cases. The TUS findings guided invasive therapeutic management in 448 cases and non-invasive management in 43 cases, while follow-up monitoring was decided in 271 cases. CONCLUSIONS This study showed that TUS can identify the most common respiratory pathologic entities encountered in hospitalized and community ambulatory patients, and is especially useful in guiding the decision making process in a diverse group of patients.
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Affiliation(s)
- N Xirouchaki
- Intensive Care Medicine Department, University Hospital of Heraklion, University of Crete, Voutes, 71110, Heraklion, Crete, Greece.
| | - M Bolaki
- Intensive Care Medicine Department, University Hospital of Heraklion, University of Crete, Voutes, 71110, Heraklion, Crete, Greece
| | - C Psarologakis
- Intensive Care Medicine Department, University Hospital of Heraklion, University of Crete, Voutes, 71110, Heraklion, Crete, Greece
| | - E Pediaditis
- Intensive Care Medicine Department, University Hospital of Heraklion, University of Crete, Voutes, 71110, Heraklion, Crete, Greece
| | - A Proklou
- Intensive Care Medicine Department, University Hospital of Heraklion, University of Crete, Voutes, 71110, Heraklion, Crete, Greece
| | - E Papadakis
- Intensive Care Medicine Department, University Hospital of Heraklion, University of Crete, Voutes, 71110, Heraklion, Crete, Greece
| | - E Kondili
- Intensive Care Medicine Department, University Hospital of Heraklion, University of Crete, Voutes, 71110, Heraklion, Crete, Greece
| | - D Georgopoulos
- Intensive Care Medicine Department, University Hospital of Heraklion, University of Crete, Voutes, 71110, Heraklion, Crete, Greece
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17
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Inci K, Macit Aydın E, Aygencel G, Türkoğlu M. Association between nutritional risk status and both diaphragmatic dysfunction and diaphragm atrophy in medical ıntensive care unit patients. NUTR HOSP 2024. [PMID: 38450486 DOI: 10.20960/nh.05011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024] Open
Abstract
AIM critical illness often leads to malnutrition and diaphragmatic dysfunction (DD), common in intensive care units (ICU). Ultrasonography (US) is a potent tool for detecting DD. This study examines the connection between malnutrition risk and DD in ICU patients using ultrasonographic diaphragm measurements in medical ICU patients. METHODS we assessed nutritional risk using risk screening tools and mid-upper arm circumference measurements (MUAC). Diaphragm atrophy (DA) and DD were evaluated by measuring diaphragmatic excursion (DE), thickness, and thickening fraction (TF) by US. We then compared these diaphragmatic measurements in patients based on their nutritional risk scores. RESULTS of the fifty patients studied, 54 % to 78 % were at risk of malnutrition, 28 % exhibited diaphragm atrophy (DA), and 24 % showed DD upon ICU admission. Malnutrition risk diagnosed by all nutritional risk screening tools was significantly more frequent in patients with DD, while diagnosed by MUAC was considerably higher in patients with DA. A total of 16 patients (32 %) died during their ICU stay, with DD, DA, and malnutrition risks (as identified by the mNUTRIC Score) being more prevalent among non-survivors (p < 0.05). Malnutrition risk (as determined by the mNUTRIC Score) was an independent risk factor for DD [OR (95 % CI): 6.6 (1.3-34), p = 0.03]. CONCLUSION malnutrition risk may be significantly associated with DD and DA in medical ICU patients upon ICU admission.
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Affiliation(s)
- Kamil Inci
- Department of Internal Medicine. Division of Critical Care. Faculty of Medicine. Gazi University
| | | | - Gulbin Aygencel
- Department of Internal Medicine. Division of Critical Care. Faculty of Medicine. Gazi University
| | - Melda Türkoğlu
- Department of Internal Medicine. Division of Critical Care. Faculty of Medicine. Gazi University
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18
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Al-Husinat L, Jouryyeh B, Rawashdeh A, Robba C, Silva PL, Rocco PRM, Battaglini D. The Role of Ultrasonography in the Process of Weaning from Mechanical Ventilation in Critically Ill Patients. Diagnostics (Basel) 2024; 14:398. [PMID: 38396437 PMCID: PMC10888003 DOI: 10.3390/diagnostics14040398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 01/22/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024] Open
Abstract
Weaning patients from mechanical ventilation (MV) is a complex process that may result in either success or failure. The use of ultrasound at the bedside to assess organs may help to identify the underlying mechanisms that could lead to weaning failure and enable proactive measures to minimize extubation failure. Moreover, ultrasound could be used to accurately identify pulmonary diseases, which may be responsive to respiratory physiotherapy, as well as monitor the effectiveness of physiotherapists' interventions. This article provides a comprehensive review of the role of ultrasonography during the weaning process in critically ill patients.
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Affiliation(s)
- Lou’i Al-Husinat
- Department of Clinical Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan;
| | - Basil Jouryyeh
- Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan; (B.J.); (A.R.)
| | - Ahlam Rawashdeh
- Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan; (B.J.); (A.R.)
| | - Chiara Robba
- Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy;
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, 16132 Genova, Italy
| | - Pedro Leme Silva
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Rio de Janeiro 21941, Brazil; (P.L.S.); (P.R.M.R.)
| | - Patricia Rieken Macedo Rocco
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Rio de Janeiro 21941, Brazil; (P.L.S.); (P.R.M.R.)
| | - Denise Battaglini
- Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy;
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Marques MR, Pereira JM, Paiva JA, de Casasola-Sánchez GG, Tung-Chen Y. Ultrasonography to Access Diaphragm Dysfunction and Predict the Success of Mechanical Ventilation Weaning in Critical Care: A Narrative Review. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:223-236. [PMID: 37915259 DOI: 10.1002/jum.16363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/09/2023] [Indexed: 11/03/2023]
Abstract
INTRODUCTION Weaning failure is common in mechanically ventilated patients, and whether ultrasound (US) can predict weaning outcome remains controversial. This review aims to evaluate the diaphragmatic function measured by US as a predictor of weaning outcome. METHODS PubMed was searched to identify original articles about the use of diaphragmatic US in ICU patients. A total of 61 citations were retrieved initially; available data of 26 studies were included in this review. RESULTS To assess diaphragmatic dysfunction in adults, six studies evaluated excursion, five evaluated thickening fraction, and both in nine. Despite heterogeneity in the diagnostic accuracy of diaphragm US among the studies, the sonographic indices showed good diagnostic performance for predicting weaning outcome. CONCLUSIONS Diaphragmatic US can be a useful and accurate tool to detect diaphragmatic dysfunction in critically ill patients and predict weaning outcome.
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Affiliation(s)
- Marta Rafael Marques
- Department of Intensive Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - José Manuel Pereira
- Department of Intensive Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Medicine, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - José Artur Paiva
- Department of Intensive Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Medicine, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | | | - Yale Tung-Chen
- Department of Internal Medicine, Hospital Universitario La Paz, Madrid, Spain
- Department of Medicine, Universidad Alfonso X, Villanueva de la Cañada, Madrid, Spain
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Ma J, Zhang H, Pang X, Zhang J, Zhao R, Wang J, Chang X, Guo J, Zhang W. Diaphragmatic ultrasonography as a predictor of respiratory muscle fatigue in myasthenia gravis. Muscle Nerve 2024; 69:199-205. [PMID: 38124677 DOI: 10.1002/mus.28020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 11/29/2023] [Accepted: 12/10/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION/AIMS Easy fatigability, the clinical hallmark of generalized myasthenia gravis (GMG), cannot be detected in a dynamic way. The aim of this study was to assess respiratory function dynamically through diaphragmatic ultrasonography (DUS) in GMG patients. METHODS GMG patients and controls were recruited in a 1:1 ratio. DUS was performed during one quiet breath and 15 consecutive deep breaths. The diaphragm thicknesses were measured at different positions. Diaphragm thickening fraction (TFdi) and the maximal change in diaphragm thickness (Tmax) during 15 consecutive deep breaths were calculated and transformed to normality, named N-TFdi and N-Tmax, respectively. The percentages of changes in TFdi and Tmax compared with baseline were named ΔTFdi and ΔTmax, respectively. The diagnostic parameter for respiratory muscle fatigue was chosen from ΔTFdi and ΔTmax at different deep breath times according to their ability to distinguish GMG patients from controls and the interrater reliability of TFdi and Tmax. RESULTS Thirty-four GMG patients and 30 healthy controls were enrolled. N-TFdi and N-Tmax significantly changed as the number of deep breaths increased (p < .001) in GMG patients, but not in controls. ΔTmax of the 15th deep breath (ΔTmax15) was selected as the diagnostic parameter for respiratory muscle fatigue. There were no significant differences in percentage of predicted values of forced vital capacity and arterial partial pressure of carbon dioxide between patients with normal and abnormal ΔTmax15. DISCUSSION DUS could identify diaphragm fatiguability in GMG patients, which may be more reliable and sensitive in assessment of diaphragm fatigue than conventional methods.
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Affiliation(s)
- Jing Ma
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
- First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Huiqiu Zhang
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
- First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Xiaomin Pang
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Jing Zhang
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Rongjuan Zhao
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Juan Wang
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Xueli Chang
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Junhong Guo
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Wei Zhang
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
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21
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Gong S, Ding X, Wang X. Assessment of Pulmonary Circulation of Critically Ill Patients Based on Critical Care Ultrasound. J Clin Med 2024; 13:722. [PMID: 38337417 PMCID: PMC10856787 DOI: 10.3390/jcm13030722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/01/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
Pulmonary circulation is crucial in the human circulatory system, facilitating the oxygenation of blood as it moves from the right heart to the lungs and then to the left heart. However, during critical illness, pulmonary microcirculation can be vulnerable to both intrapulmonary and extrapulmonary injuries. To assess these potential injuries in critically ill patients, critical point-of-care ultrasound can be used to quantitatively and qualitatively evaluate the right atrium, right ventricle, pulmonary artery, lung, pulmonary vein, and left atrium along the direction of blood flow. This assessment is particularly valuable for common ICU diseases such as acute respiratory distress syndrome (ARDS), sepsis, pulmonary hypertension, and cardiogenic pulmonary edema. It has significant potential for diagnosing and treating these conditions in critical care medicine.
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Affiliation(s)
| | - Xin Ding
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Beijing 100730, China;
| | - Xiaoting Wang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Beijing 100730, China;
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22
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Gong S, Lian H, Ding X, Wang X. High Respiratory and Cardiac Drive Exacerbate Secondary Lung Injury in Patients With Critical Illness. J Intensive Care Med 2024:8850666231222220. [PMID: 38173252 DOI: 10.1177/08850666231222220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
The high respiratory and cardiac drive is essential to the host-organ unregulated response. When a primary disease and an unregulated secondary response are uncontrolled, the patient may present in a high respiratory and cardiac drive state. High respiratory drive can cause damage to the lungs, pulmonary circulation, and diaphragm, while high cardiac drive can lead to fluid leakage and infiltration as well as pulmonary interstitial edema. A "respiratory and cardiac dual high drive" state may be a sign of an unregulated response and can lead to secondary lung injury through the increase of transvascular pressure and pulmonary microcirculation injury. Ultrasound examination of the lung, heart, and diaphragm is important when evaluating the phenotype of high respiratory drive in critically ill patients. Ultrasound assessment can guide sedation, analgesia, and antistress treatment and reduce the risk of high respiratory and cardiac drive-induced lung injury in these patients.
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Affiliation(s)
- Shiyi Gong
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Hui Lian
- Department of Health Care, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xin Ding
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoting Wang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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23
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Umbrello M, Brogi E, Formenti P, Corradi F, Forfori F. Ultrasonographic Features of Muscular Weakness and Muscle Wasting in Critically Ill Patients. J Clin Med 2023; 13:26. [PMID: 38202033 PMCID: PMC10780243 DOI: 10.3390/jcm13010026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/12/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
Muscle wasting begins as soon as in the first week of one's ICU stay and patients with multi-organ failure lose more muscle mass and suffer worse functional impairment as a consequence. Muscle wasting and weakness are mainly characterized by a generalized, bilateral lower limb weakness. However, the impairment of the respiratory and/or oropharyngeal muscles can also be observed with important consequences for one's ability to swallow and cough. Muscle wasting represents the result of the disequilibrium between breakdown and synthesis, with increased protein degradation relative to protein synthesis. It is worth noting that the resulting functional disability can last up to 5 years after discharge, and it has been estimated that up to 50% of patients are not able to return to work during the first year after ICU discharge. In recent years, ultrasound has played an increasing role in the evaluation of muscle. Indeed, ultrasound allows an objective evaluation of the cross-sectional area, the thickness of the muscle, and the echogenicity of the muscle. Furthermore, ultrasound can also estimate the thickening fraction of muscle. The objective of this review is to analyze the current understanding of the pathophysiology of acute skeletal muscle wasting and to describe the ultrasonographic features of normal muscle and muscle weakness.
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Affiliation(s)
- Michele Umbrello
- Department Intensive Care and Anesthesia, ASST Ovest Milanese, Ospedale Nuovo di Legnano, 20025 Legnano, Italy
| | - Etrusca Brogi
- Department Anaesthesia and Intensive Care, University of Pisa, 56126 Pisa, Italy
| | - Paolo Formenti
- Departement of Anesthesia and Intensive Care, ASST Nord Milano, Ospedale E Bassini, 20092 Cinisello Balsamo, Italy
| | - Francesco Corradi
- Department Anaesthesia and Intensive Care, University of Pisa, 56126 Pisa, Italy
| | - Francesco Forfori
- Department Anaesthesia and Intensive Care, University of Pisa, 56126 Pisa, Italy
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24
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Olímpio Júnior H, Camilo GB, Marques JA, Xavier RS, Santos CE, Lopes AJ. Effects of transcutaneous electrical diaphragmatic stimulation in critically ill elderly patients: a randomized controlled trial. Physiother Theory Pract 2023:1-10. [PMID: 38044840 DOI: 10.1080/09593985.2023.2289053] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/25/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Elderly patients under invasive mechanical ventilation (IMV) are more susceptible to muscle weakness. In the out-of-hospital environment, there are benefits to transcutaneous electrical diaphragmatic stimulation (TEDS), which is an easy-to-apply and low-cost technique. OBJECTIVE To evaluate the effect of TEDS on respiratory muscle strength, diaphragm thickness (DT), and IMV time in critically ill elderly patients. METHODS This was a randomized controlled trial in which patients were divided into an experimental group (EG) and a control group (CG). TEDS started 24 h after orotracheal intubation and lasted until the end of weaning. Both groups underwent the following assessments during the spontaneous breathing test after weaning from mechanical ventilation (MV): measurement of respiratory muscle strength by pressure gauge, analysis of DT by lung ultrasound, and extubation failure prevention checklist. RESULTS There were 23 participants in the EG and 21 in the CG. The median age was 66 (60-79) years. The mean values of the diaphragmatic thickening index in the EG and CG participants were 99.13 ± 26.75 and 66.88 ± 31.77, respectively (p = .001, Cohen's d = 1.094). The mean values of maximum inspiratory pressure in the EG and CG were 22.04 ± 3.41 and 19.34 ± 4.23 cmH2O, respectively (p = .005, Cohen's d = 0.698). The Tobin index and the integrative weaning index were similar between groups (p = .584 and p = .102, respectively). The duration of MV in the EG and CG was 6.28 ± 2.68 and 9.21 ± 2.76 days, respectively (p = .001, Cohen's d = -1.075). CONCLUSION Critically ill elderly patients receiving TEDS had shorter MV time, greater inspiratory muscle strength, and greater diaphragmatic contraction capacity according to their thickness fraction.
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Affiliation(s)
- Hebert Olímpio Júnior
- Postgraduate Programme in Medical Sciences, School of Medical Sciences, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Gustavo Bittencourt Camilo
- Postgraduate Programme in Medical Sciences, School of Medical Sciences, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
- Faculty of Medical and Health Sciences of Juiz de Fora (SUPREMA), Minas Gerais, Brazil
| | | | - Rosemere Saldanha Xavier
- Local Development Postgraduate Programme, Centro Universitario Augusto Motta (UNISUAM), Rio de Janeiro, Brazil
| | - Carlos Eduardo Santos
- Rehabilitation Sciences Postgraduate Programme, Centro Universitario Augusto Motta (UNISUAM), Rio de Janeiro, Brazil
| | - Agnaldo José Lopes
- Postgraduate Programme in Medical Sciences, School of Medical Sciences, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
- Local Development Postgraduate Programme, Centro Universitario Augusto Motta (UNISUAM), Rio de Janeiro, Brazil
- Rehabilitation Sciences Postgraduate Programme, Centro Universitario Augusto Motta (UNISUAM), Rio de Janeiro, Brazil
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25
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Scarlata S, Okoye C, Zotti S, Lauretani F, Nouvenne A, Cerundolo N, Bruni AA, Torrini M, Finazzi A, Mazzarone T, Lunian M, Zucchini I, Maccioni L, Guarino D, Fabbri Della Faggiola S, Capacci M, Bianco MG, Guarona G, Bellelli G, Monzani F, Virdis A, Antonelli Incalzi R, Ungar A, Ticinesi A. Advancing healthcare through thoracic ultrasound research in older patients. Aging Clin Exp Res 2023; 35:2887-2901. [PMID: 37950845 PMCID: PMC10721707 DOI: 10.1007/s40520-023-02590-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/08/2023] [Indexed: 11/13/2023]
Abstract
This paper reports the proceedings of a meeting convened by the Research Group on Thoracic Ultrasound in Older People of the Italian Society of Gerontology and Geriatrics, to discuss the current state-of-the-art of clinical research in the field of geriatric thoracic ultrasound and identify unmet research needs and potential areas of development. In the last decade, point-of-care thoracic ultrasound has entered clinical practice for diagnosis and management of several respiratory illnesses, such as bacterial and viral pneumonia, pleural effusion, acute heart failure, and pneumothorax, especially in the emergency-urgency setting. Very few studies, however, have been specifically focused on older patients with frailty and multi-morbidity, who frequently exhibit complex clinical pictures needing multidimensional evaluation. At the present state of knowledge, there is still uncertainty on the best requirements of ultrasound equipment, methodology of examination, and reporting needed to optimize the advantages of thoracic ultrasound implementation in the care of geriatric patients. Other issues regard differential diagnosis between bacterial and aspiration pneumonia, objective grading of interstitial syndrome severity, quantification and monitoring of pleural effusions and solid pleural lesions, significance of ultrasonographic assessment of post-COVID-19 sequelae, and prognostic value of assessment of diaphragmatic thickness and motility. Finally, application of remote ultrasound diagnostics in the community and nursing home setting is still poorly investigated by the current literature. Overall, the presence of several open questions on geriatric applications of thoracic ultrasound represents a strong call to implement clinical research in this field.
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Affiliation(s)
- Simone Scarlata
- Operative Research Unit of Internal Medicine, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Rome, Italy
- Department of Medicine and Surgery, Research Unit of Geriatrics, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Chukwuma Okoye
- School of Medicine and Surgery, University of Milano-Bicocca, Via Giovanni Battista Pergolesi 33, 20900, Monza, Italy.
- Department of Neurobiology, Care Sciences and Society, Department of Geriatrics Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
| | - Sonia Zotti
- Department of Medicine and Surgery, Research Unit of Geriatrics, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Fulvio Lauretani
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Antonio Nouvenne
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Nicoletta Cerundolo
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Adriana Antonella Bruni
- Acute Geriatric Unit, Fondazione IRCCS San Gerardo de Tintori, Via Giovanni Battista Pergolesi 33, 20900, Monza, Italy
| | - Monica Torrini
- Geriatrics and Intensive Care Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Alberto Finazzi
- School of Medicine and Surgery, University of Milano-Bicocca, Via Giovanni Battista Pergolesi 33, 20900, Monza, Italy
| | - Tessa Mazzarone
- Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Marco Lunian
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Irene Zucchini
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Lorenzo Maccioni
- Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Daniela Guarino
- Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | | | - Marco Capacci
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Maria Giovanna Bianco
- Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Guglielmo Guarona
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Giuseppe Bellelli
- School of Medicine and Surgery, University of Milano-Bicocca, Via Giovanni Battista Pergolesi 33, 20900, Monza, Italy
- Acute Geriatric Unit, Fondazione IRCCS San Gerardo de Tintori, Via Giovanni Battista Pergolesi 33, 20900, Monza, Italy
| | - Fabio Monzani
- Casa di Cura Venerabile Confraternita di Misericordia Navacchio, 56023, Pisa, Italy
| | - Agostino Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Raffaele Antonelli Incalzi
- Operative Research Unit of Internal Medicine, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Rome, Italy
- Department of Medicine and Surgery, Research Unit of Geriatrics, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Andrea Ungar
- Geriatrics and Intensive Care Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Andrea Ticinesi
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
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He G, Han Y, Zhan Y, Yao Y, Zhou H, Zheng X. The combined use of parasternal intercostal muscle thickening fraction and P0.1 for prediction of weaning outcomes. Heart Lung 2023; 62:122-128. [PMID: 37480723 DOI: 10.1016/j.hrtlng.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND A variety of parameters and diaphragmatic ultrasound in ventilator weaning has been studied extensively, and the findings yield inconsistent conclusions. The parasternal intercostal muscle holds important substantial respiratory reserve capacity when the central drive is enhanced, the predictive value of combining parasternal intercostal muscle ultrasound parameters with P0.1(airway occlusion pressure at 100 msec) in assessing ventilator weaning outcomes is still unknown. OBJECTIVES Our study aimed to evaluate the predictive efficacy of parasternal intercostal muscle ultrasound in conjunction with P0.1 in determining weaning failure. METHODS We recruited patients who had been admitted to ICU and had been receiving mechanical ventilation for over two days. All patients underwent a half-hour spontaneous breathing trial (SBT) with low-level pressure support ventilation (PSV). They were positioned semi-upright for parasternal intercostal muscle ultrasound evaluations, including parasternal intercostal muscle thickness (PIMT), and parasternal intercostal muscle thickening fraction (PIMTF); P0.1 was obtained from the ventilator. Weaning failure was defined as the need for non-invasive positive pressure ventilation or re-intubation within 48 h post-weaning. RESULTS Of the 56 enrolled patients with a mean age of 63.04 ± 15.80 years, 13 (23.2%) experienced weaning failure. There were differences in P0.1 (P = .001) and PIMTF (P = .017) between the two groups, but also in patients with a diaphragm thickness ≥ 2 mm. The predictive threshold values were PIMTF ≥ 13.15% and P0.1 ≥ 3.9 cmH2O for weaning failure. The AUROC for predicting weaning failure was 0.721 for PIMTF, 0.792 for P0.1, and 0.869 for the combination of PIMTF and P0.1. CONCLUSIONS The parasternal intercostal muscle thickening fraction and P0.1 are independently linked to weaning failure, especially in patients with normal diaphragm thickness. The combination of parasternal intercostal muscle thickening fraction and P0.1 can serve as a valuable tool for the precise clinical prediction of weaning outcomes. TRIAL REGISTRATION Chinese Clinical Trial Registry website (ChiCTR2200065422).
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Affiliation(s)
- Guojun He
- Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, PR China; Key Laboratory of Clinical Evaluation Technology for Medical Device of Zhejiang Province, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, PR China
| | - Yijiao Han
- Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, PR China
| | - Yasheng Zhan
- Department of Critical Care Medicine, Jinhua People's Hospital, Jinhua, Zhejiang 321000, PR China
| | - Yake Yao
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, PR China
| | - Hua Zhou
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, PR China.
| | - Xia Zheng
- Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, PR China; Key Laboratory of Clinical Evaluation Technology for Medical Device of Zhejiang Province, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, PR China.
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27
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Varón-Vega F, Giraldo-Cadavid LF, Uribe AM, Rincón A, Palacios J, Crevoisier S, Tuta-Quintero E, Ordoñez L, Boada N, Rincón P, Poveda M, Monedero P. Utilization of spontaneous breathing trial, objective cough test, and diaphragmatic ultrasound results to predict extubation success: COBRE-US trial. Crit Care 2023; 27:414. [PMID: 37908002 PMCID: PMC10617213 DOI: 10.1186/s13054-023-04708-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/24/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND The results of clinical and weaning readiness tests and the spontaneous breathing trial (SBT) are used to predict the success of the weaning process and extubation. METHODS We evaluated the capacity of the cuff leak test, rate of rapid and shallow breathing, cough intensity, and diaphragmatic contraction velocity (DCV) to predict the success of the SBT and extubation in a prospective, multicenter observational study with consecutive adult patients admitted to four intensive care units. We used receiver operating characteristic (ROC) curves to assess the tests' predictive capacity and built predictive models using logistic regression. RESULTS We recruited 367 subjects who were receiving invasive mechanical ventilation and on whom 456 SBTs were performed, with a success rate of 76.5%. To predict the success of the SBT, we derived the following equation: (0.56 × Cough) - (0.13 × DCV) + 0.25. When the cutoff point was ≥ 0.83, the sensitivity was 91.5%, the specificity was 22.1%, and the overall accuracy was 76.2%. The area under the ROC curve (AUC-ROC) was 0.63. To predict extubation success, we derived the following equation: (5.7 × SBT) + (0.75 × Cough) - (0.25 × DCV) - 4.5. When the cutoff point was ≥ 1.25, the sensitivity was 96.8%, the specificity was 78.4%, and the overall accuracy was 91.5%. The AUC-ROC of this model was 0.91. CONCLUSION Objective measurement of cough and diaphragmatic contraction velocity could be used to predict SBT success. The equation for predicting successful extubation, which includes SBT, cough, and diaphragmatic contraction velocity values, showed excellent discriminative capacity.
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Affiliation(s)
- Fabio Varón-Vega
- Critical Care and Lung Transplantation Service, Fundación Neumológica Colombiana, Fundación Cardio Infantil, Bogotá, Colombia.
- Critical Care Service, Fundación Neumológica Colombiana, Fundación Cardio Infantil, Cra. 13B #161 - 85, 110131, Bogotá, Colombia.
| | - Luis F Giraldo-Cadavid
- Interventional Pulmonology Service, Fundación Neumológica Colombiana, Bogotá, Colombia
- School of Medicine, Universidad de La Sabana, Chía, Colombia
| | - Ana María Uribe
- Critical Care Service, Fundación Neumológica Colombiana, Fundación Cardio Infantil, Cra. 13B #161 - 85, 110131, Bogotá, Colombia
| | - Adriana Rincón
- Critical Care and Lung Transplantation Service, Fundación Neumológica Colombiana, Fundación Cardio Infantil, Bogotá, Colombia
| | - Jonathan Palacios
- Critical Care Service, Fundación Neumológica Colombiana, Fundación Cardio Infantil, Cra. 13B #161 - 85, 110131, Bogotá, Colombia
| | - Stephanie Crevoisier
- Critical Care Service, Fundación Neumológica Colombiana, Fundación Cardio Infantil, Cra. 13B #161 - 85, 110131, Bogotá, Colombia
| | | | - Lina Ordoñez
- Critical Care Service, Fundación Neumológica Colombiana, Fundación Cardio Infantil, Cra. 13B #161 - 85, 110131, Bogotá, Colombia
| | - Natalia Boada
- Critical Care Service, Fundación Neumológica Colombiana, Fundación Cardio Infantil, Cra. 13B #161 - 85, 110131, Bogotá, Colombia
- Critical Care Service, Fundación Clínica Shaio, Bogotá, Colombia
| | - Paola Rincón
- Critical Care Service, Fundación Neumológica Colombiana, Fundación Cardio Infantil, Cra. 13B #161 - 85, 110131, Bogotá, Colombia
- Critical Care Service, Fundación Clínica Shaio, Bogotá, Colombia
| | - Marcela Poveda
- Critical Care Service, Fundación Clínica Shaio, Bogotá, Colombia
| | - Pablo Monedero
- School of Medicine, Universidad de Navarra, Pamplona, Spain
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Bosch-Compte R, Parrilla FJ, Muñoz-Bermúdez R, Dot I, Climent C, Masclans JR, Marin-Corral J, Pérez-Terán P. Comparing lung aeration and respiratory effort using two different spontaneous breathing trial: T-piece vs pressure support ventilation. Med Intensiva 2023:S2173-5727(23)00131-5. [PMID: 37798153 DOI: 10.1016/j.medine.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/27/2023] [Accepted: 06/30/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVE To assess the changes in lung aeration and respiratory effort generated by two different spontaneous breathing trial (SBT): T-piece (T-T) vs pressure support ventilation (PSV). DESIGN Prospective, interventionist and randomized study. SETTING Intensive Care Unit (ICU) of Hospital del Mar. PARTICIPANTS Forty-three ventilated patients for at least 24 h and considered eligible for an SBT were included in the study between October 2017 and March 2020. INTERVENTIONS 30-min SBT with T-piece (T-T group, 20 patients) or 8-cmH2O PSV and 5-cmH2O positive end expiratory pressure (PSV group, 23 patients). MAIN VARIABLES OF INTEREST Demographics, clinical data, physiological variables, lung aeration evaluated with electrical impedance tomography (EIT) and lung ultrasound (LUS), and respiratory effort using diaphragmatic ultrasonography (DU) were collected at different timepoints: basal (BSL), end of SBT (EoSBT) and one hour after extubation (OTE). RESULTS There were a loss of aeration measured with EIT and LUS in the different study timepoints, without statistical differences from BSL to OTE, between T-T and PSV [LUS: 3 (1, 5.5) AU vs 2 (1, 3) AU; p = 0.088; EELI: -2516.41 (-5871.88, 1090.46) AU vs -1992.4 (-3458.76, -5.07) AU; p = 0.918]. Percentage of variation between BSL and OTE, was greater when LUS was used compared to EIT (68.1% vs 4.9%, p ≤ 0.001). Diaphragmatic excursion trend to decrease coinciding with a loss of aeration during extubation. CONCLUSION T-T and PSV as different SBT strategies in ventilated patients do not show differences in aeration loss, nor estimated respiratory effort or tidal volume measured by EIT, LUS and DU.
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Affiliation(s)
- Raquel Bosch-Compte
- Critical Care Department, Hospital del Mar, Critical Illness Research Group (GREPAC), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.
| | - Francisco José Parrilla
- Critical Care Department, Hospital del Mar, Critical Illness Research Group (GREPAC), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Rosana Muñoz-Bermúdez
- Critical Care Department, Hospital del Mar, Critical Illness Research Group (GREPAC), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Irene Dot
- Critical Care Department, Hospital del Mar, Critical Illness Research Group (GREPAC), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Cristina Climent
- Critical Care Department, Hospital del Mar, Critical Illness Research Group (GREPAC), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Joan Ramon Masclans
- Critical Care Department, Hospital del Mar, Critical Illness Research Group (GREPAC), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; Medicine and Life Sciences Department (MELIS), Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Judith Marin-Corral
- Critical Care Department, Hospital del Mar, Critical Illness Research Group (GREPAC), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; Division of Pulmonary Diseases & Critical Care Medicine, South Texas Veterans Health Care System and University of Texas Health San Antonio, San Antonio, TX, USA
| | - Purificación Pérez-Terán
- Critical Care Department, Hospital del Mar, Critical Illness Research Group (GREPAC), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
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Havaldar AA, Krishna B. Wean to Win. Indian J Crit Care Med 2023; 27:695-696. [PMID: 37908418 PMCID: PMC10613874 DOI: 10.5005/jp-journals-10071-24556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023] Open
Abstract
How to cite this article: Havaldar AA, Krishna B. Wean to Win. Indian J Crit Care Med 2023;27(10):695-696.
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Affiliation(s)
- Amarja Ashok Havaldar
- Department of Critical Care, St. John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Bhuvana Krishna
- Department of Critical Care, St. John's Medical College Hospital, Bengaluru, Karnataka, India
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30
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Serrano DAR, Terán PP, Blancas R, Arroyo M. Pleuropulmonary and diaphragmatic ultrasound in intensive care medicine. Med Intensiva 2023; 47:594-602. [PMID: 37858366 DOI: 10.1016/j.medine.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 06/23/2023] [Indexed: 10/21/2023]
Abstract
The usefulness of ultrasound for chest exploration was described in 1968. It was not until the 1990s, when its use became widespread in Intensive Care Units as a diagnostic, monitoring and procedural guide tool. The fact that it is a non-invasive tool, accessible at the bedside, with a sensitivity and specificity close to computerized tomography (CT) and with a short learning curve, have made it a mandatory technique in the management of critically ill patients. It is essential to know that there are different air/fluid ratio generated by different pathologies that gives rise to one echographic pattern or another. The identification of these patterns together with the clinical information will allow to make an accurate diagnosis in most settings of respiratory failure. Likewise, we must not forget the importance of evaluating diaphragmatic function by ultrasound during weaning from mechanical ventilation.
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Affiliation(s)
- Diego Aníbal Rodríguez Serrano
- Servicio de Medicina Intensiva, Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain; Universidad Alfonso X el Sabio, Madrid, Spain
| | - Purificación Pérez Terán
- Servicio Medicina Intensiva, Hospital del Mar, Barcelona, Spain; Grupo de Investigación en Patología Crítica (GREPAC), Instituto de Investigaciones Médicas Hospital del Mar (IMIM), Barcelona, Spain; Universidad Pompeu Fabra, Barcelona, Spain.
| | - Rafael Blancas
- Universidad Alfonso X el Sabio, Madrid, Spain; Servicio de Medicina Intensiva, Hospital Universitario del Tajo, Aranjuez, Spain.
| | - Marta Arroyo
- Servicio de Medicina Intensiva, Hospital Universitario de Burgos, Burgos, Spain
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31
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Yakut H, Yalcinkaya G, Ozyurek S, Ozalevli S, Salik Sengul Y, Birlik M. Assessment of diaphragmatic function by ultrasonography in patients with systemic sclerosis and its relation to clinical parameters : A case-control study. Wien Klin Wochenschr 2023; 135:528-537. [PMID: 37010595 DOI: 10.1007/s00508-023-02163-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/12/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Diaphragmatic function can be affected in many diseases and disorders. Although systemic sclerosis (SSc) is a serious connective tissue disease that affects not only the skin but also the pulmonary and musculoskeletal systems, there is insufficient information about diaphragm function. AIMS To compare the diaphragmatic parameters by ultrasonography (USG) in patients with SSc and healthy individuals and examine the relationship between these parameters and clinical features in patients with SSc. METHODS This study included 13 patients with SSc and 15 healthy individuals. Muscle thickness (in deep inspiration Tins and at the end of calm expiration Texp), changes in thickness (∆T), and thickening fraction at deep breathing were evaluated by USG. Skin thickness, pulmonary function tests, respiratory muscle strength, and the perception of dyspnea were measured as clinical features. RESULTS The results of Texp, Tins, and ∆T were similar in both groups (p > 0.05), albeit patients in the SSc group had less thickening fraction compared to the control group (79.9 ± 36.7 cm and 103.8 ± 20.6 cm, respectively, p < 0.05). The Tins, ∆T, and thickening fraction of the diaphragm were associated with skin thickness, pulmonary function test parameters, and respiratory muscle strength (p < 0.05). Besides, there was significant correlation between muscle thickening fraction and perception of dyspnea (p < 0.05). CONCLUSION These results confirm that diaphragm thickness and contractility can be affected in patients with SSc. Therefore, ultrasonographic evaluation of the diaphragm can play a complementary role to pulmonary function test and respiratory muscle strength measurement in the diagnosis and follow-up of patients with SSc.
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Affiliation(s)
- Hazal Yakut
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Buyukdere Meselik Campus, Eskisehir Osmangazi University, 26040, Eskisehir, Turkey.
| | - Gamze Yalcinkaya
- Institute of Health Sciences, Dokuz Eylul University, Izmir, Turkey
| | - Seher Ozyurek
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
| | - Sevgi Ozalevli
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
| | - Yesim Salik Sengul
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
| | - Merih Birlik
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University, Izmir, Turkey
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32
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Visagan R, Boseta E, Zoumprouli A, Papadopoulos MC, Saadoun S. Spinal cord perfusion pressure correlates with breathing function in patients with acute, cervical traumatic spinal cord injuries: an observational study. Crit Care 2023; 27:362. [PMID: 37730639 PMCID: PMC10512582 DOI: 10.1186/s13054-023-04643-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/09/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVE This study aims to determine the relationship between spinal cord perfusion pressure (SCPP) and breathing function in patients with acute cervical traumatic spinal cord injuries. METHODS We included 8 participants without cervical TSCI plus 13 patients with cervical traumatic spinal cord injuries, American Spinal Injury Association Impairment Scale grades A-C. In the TSCI patients, we monitored intraspinal pressure from the injury site for up to a week and computed the SCPP as mean arterial pressure minus intraspinal pressure. Breathing function was quantified by diaphragmatic electromyography using an EDI (electrical activity of the diaphragm) nasogastric tube as well as by ultrasound of the diaphragm and the intercostal muscles performed when sitting at 20°-30°. RESULTS We analysed 106 ultrasound examinations (total 1370 images/videos) and 198 EDI recordings in the patients with cervical traumatic spinal cord injuries. During quiet breathing, low SCPP (< 60 mmHg) was associated with reduced EDI-peak (measure of inspiratory effort) and EDI-min (measure of the tonic activity of the diaphragm), which increased and then plateaued at SCPP 60-100 mmHg. During quiet and deep breathing, the diaphragmatic thickening fraction (force of diaphragmatic contraction) plotted versus SCPP had an inverted-U relationship, with a peak at SCPP 80-90 mmHg. Diaphragmatic excursion (up and down movement of the diaphragm) during quiet breathing did not correlate with SCPP, but diaphragmatic excursion during deep breathing plotted versus SCPP had an inverse-U relationship with a peak at SCPP 80-90 mmHg. The thickening fraction of the intercostal muscles plotted versus SCPP also had inverted-U relationship, with normal intercostal function at SCPP 80-100 mmHg, but failure of the upper and middle intercostals to contract during inspiration (i.e. abdominal breathing) at SCPP < 80 or > 100 mmHg. CONCLUSIONS After acute, cervical traumatic spinal cord injuries, breathing function depends on the SCPP. SCPP 80-90 mmHg correlates with optimum diaphragmatic and intercostal muscle function. Our findings raise the possibility that intervention to maintain SCPP in this range may accelerate ventilator liberation which may reduce stay in the neuro-intensive care unit.
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Affiliation(s)
- Ravindran Visagan
- Academic Neurosurgery Unit, St. George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Ellaine Boseta
- Academic Neurosurgery Unit, St. George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
- Neuro-anaesthesia and Neuro-intensive Care Unit, St. George's Hospital, London, SW17 0QT, UK
| | - Argyro Zoumprouli
- Neuro-anaesthesia and Neuro-intensive Care Unit, St. George's Hospital, London, SW17 0QT, UK
| | - Marios C Papadopoulos
- Academic Neurosurgery Unit, St. George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Samira Saadoun
- Academic Neurosurgery Unit, St. George's, University of London, Cranmer Terrace, London, SW17 0RE, UK.
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Gu D, Zhang B, Li J, Li Y, Wang Z, Diao J. Diagnostic Value of Pulmonary Ultrasound and Arterial Blood Gas Analysis in Acute Patients with Severe Injuries Complicated by Respiratory Failure-A Retrospective Study. J Multidiscip Healthc 2023; 16:2707-2714. [PMID: 37727596 PMCID: PMC10505646 DOI: 10.2147/jmdh.s424667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/01/2023] [Indexed: 09/21/2023] Open
Abstract
Background To investigate the early application of pulmonary ultrasonography and arterial blood gas analysis in critical patients with severe multiple injuries exacerbated by respiratory failure. Patients and Methods The retrospective selection was performed on 81 patients admitted to our critical care unit between January 2020 and January 2021 with severe multiple injuries rendered worse by respiratory failure. Based on the different examination procedures, the patients were categorised into three groups (n=27): group A; diagnosed with pulmonary ultrasonography, group B; diagnosed with arterial blood gas; and group C; diagnosed with both pulmonary ultrasonography and arterial blood gas analyses. Patients were subsequently divided into a survival group (n = 65) and a death group (n = 16). On an annual basis, patients' prognoses were examined in relation to the predictive value of pulmonary ultrasound. Results Initial diagnosis, diagnosis, and initial correct treatment times were significantly shorter in groups B and C than group A (P<0.05). In contrast, initial diagnosis time, diagnosis time, and initial correct treatment times were potentially shorter in group C than in group B (P<0.05). Compared to groups B and C, group A had a considerably lower diagnosis rate for the examination methods (P<0.05). The right diaphragm displacement and left diaphragm displacement in the survival group were potentially higher than the LUS score (P < 0.05). In contrast, the survival group's lung ultrasound score (LUS) was considerably lower than the death group's. Statistical analysis showed that the predictive values of right diaphragm displacement, left diaphragm displacement, and mean diaphragm displacement were significant compared with the LUS score. The findings of the receiver operating characteristic curve demonstrated that the right, left, and average diaphragm displacements had high predictive values. Conclusion In the early evaluation of patients with severe multiple injuries complicated by respiratory failure, pulmonary ultrasonography combined with arterial blood gas analysis is crucial for the rapid diagnosis and prognosis prediction of patients.
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Affiliation(s)
- Dongming Gu
- Department of Emergency, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, People’s Republic of China
| | - Bo Zhang
- Department of Emergency, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, People’s Republic of China
| | - Jing Li
- Department of Emergency, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, People’s Republic of China
| | - Yanpeng Li
- Department of Emergency, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, People’s Republic of China
| | - Zhihua Wang
- Department of Emergency, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, People’s Republic of China
| | - Jianjun Diao
- Department of Emergency, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, People’s Republic of China
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Takahashi Y, Morisawa T, Okamoto H, Nakanishi N, Matsumoto N, Saitoh M, Takahashi T, Fujiwara T. Diaphragm Dysfunction and ICU-Acquired Weakness in Septic Shock Patients with or without Mechanical Ventilation: A Pilot Prospective Observational Study. J Clin Med 2023; 12:5191. [PMID: 37629233 PMCID: PMC10455261 DOI: 10.3390/jcm12165191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/05/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
Sepsis is a risk factor for diaphragm dysfunction and ICU-acquired weakness (ICU-AW); however, the impact of mechanical ventilation (MV) on these relationships has not been thoroughly investigated. This study aimed to compare the incidence of diaphragm dysfunction and ICU-AW in patients with septic shock, with and without MV. We conducted a single-center prospective observational study that included consecutive patients diagnosed with septic shock admitted to the ICU between March 2021 and February 2022. Ultrasound measurements of diaphragm thickness and manual measurements of limb muscle strength were repeated after ICU admission. The incidences of diaphragm dysfunction and ICU-AW, as well as their associations with clinical outcomes, were compared between patients with MV and without MV (non-MV). Twenty-four patients (11 in the MV group and 13 in the non-MV group) were analyzed. At the final measurements in the MV group, eight patients (72.7%) had diaphragm dysfunction, and six patients (54.5%) had ICU-AW. In the non-MV group, 10 patients (76.9%) had diaphragm dysfunction, and three (23.1%) had ICU-AW. No association was found between diaphragm dysfunction and clinical outcomes. Patients with ICU-AW in the MV group had longer ICU and hospital stays. Among patients with septic shock, the incidence of diaphragm dysfunction was higher than that of ICU-AW, irrespective of the use of MV. Further studies are warranted to examine the association between diaphragm dysfunction and clinical outcomes.
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Affiliation(s)
- Yuta Takahashi
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (Y.T.); (T.F.)
- Department of Rehabilitation, St. Luke’s International Hospital, Tokyo 104-8560, Japan
| | - Tomoyuki Morisawa
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo 113-8421, Japan; (M.S.); (T.T.)
| | - Hiroshi Okamoto
- Department of Critical Care Medicine, St. Luke’s International Hospital, Tokyo 104-8560, Japan;
| | - Nobuto Nakanishi
- Division of Disaster and Emergency Medicine, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan;
| | - Noriko Matsumoto
- Department of Nutrition, St. Luke’s International Hospital, Tokyo 104-8560, Japan;
| | - Masakazu Saitoh
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo 113-8421, Japan; (M.S.); (T.T.)
| | - Tetsuya Takahashi
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo 113-8421, Japan; (M.S.); (T.T.)
| | - Toshiyuki Fujiwara
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (Y.T.); (T.F.)
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo 113-8421, Japan; (M.S.); (T.T.)
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Bureau C, Van Hollebeke M, Dres M. Managing respiratory muscle weakness during weaning from invasive ventilation. Eur Respir Rev 2023; 32:32/168/220205. [PMID: 37019456 PMCID: PMC10074167 DOI: 10.1183/16000617.0205-2022] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 11/08/2022] [Indexed: 04/07/2023] Open
Abstract
Weaning is a critical stage of an intensive care unit (ICU) stay, in which the respiratory muscles play a major role. Weakness of the respiratory muscles, which is associated with significant morbidity in the ICU, is not limited to atrophy and subsequent dysfunction of the diaphragm; the extradiaphragmatic inspiratory and expiratory muscles also play important parts. In addition to the well-established deleterious effect of mechanical ventilation on the respiratory muscles, other risk factors such as sepsis may be involved. Weakness of the respiratory muscles can be suspected visually in a patient with paradoxical movement of the abdominal compartment. Measurement of maximal inspiratory pressure is the simplest way to assess respiratory muscle function, but it does not specifically take the diaphragm into account. A cut-off value of -30 cmH2O could identify patients at risk for prolonged ventilatory weaning; however, ultrasound may be better for assessing respiratory muscle function in the ICU. Although diaphragm dysfunction has been associated with weaning failure, this diagnosis should not discourage clinicians from performing spontaneous breathing trials and considering extubation. Recent therapeutic developments aimed at preserving or restoring respiratory muscle function are promising.
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Affiliation(s)
- Côme Bureau
- Sorbonne Université, INSERM, UMR_S1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
- AP-HP Sorbonne Université, Hôpital Pitié-Salpêtrière, Service de Médecine Intensive et Réanimation, Département R3S, Paris, France
| | - Marine Van Hollebeke
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Martin Dres
- Sorbonne Université, INSERM, UMR_S1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
- AP-HP Sorbonne Université, Hôpital Pitié-Salpêtrière, Service de Médecine Intensive et Réanimation, Département R3S, Paris, France
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Maggi L, De Fazio G, Guglielmi R, Coluzzi F, Fiorelli S, Rocco M. COVID-19 Lung Ultrasound Scores and Lessons from the Pandemic: A Narrative Review. Diagnostics (Basel) 2023; 13:diagnostics13111972. [PMID: 37296825 DOI: 10.3390/diagnostics13111972] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023] Open
Abstract
The WHO recently declared that COVID-19 no longer constitutes a public health emergency of international concern; however, lessons learned through the pandemic should not be left behind. Lung ultrasound was largely utilized as a diagnostic tool thanks to its feasibility, easy application, and the possibility to reduce the source of infection for health personnel. Lung ultrasound scores consist of grading systems used to guide diagnosis and medical decisions, owning a good prognostic value. In the emergency context of the pandemic, several lung ultrasound scores emerged either as new scores or as modifications of pre-existing ones. Our aim is to clarify the key aspects of lung ultrasound and lung ultrasound scores to standardize their clinical use in a non-pandemic context. The authors searched on PubMed for articles related to "COVID-19", "ultrasound", and "Score" until 5 May 2023; other keywords were "thoracic", "lung", "echography", and "diaphragm". A narrative summary of the results was made. Lung ultrasound scores are demonstrated to be an important tool for triage, prediction of severity, and aid in medical decisions. Ultimately, the existence of numerous scores leads to a lack of clarity, confusion, and an absence of standardization.
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Affiliation(s)
- Luigi Maggi
- Government of Italy Ministry of Interior, 00189 Rome, Italy
| | - Giulia De Fazio
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy
| | - Riccardo Guglielmi
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy
| | - Flaminia Coluzzi
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, 04100 Latina, Italy
- Unit of Anaesthesia, Intensive Care and Pain Medicine, Sant'Andrea University Hospital, 00189 Rome, Italy
| | - Silvia Fiorelli
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy
| | - Monica Rocco
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy
- Unit of Anaesthesia, Intensive Care and Pain Medicine, Sant'Andrea University Hospital, 00189 Rome, Italy
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Alay GH, Tatlisuluoglu D, Turan G. Evaluation of IntelliVent-ASV® and PS-SIMV Mode Using Ultrasound (US) Measurements in Terms of Diaphragm Atrophy. Cureus 2023; 15:e40244. [PMID: 37309540 PMCID: PMC10257811 DOI: 10.7759/cureus.40244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Mechanical ventilation is a life-saving intervention for critically ill patients, but it can also lead to diaphragm atrophy, which may prolong the duration of mechanical ventilation and the length of stay in the intensive care unit. IntelliVent-ASV® (Hamilton Medical, Rhäzüns, Switzerland) is a new mode of ventilation that has been developed to reduce diaphragm atrophy by promoting spontaneous breathing efforts. In this study, we aimed to evaluate the effectiveness of IntelliVent-ASV® and pressure support-synchronized intermittent mandatory ventilation (PS-SIMV) mode in reducing diaphragm atrophy by measuring diaphragm thickness using ultrasound (US) imaging. METHODS We enrolled 60 patients who required mechanical ventilation due to respiratory failure and were randomized into two groups: IntelliVent-ASV® and PS-SIMV. We measured the diaphragm thickness using US imaging at admission and on the seventh day of mechanical ventilation. RESULTS Our results showed that diaphragm thickness decreased significantly in the PS-SIMV group but remained unchanged in the IntelliVent-ASV® group. The difference in diaphragm thickness between the two groups was statistically significant on the seventh day of mechanical ventilation. CONCLUSIONS IntelliVent-ASV® may reduce diaphragm atrophy by promoting spontaneous breathing efforts. Our study suggests that this new mode of ventilation may be a promising approach to preventing diaphragm atrophy in mechanically ventilated patients. Further studies using invasive measures of diaphragm function are warranted to confirm these findings.
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Affiliation(s)
- Gulcin Hilal Alay
- Intensive Care Unit, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Istanbul, TUR
| | - Derya Tatlisuluoglu
- Intensive Care Unit, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Istanbul, TUR
| | - Guldem Turan
- Intensive Care Unit, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Istanbul, TUR
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Bruna M, Hidalgo G, Castañeda S, Galvez M, Bravo D, Benitez R, Tobar R, Quevedo J, Rodríguez J, Murua C, Madariaga R, Benavides C, Huilcaman M, Martinez F, Retamal J, Kattan E. Diaphragmatic Ultrasound Predictors of High-Flow Nasal Cannula Therapeutic Failure in Critically Ill Patients With SARS-CoV-2 Pneumonia. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:1277-1284. [PMID: 36444988 PMCID: PMC9878163 DOI: 10.1002/jum.16141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 10/19/2022] [Accepted: 11/14/2022] [Indexed: 05/18/2023]
Abstract
OBJECTIVES High flow nasal cannula (HFNC) is frequently used in patients with acute respiratory failure, but there is limited evidence regarding predictors of therapeutic failure. The objective of this study was to assess diaphragmatic ultrasound criteria as predictors of failure to HFNC, defined as the need for orotracheal intubation or death. METHODS Prospective cohort study including adult patients consecutively admitted to the critical care unit, from July 24 to October 20, 2020, with respiratory failure secondary to SARS-CoV-2 pneumonia who required HFNC. After 12 hours of HFNC initiation we measured ROX index (ratio of SpO2 /FiO2 to respiratory rate), excursion and diaphragmatic contraction speed (diaphragmatic excursion/inspiratory time) by ultrasound, both in supine and prone position. RESULTS In total, 41 patients were analyzed, 25 succeeded and 16 failed HFNC therapy. At 12 hours, patients who succeeded HFNC therapy presented higher ROX index in supine position (9.8 [9.1-15.6] versus 5.4 [3.9-6.8], P < .01), and higher PaO2 /FiO2 ratio (186 [135-236] versus 117 [103-162] mmHg, P = .03). To predict therapeutic failure, the supine diaphragmatic contraction speed presented sensitivity of 89% and a specificity of 57%, while the ROX index presented a sensitivity of 92.8% and a specificity of 75%. CONCLUSIONS Diaphragmatic contraction speed by ultrasound emerges as a diagnostic complement to clinical tools to predict HFNC success. Future studies should confirm these results.
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Affiliation(s)
- Mario Bruna
- Intensive Care UnitHospital de QuilpueQuilpueChile
| | | | | | - Miguel Galvez
- Intensive Care UnitHospital Gustavo FrickeViña del MarChile
| | - Diego Bravo
- Intensive Care UnitHospital Gustavo FrickeViña del MarChile
| | | | - Rodolfo Tobar
- Intensive Care UnitHospital Gustavo FrickeViña del MarChile
| | - José Quevedo
- Intensive Care UnitHospital Gustavo FrickeViña del MarChile
| | - José Rodríguez
- Intensive Care UnitHospital Gustavo FrickeViña del MarChile
| | - Camila Murua
- Intensive Care UnitHospital Gustavo FrickeViña del MarChile
| | | | | | | | - Felipe Martinez
- Facultad de Medicina, Escuela de MedicinaUniversidad Andrés BelloViña del MarChile
| | - Jaime Retamal
- Departamento de Medicina Intensiva, Facultad de MedicinaPontificia Universidad Católica de ChileSantiagoChile
| | - Eduardo Kattan
- Departamento de Medicina Intensiva, Facultad de MedicinaPontificia Universidad Católica de ChileSantiagoChile
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Liu X, Yang Y, Jia J. Respiratory muscle ultrasonography evaluation and its clinical application in stroke patients: A review. Front Neurosci 2023; 17:1132335. [PMID: 37090789 PMCID: PMC10115993 DOI: 10.3389/fnins.2023.1132335] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 03/20/2023] [Indexed: 04/25/2023] Open
Abstract
Background Respiratory muscle ultrasound is a widely available, highly feasible technique that can be used to study the contribution of the individual respiratory muscles related to respiratory dysfunction. Stroke disrupts multiple functions, and the respiratory function is often significantly decreased in stroke patients. Method A search of the MEDLINE, Web of Science, and PubMed databases was conducted. We identified studies measuring respiratory muscles in healthy and patients by ultrasonography. Two reviewers independently extracted and documented data regarding to the criteria. Data were extracted including participant demographics, ultrasonography evaluation protocol, subject population, reference values, etc. Result A total of 1954 participants from 39 studies were included. Among them, there were 1,135 participants from 19 studies on diaphragm, 259 participants from 6 studies on extra-diaphragmatic inspiratory muscles, and 560 participants from 14 studies on abdominal expiratory muscles. The ultrasonic evaluation of diaphragm and abdominal expiratory muscle thickness had a relatively typically approach, while, extra-diaphragmatic inspiratory muscles were mainly used in ICU that lack of a consistent paradigm. Conclusion Diaphragm and expiratory muscle ultrasound has been widely used in the assessment of respiratory muscle function. On the contrary, there is not enough evidence to assess extra-diaphragmatic inspiratory muscles by ultrasound. In addition, the thickness of the diaphragm on the hemiplegic side was lower than that on the non-hemiplegic side in stroke patients. For internal oblique muscle (IO), rectus abdominis muscle (RA), transversus abdominis muscle (TrA), and external oblique muscle (EO), most studies showed that the thickness on the hemiplegic side was lower than that on the non-hemiplegic side.Clinical Trial Registration: The protocol of this review was registered in the PROSPERO database (CRD42022352901).
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Affiliation(s)
- Xiaoman Liu
- Department of Rehabilitation Medicine, The People’s Hospital of Suzhou New District, Suzhou, China
| | - Ying Yang
- Department of Rehabilitation Medicine, The People’s Hospital of Suzhou New District, Suzhou, China
| | - Jie Jia
- Department of Rehabilitation Medicine, Fudan University Huashan Hospital, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Fudan University Huashan Hospital, Shanghai, China
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Formenti P, Miori S, Galimberti A, Umbrello M. The Effects of Positive End Expiratory Pressure and Lung Volume on Diaphragm Thickness and Thickening. Diagnostics (Basel) 2023; 13:diagnostics13061157. [PMID: 36980465 PMCID: PMC10047794 DOI: 10.3390/diagnostics13061157] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
Introduction: Diaphragm dysfunction is common in patients undergoing mechanical ventilation. The application of positive end-expiratory pressure (PEEP) and the varying end-expiratory lung volume cause changes in diaphragm geometry. We aimed to assess the impact of the level of PEEP and lung inflation on diaphragm thickness, thickening fraction and displacement. Methods: An observational study in a mixed medical and surgical ICU was conducted. The patients underwent a PEEP-titration trial with the application of three random levels of PEEP: 0 cmH2O (PEEP0), 8 cmH2O (PEEP8) and 15 cmH2O (PEEP15). At each step, the indices of respiratory effort were assessed, together with arterial blood and diaphragm ultrasound; end-expiratory lung volume was measured. Results: 14 patients were enrolled. The tidal volume, diaphragm displacement and thickening fraction were significantly lower with higher levels of PEEP, while both the expiratory and inspiratory thickness increased with higher PEEP levels. The inspiratory effort, as evaluated by the esophageal pressure swing, was unchanged. Both the diaphragm thickening fraction and displacement were significantly correlated with inspiratory effort in the whole dataset. For both measurements, the correlation was stronger at lower levels of PEEP. The difference in the diaphragm thickening fraction during tidal breathing between PEEP 15 and PEEP 0 was negatively related to the change in the functional residual capacity and the change in alveolar dead space. Conclusions: Different levels of PEEP significantly modified the diaphragmatic thickness and thickening fraction, showing a PEEP-induced decrease in the diaphragm contractile efficiency. When using ultrasound to assess diaphragm size and function, the potential effect of lung inflation should be taken into account.
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Affiliation(s)
- Paolo Formenti
- SC Anestesia e Rianimazione I, ASST Santi Paolo e Carlo-Polo Universitario, Ospedale San Paolo, 20142 Milan, Italy
| | - Sara Miori
- SC Anestesia e Rianimazione I, Ospedale Santa Chiara, APSS, 30014 Trento, Italy
| | - Andrea Galimberti
- SC Anestesia Rianimazione e Terapia Intensiva ASST Nord Milano Ospedale Bassini, 20092 Cinisello Balsamo, Italy
| | - Michele Umbrello
- SC Anestesia e Rianimazione II, ASST Santi Paolo e Carlo-Polo Universitario, Ospedale San Carlo Borromeo, 20148 Milan, Italy
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Santana PV, Cardenas LZ, de Albuquerque ALP. Diaphragm Ultrasound in Critically Ill Patients on Mechanical Ventilation—Evolving Concepts. Diagnostics (Basel) 2023; 13:diagnostics13061116. [PMID: 36980423 PMCID: PMC10046995 DOI: 10.3390/diagnostics13061116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/11/2023] [Accepted: 03/13/2023] [Indexed: 03/18/2023] Open
Abstract
Mechanical ventilation (MV) is a life-saving respiratory support therapy, but MV can lead to diaphragm muscle injury (myotrauma) and induce diaphragmatic dysfunction (DD). DD is relevant because it is highly prevalent and associated with significant adverse outcomes, including prolonged ventilation, weaning failures, and mortality. The main mechanisms involved in the occurrence of myotrauma are associated with inadequate MV support in adapting to the patient’s respiratory effort (over- and under-assistance) and as a result of patient-ventilator asynchrony (PVA). The recognition of these mechanisms associated with myotrauma forced the development of myotrauma prevention strategies (MV with diaphragm protection), mainly based on titration of appropriate levels of inspiratory effort (to avoid over- and under-assistance) and to avoid PVA. Protecting the diaphragm during MV therefore requires the use of tools to monitor diaphragmatic effort and detect PVA. Diaphragm ultrasound is a non-invasive technique that can be used to monitor diaphragm function, to assess PVA, and potentially help to define diaphragmatic effort with protective ventilation. This review aims to provide clinicians with an overview of the relevance of DD and the main mechanisms underlying myotrauma, as well as the most current strategies aimed at minimizing the occurrence of myotrauma with special emphasis on the role of ultrasound in monitoring diaphragm function.
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Affiliation(s)
- Pauliane Vieira Santana
- Intensive Care Unit, AC Camargo Cancer Center, São Paulo 01509-011, Brazil
- Correspondence: (P.V.S.); (A.L.P.d.A.)
| | - Letícia Zumpano Cardenas
- Intensive Care Unit, Physical Therapy Department, AC Camargo Cancer Center, São Paulo 01509-011, Brazil
| | - Andre Luis Pereira de Albuquerque
- Pulmonary Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, Brazil
- Sírio-Libanês Teaching and Research Institute, Hospital Sírio Libanês, São Paulo 01308-060, Brazil
- Correspondence: (P.V.S.); (A.L.P.d.A.)
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Huang C, Wang X, Gao S, Luo W, Zhao X, Zhou Q, Huang W, Xiao Y. Sugammadex Versus Neostigmine for Recovery of Respiratory Muscle Strength Measured by Ultrasonography in the Postextubation Period: A Randomized Controlled Trial. Anesth Analg 2023; 136:559-568. [PMID: 36279410 PMCID: PMC9907681 DOI: 10.1213/ane.0000000000006219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although sugammadex is well known for its use in reducing the incidence of residual neuromuscular blockade, this has not always been translated to improved clinical measures of postoperative respiratory muscle strength. Expiratory muscles play an important role in airway clearance and inspiratory muscle capacity augmentation, yet they have not been well studied. Therefore, we tested the hypothesis on whether sugammadex could enhance expiratory muscle strength recovery more completely than neostigmine in the immediate postextubation period. METHODS Adult patients having microlaryngeal surgery under total intravenous anesthesia were randomized to receive sugammadex or neostigmine. The thickening fraction of internal oblique abdominal muscle (TF IO ) and diaphragm excursion, respectively, reflecting expiratory and inspiratory muscle strength, were measured via ultrasonography at 3 time points: before induction (baseline), train-of-four ratio (TOFR) recovery to 0.9, and 30 minutes after postanesthesia care unit (PACU) arrival. The primary outcome was the change in TF IO from baseline to TOFR ≥0.9. The postoperative changes of diaphragm excursion from baseline, incidences of TF IO and diaphragm excursion returning to baseline levels, and the time from TOFR 0.9 to 0.95 and 1 were also measured. RESULTS Among 58 patients, a significant difference in the change in TF IO from baseline to TOFR ≥0.9 between the sugammadex and neostigmine groups was observed: mean ± standard deviation, 9% ± 6% vs 16% ± 9%; difference in means: -6% (95% confidence interval [CI], -10 to -2); and adjusted P =.005 (adjusting for imbalanced variables between 2 groups). Sugammadex resulted in smaller changes in diaphragm excursion from baseline to TOFR ≥0.9 compared with neostigmine: difference in means: -0.83 cm (99.4% CI, -1.39 to -0.28 cm; Bonferroni-corrected P < .001). After 30 minutes in the postanesthesia care unit (PACU),33% of patients reversed with sugammadex versus 14% of those receiving neostigmine reached baseline TF IO levels (99.4% CI, -14 to 52; Bonferroni-corrected P > .999). The incidences of TF IO and diaphragm excursion returning to baseline were relatively low (<40%) in both groups despite TOFR reaching 1. The median time from TOFR of 0.9 to 0.95 and to 1 among patients receiving sugammadex was 7 and 10× faster than those receiving neostigmine (0.3 vs 2 minutes, Bonferroni-corrected P = .003; 0.5 vs 5.3 minutes, Bonferroni-corrected P < .001, respectively). CONCLUSIONS Sugammadex provides a more complete recovery of expiratory muscle strength than neostigmine at TOFR ≥0.9. Our data suggest that the respiratory muscle strength might still be impaired despite TOFR reaching 1.
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Affiliation(s)
- Chanyan Huang
- From the Department of Anesthesiology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xuan Wang
- From the Department of Anesthesiology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shaowei Gao
- From the Department of Anesthesiology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wei Luo
- From the Department of Anesthesiology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xu Zhao
- From the Department of Anesthesiology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qian Zhou
- the Department of Medical Statistics, Clinical Trials Unit, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wenqi Huang
- From the Department of Anesthesiology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ying Xiao
- From the Department of Anesthesiology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Soták M, Tyll T, Roubík K. Temporary phrenic nerve stimulated patients: What is the role of ultrasound examination? Artif Organs 2023; 47:464-469. [PMID: 36398921 DOI: 10.1111/aor.14453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/24/2022] [Accepted: 10/28/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Prolonged mechanical ventilation caused by ventilator-induced diaphragm dysfunction (VIDD) is a serious problem in critically ill patients. Identification of patients who will have difficulty weaning from ventilation along with attempts to reduce total time on mechanical ventilation is some of the aims of intensive care medicine. OBSERVATIONS This article briefly summarizes current options for temporary phrenic nerve stimulation therapy in an effort to keep the diaphragm active as direct prevention and treatment of ventilator-associated diaphragmatic dysfunction in patients on mechanical ventilation. The results of feasibility studies using different approaches are promising but so far, the clinical relevance is low. One important question is which tool would reliably identify early signs of diaphragmatic dysfunction and also be useful in guiding therapy. The authors present a brief overview of the current options considering the advantages and disadvantages of the available examination modalities. Despite the fact that current data point out some limitations of ultrasound examination, we believe that it still has a unique position in the bedside examination of critically ill patients on mechanical ventilation. CONCLUSION Temporary phrenic nerve stimulation, regardless of the specific approach used, has the potential to directly treat or reverse VIDD, and ultrasound examination plays an important role in the comprehensive care of critically ill patients.
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Affiliation(s)
- Michal Soták
- Military University Hospital Prague, Department of Anesthesiology and Intensive Care, 1st Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, Czech Republic.,Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Tomáš Tyll
- Military University Hospital Prague, Department of Anesthesiology and Intensive Care, 1st Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, Czech Republic
| | - Karel Roubík
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, Prague, Czech Republic
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Safai Zadeh E, Görg C, Prosch H, Horn R, Jenssen C, Dietrich CF. The Role of Thoracic Ultrasound for Diagnosis of Diseases of the Chest Wall, the Mediastinum, and the Diaphragm-Narrative Review and Pictorial Essay. Diagnostics (Basel) 2023; 13:767. [PMID: 36832255 PMCID: PMC9956010 DOI: 10.3390/diagnostics13040767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/29/2023] [Accepted: 02/08/2023] [Indexed: 02/22/2023] Open
Abstract
The diagnostic capabilities of ultrasound extend far beyond the evaluation of the pleural space and lungs. Sonographic evaluation of the chest wall is a classic extension of the clinical examination of visible, palpable, or dolent findings. Unclear mass lesions of the chest wall can be differentiated accurately and with low risk by additional techniques such as color Doppler imaging, contrast-enhanced ultrasound, and, in particular, ultrasound-guided biopsy. For imaging of mediastinal pathologies, ultrasound has only a complementary function but is valuable for guidance of percutaneous biopsies of malignant masses. In emergency medicine, ultrasound can verify and support correct positioning of endotracheal tubes. Diaphragmatic ultrasound benefits from the real-time nature of sonographic imaging and is becoming increasingly important for the assessment of diaphragmatic function in long-term ventilated patients. The clinical role of thoracic ultrasound is reviewed in a combination of narrative review and pictorial essay.
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Affiliation(s)
- Ehsan Safai Zadeh
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, 35033 Marburg, Germany
| | - Christian Görg
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, 35033 Marburg, Germany
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna General Hospital, 1090 Vienna, Austria
| | - Rudolf Horn
- Center da Sandà Val Müstair, 7536 Sta. Maria, Switzerland
| | - Christian Jenssen
- Medical Department, Krankenhaus Maerkisch-Oderland, 15344 Strausberg, Germany
- Brandenburg Institute of Clinical Ultrasound, Medical University Brandenburg, 16816 Neuruppin, Germany
| | - Christoph Frank Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Bern, Beau Site, Salem und Permanence, 3018 Bern, Switzerland
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Mohsen N, Nasef N, Ghanem M, Yeung T, Deekonda V, Ma C, Kajal D, Baczynski M, Jain A, Mohamed A. Accuracy of lung and diaphragm ultrasound in predicting successful extubation in extremely preterm infants: A prospective observational study. Pediatr Pulmonol 2023; 58:530-539. [PMID: 36324211 DOI: 10.1002/ppul.26223] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/28/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Chest ultrasound has emerged as a promising tool in predicting extubation readiness in adults and children, yet its utility in preterm infants is lacking. Our aim was to assess the utility of lung ultrasound severity score (LUSS) and diaphragmatic function in predicting extubation readiness in extremely preterm infants. STUDY DESIGN In this prospective cohort study, preterm infants < 28 weeks gestational age (GA) who received invasive mechanical ventilation for ≥12 h were enrolled. Chest ultrasound was performed before extubation. The primary outcome was lung ultrasound accuracy for predicting successful extubation at 3 days. Descriptive statistics and logistic regression were done using SPSS version 22. RESULTS We enrolled 45 infants, of whom 36 (80%) were successfully extubated. GA and postmenstrual age (PMA) at extubation were significantly higher in the successful group. The LUSS was significantly lower in the successful group compared to failed group (11.9 ± 3.2 vs. 19.1 ± 3.1 p < 0.001). The two groups had no statistically significant difference in diaphragmatic excursion or diaphragmatic thickness fraction. Logistic regression analysis controlling for GA and PMA at extubation showed LUSS was an independent predictor for successful extubation (odd ratio 0.46, 95% confidence interval [0.23-0.9], p = 0.02). The area under the receiver operating characteristic curve was 0.95 (p ˂ 0.001) for LUSS, and a cut-off value of ≥15 had 95% sensitivity and 85% specificity in detecting extubation failure. CONCLUSION In extremely preterm infants, lung ultrasound has good accuracy for predicting successful extubation. However, diaphragmatic measurements were not reliable predictors.
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Affiliation(s)
- Nada Mohsen
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Nehad Nasef
- Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohab Ghanem
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Telford Yeung
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Pediatrics, Windsor Regional Hospital Metropolitan campus, Windsor, Ontario, Canada
| | | | - Carmen Ma
- Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Dilkash Kajal
- Mount Sinai Hospital, Toronto, Ontario, Canada.,Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | | | - Amish Jain
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Adel Mohamed
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Mount Sinai Hospital, Toronto, Ontario, Canada
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Demi L, Wolfram F, Klersy C, De Silvestri A, Ferretti VV, Muller M, Miller D, Feletti F, Wełnicki M, Buda N, Skoczylas A, Pomiecko A, Damjanovic D, Olszewski R, Kirkpatrick AW, Breitkreutz R, Mathis G, Soldati G, Smargiassi A, Inchingolo R, Perrone T. New International Guidelines and Consensus on the Use of Lung Ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:309-344. [PMID: 35993596 PMCID: PMC10086956 DOI: 10.1002/jum.16088] [Citation(s) in RCA: 66] [Impact Index Per Article: 66.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/28/2022] [Accepted: 07/31/2022] [Indexed: 05/02/2023]
Abstract
Following the innovations and new discoveries of the last 10 years in the field of lung ultrasound (LUS), a multidisciplinary panel of international LUS experts from six countries and from different fields (clinical and technical) reviewed and updated the original international consensus for point-of-care LUS, dated 2012. As a result, a total of 20 statements have been produced. Each statement is complemented by guidelines and future developments proposals. The statements are furthermore classified based on their nature as technical (5), clinical (11), educational (3), and safety (1) statements.
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Affiliation(s)
- Libertario Demi
- Department of Information Engineering and Computer ScienceUniversity of TrentoTrentoItaly
| | - Frank Wolfram
- Department of Thoracic and Vascular SurgerySRH Wald‐Klinikum GeraGeraGermany
| | - Catherine Klersy
- Unit of Clinical Epidemiology and BiostatisticsFondazione IRCCS Policlinico S. MatteoPaviaItaly
| | - Annalisa De Silvestri
- Unit of Clinical Epidemiology and BiostatisticsFondazione IRCCS Policlinico S. MatteoPaviaItaly
| | | | - Marie Muller
- Department of Mechanical and Aerospace EngineeringNorth Carolina State UniversityRaleighNorth CarolinaUSA
| | - Douglas Miller
- Department of RadiologyMichigan MedicineAnn ArborMichiganUSA
| | - Francesco Feletti
- Department of Diagnostic ImagingUnit of Radiology of the Hospital of Ravenna, Ausl RomagnaRavennaItaly
- Department of Translational Medicine and for RomagnaUniversità Degli Studi di FerraraFerraraItaly
| | - Marcin Wełnicki
- 3rd Department of Internal Medicine and CardiologyMedical University of WarsawWarsawPoland
| | - Natalia Buda
- Department of Internal Medicine, Connective Tissue Disease and GeriatricsMedical University of GdanskGdanskPoland
| | - Agnieszka Skoczylas
- Geriatrics DepartmentNational Institute of Geriatrics, Rheumatology and RehabilitationWarsawPoland
| | - Andrzej Pomiecko
- Clinic of Pediatrics, Hematology and OncologyUniversity Clinical CenterGdańskPoland
| | - Domagoj Damjanovic
- Heart Center Freiburg University, Department of Cardiovascular Surgery, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Robert Olszewski
- Department of Gerontology, Public Health and DidacticsNational Institute of Geriatrics, Rheumatology and RehabilitationWarsawPoland
| | - Andrew W. Kirkpatrick
- Departments of Critical Care Medicine and SurgeryUniversity of Calgary and the TeleMentored Ultrasound Supported Medical Interventions Research GroupCalgaryCanada
| | - Raoul Breitkreutz
- FOM Hochschule für Oekonomie & Management gGmbHDepartment of Health and SocialEssenGermany
| | - Gebhart Mathis
- Emergency UltrasoundAustrian Society for Ultrasound in Medicine and BiologyViennaAustria
| | - Gino Soldati
- Diagnostic and Interventional Ultrasound UnitValledel Serchio General HospitalLuccaItaly
| | - Andrea Smargiassi
- Pulmonary Medicine Unit, Department of Medical and Surgical SciencesFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
- Department of Internal Medicine, IRCCS San Matteo Hospital FoundationUniversity of PaviaPaviaItaly
| | - Riccardo Inchingolo
- Pulmonary Medicine Unit, Department of Medical and Surgical SciencesFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
- Department of Internal Medicine, IRCCS San Matteo Hospital FoundationUniversity of PaviaPaviaItaly
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Le Neindre A, Hansell L, Wormser J, Gomes Lopes A, Diaz Lopez C, Romanet C, Choukroun G, Nguyen M, Philippart F, Guinot PG, Buscher H, Bouhemad B, Ntoumenopoulos G. Thoracic ultrasound influences physiotherapist's clinical decision-making in respiratory management of critical care patients: a multicentre cohort study. Thorax 2023; 78:169-175. [PMID: 35321941 DOI: 10.1136/thoraxjnl-2021-218217] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 02/14/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND The potential influence of thoracic ultrasound on clinical decision-making by physiotherapists has never been studied. The aim of this study was to assess the impact of thoracic ultrasound on clinical decision-making by physiotherapists for critical care patients. METHODS This prospective, observational multicentre study was conducted between May 2017 and November 2020 in four intensive care units in France and Australia. All hypoxemic patients consecutively admitted were enrolled. The primary outcome was the net reclassification improvement (NRI), quantifying how well the new model (physiotherapist's clinical decision-making including thoracic ultrasound) reclassifies subjects as compared with an old model (clinical assessment). Secondary outcomes were the factors associated with diagnostic concordance and physiotherapy treatment modification. RESULTS A total of 151 patients were included in the analysis. The NRI for the modification of physiotherapist's clinical decisions was-40% (95% CI (-56 to -22%), p=0.02). Among the cases in which treatment was changed after ultrasound, 41% of changes were major (n=38). Using a multivariate analysis, the physiotherapist's confidence in their clinical diagnosis was associated with diagnostic concordance (adjusted OR=3.28 95% CI (1.30 to 8.71); p=0.014). Clinical diagnosis involving non-parenchymal conditions and clinical signs reflecting abolished lung ventilation were associated with diagnostic discordance (adjusted OR=0.06 95% CI (0.01 to 0.26), p<0.001; adjusted OR=0.26 95% CI (0.09 to 0.69), p=0.008; respectively). CONCLUSION Thoracic ultrasound has a high impact on the clinical decision-making process by physiotherapists for critical care patients. TRIAL REGISTRATION NUMBER NCT02881814; https://clinicaltrials.gov.
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Affiliation(s)
- Aymeric Le Neindre
- Respiratory Intensive Care and Clinical Research Units, Hopital Forcilles, Ferolles-Attilly, France.,UMR1231 - Lipide Nutrition Cancer, Université de Bourgogne, Dijon, France
| | - Louise Hansell
- Physiotherapy, Royal North Shore Hospital, St Leonards, New South Wales, Australia.,Sydney School of Health Sciences, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Johan Wormser
- Intensive Care Unit, Fondation Hopital Saint Joseph, Paris, France
| | - Andreia Gomes Lopes
- Physiotherapy and Clinical Research Units, Hopital Forcilles, Ferolles-Attilly, France
| | | | | | - Gerald Choukroun
- Soins intensifs respiratoires & Réadaptation post-réanimation, Hopital Forcilles, Ferolles-Attilly, Île-de-France, France
| | - Maxime Nguyen
- Anesthesiology and Intensive Care Medicine, University Hospital Centre of Dijon, Dijon, France
| | | | - Pierre-Grégoire Guinot
- Anesthesiology and Intensive Care Medicine, University Hospital Centre of Dijon, Dijon, France
| | - Hergen Buscher
- Intensive Care Unit, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
| | - Bélaid Bouhemad
- UMR1231 - Lipide Nutrition Cancer, Université de Bourgogne, Dijon, France .,Anesthesiology and Intensive Care Medicine, University Hospital Centre of Dijon, Dijon, France
| | - George Ntoumenopoulos
- Physiotherapy, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia
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Yeung T, Mohsen N, Ghanem M, Ibrahim J, Shah J, Kajal D, Shah PS, Mohamed A. Diaphragmatic Thickness and Excursion in Preterm Infants With Bronchopulmonary Dysplasia Compared With Term or Near Term Infants: A Prospective Observational Study. Chest 2023; 163:324-331. [PMID: 35963296 DOI: 10.1016/j.chest.2022.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/29/2022] [Accepted: 08/02/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Diaphragmatic atrophy associated with mechanical ventilation is reported in pediatric and adult patients, but a similar association has not been described in preterm infants with bronchopulmonary dysplasia (BPD). RESEARCH QUESTION Does BPD impact the diaphragm thickness (DT) and diaphragm excursion (DE) in infants born before 32 weeks' gestation compared with healthy late preterm or term infants? STUDY DESIGN AND METHODS In this prospective observational case-control study, DT at end of expiration (DTexp), DT at end of inspiration (DTins), DT fraction (DTF), and DE (DE) were assessed using bedside ultrasound. Two groups were compared: infants with BPD (patients) and healthy, postmenstrual age-matched infants (control participants). To account for variations in body size between groups, diaphragmatic measurements were expressed as a ratio of body surface area (BSA). Statistical analyses were conducted using SAS software version 9.4 (SAS Institute, Inc.). RESULTS We enrolled 111 infants, including 56 preterm infants with BPD (mean ± SD study age, 37.7 ± 1.7 weeks) and 55 healthy control participants (mean ± SD study age, 38.1 ± 1.5 weeks). DTexp and DTexp to BSA ratio were significantly lower in the BPD group compared with the healthy control group (mean ± SD, 1.3 ± 0.4 mm vs 1.5 ± 0.4 mm [P = .01] and 7.1 ± 1.4 mm/m2 vs 7.8 ± 1.8 mm/m2 [P = .03]). DTF and DE were significantly higher in the BPD group vs the healthy control group (mean ± SD, 61.8 ± 26.0 vs 43.3 ± 19.7 [P < .01] and 6.0 ± 1.7 mm vs 4.4 ± 1.6 mm [P < .01], respectively). INTERPRETATION In infants with BPD, DTexp was significantly lower, whereas DTF and DE were significantly higher, compared with healthy, age-matched control participants. Future studies are required and should focus on describing the evolution of diaphragmatic dimensions in preterm infants with and without BPD. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT04941963; URL: www. CLINICALTRIALS gov.
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Affiliation(s)
- Telford Yeung
- Department of Pediatrics, University Health Network, University of Toronto; Department of Pediatrics, Mount Sinai Hospital, Toronto; Department of Pediatrics, Windsor Regional Hospital Metropolitan campus, Windsor, ON, Canada
| | - Nada Mohsen
- Department of Pediatrics, University Health Network, University of Toronto; Department of Pediatrics, Mount Sinai Hospital, Toronto; Department of Pediatrics, Mansoura University, Mansoura, Egypt
| | - Mohab Ghanem
- Department of Pediatrics, University Health Network, University of Toronto; Department of Pediatrics, Mount Sinai Hospital, Toronto
| | - Jenna Ibrahim
- Department of Pediatrics, Mount Sinai Hospital, Toronto
| | - Jyotsna Shah
- Department of Pediatrics, University Health Network, University of Toronto; Department of Pediatrics, Mount Sinai Hospital, Toronto
| | - Dilkash Kajal
- Department of Medical Imaging, University Health Network, University of Toronto; Department of Pediatrics, Mount Sinai Hospital, Toronto
| | - Prakesh S Shah
- Department of Pediatrics, University Health Network, University of Toronto; Department of Pediatrics, Mount Sinai Hospital, Toronto
| | - Adel Mohamed
- Department of Pediatrics, University Health Network, University of Toronto; Department of Pediatrics, Mount Sinai Hospital, Toronto.
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49
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Gan XY, Zhang J, Xu P, Liu SJ, Guo ZL. Early passive orthostatic training prevents diaphragm atrophy and dysfunction in intensive care unit patients on mechanical ventilation: A retrospective case‒control study. Heart Lung 2023; 59:37-43. [PMID: 36709529 DOI: 10.1016/j.hrtlng.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/19/2023] [Accepted: 01/22/2023] [Indexed: 01/29/2023]
Abstract
BACKGROUND Intensive care unit (ICU) patients on mechanical ventilation (MV), who are always bedridden, easily develop diaphragm atrophy and dysfunction. However, few studies have assessed diaphragmatic thickness and functional changes after early passive orthostatic training. OBJECTIVES This is the first study to investigate the efficacy of early passive orthostatic training in preventing diaphragm atrophy and dysfunction in ICU patients on MV. METHODS In this randomized retrospective case‒control study, 81 ICU patients on MV for 8 days or longer were enrolled. Forty-four patients received early passive orthostatic training initiated within 72 h of MV initiation (training group), and 37 patients did not receive training (no-training group). The protocol was performed for seven days, once a day for 30 min. The primary outcomes were diaphragmatic thickness and diaphragm contractile fraction (TFdi). The ventilatory parameters were secondary outcomes. RESULTS This study included 81 (45 male) ICU patients on MV [(mean ± SD) age = (60.63 ± 7.88) years]. The training group had a larger diaphragmatic thickness at end-expiration (Tdi,ee) and a smaller magnitude of decrease in Tdi,ee and TFdi (p = 0.001, 0.029, and <0.001, respectively) than the no-training group after 7 days of training. The mean arterial pressure, fraction of inspired oxygen, and white blood cell levels were decreased in the training group compared with the no-training group (p = 0.003, 0.001, and 0.026, respectively), but lactic acid levels decreased slightly in the training group with no significant difference (p = 0.708). CONCLUSIONS Early passive orthostatic training is suitable to ameliorate diaphragm atrophy and dysfunction in ICU patients on MV.
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Affiliation(s)
- Xin-Yu Gan
- Department of Rehabilitation, Beidahuang Industry Group General Hospital, 235 Hashuang Road, Nangang District, Harbin, Heilongjiang 150000, China
| | - Jun Zhang
- Department of Rehabilitation, Beidahuang Industry Group General Hospital, 235 Hashuang Road, Nangang District, Harbin, Heilongjiang 150000, China.
| | - Ping Xu
- Department of Rehabilitation, Beidahuang Industry Group General Hospital, 235 Hashuang Road, Nangang District, Harbin, Heilongjiang 150000, China
| | - Si-Jin Liu
- Department of Nursing, Harbin Medical University, Daqing, Heilongjiang 163319, China
| | - Zhi-Lin Guo
- Department of Rehabilitation, Beidahuang Industry Group General Hospital, 235 Hashuang Road, Nangang District, Harbin, Heilongjiang 150000, China
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50
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Kim T, Huh S, Chung JH, Kim YS, Yun RY, Park O, Lee SE. Clinical values of diaphragmatic movement in patients with chronic obstructive pulmonary disease. BMC Pulm Med 2023; 23:33. [PMID: 36703157 PMCID: PMC9881315 DOI: 10.1186/s12890-022-02220-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 11/02/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The limitation of activity due to dyspnea in chronic obstructive pulmonary disease (COPD) patients is affected by diaphragmatic dysfunction and reduced lung function. This study aimed to analyze the association between diaphragm function variables and forced expiratory volume in the first second (FEV1) and to estimate the clinical significance of diaphragm function in the correlation between COPD severity and lung function. METHODS This prospective, single-center, cross-sectional observational study enrolled 60 COPD patients in a respiratory outpatient clinic. Data for baseline characteristics and the dyspnea scale were collected. Participants underwent a pulmonary function test (PFT), a 6-minute walk test (6MWT), and diaphragm function by ultrasonography. RESULTS The right excursion at forced breathing showed the most significant correlation with FEV1 (r = 0.370, p = 0.004). The cutoff value was 6.7 cm of the right diaphragmatic excursion at forced breathing to identify the FEV1 above 50% group. In the group with a right diaphragmatic excursion at forced breathing < 6.7 cm, modified Medical Research Council (mMRC), St. George's Respiratory Questionnaire and the total distance of 6MWT showed no difference between groups with FEV1 under and above 50% (p > 0.05). In the group with ≥ 6.7 cm, mMRC and the total distance of 6MWT showed a significant difference between FEV1 under and above 50% (p = 0.014, 456.7 ± 69.7 m vs. 513.9 ± 60.3 m, p = 0.018, respectively). CONCLUSION The right diaphragmatic forced excursion was closely related to FEV1, and analysis according to the right diaphragmatic forced excursion-based cut-off value showed a significant difference between both groups. When the diaphragm function was maintained, there was a lot of difference in the 6MWT's factors according to the FEV1 value. Our data suggest that diaphragmatic function should be performed when interpreting PFT.
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Affiliation(s)
- Taehwa Kim
- grid.412591.a0000 0004 0442 9883Division of Respiratory, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University Yangsan Hospital and Pusan National University School of Medicine, Geumo-ro 20, Beomeo-ri, Yangsan-si, Gyeongsangnam-do 50612 Republic of Korea ,grid.412591.a0000 0004 0442 9883BioMedical Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Sungchul Huh
- grid.412591.a0000 0004 0442 9883Department of Rehabilitation Medicine, Rehabilitation Hospital, Pusan National University Yangsan, Yangsan, South Korea
| | - Jae Heun Chung
- grid.412591.a0000 0004 0442 9883Division of Respiratory, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University Yangsan Hospital and Pusan National University School of Medicine, Geumo-ro 20, Beomeo-ri, Yangsan-si, Gyeongsangnam-do 50612 Republic of Korea ,grid.412591.a0000 0004 0442 9883BioMedical Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Yun Seong Kim
- grid.412591.a0000 0004 0442 9883Division of Respiratory, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University Yangsan Hospital and Pusan National University School of Medicine, Geumo-ro 20, Beomeo-ri, Yangsan-si, Gyeongsangnam-do 50612 Republic of Korea ,grid.412591.a0000 0004 0442 9883BioMedical Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Ra Yu Yun
- grid.412591.a0000 0004 0442 9883Department of Rehabilitation Medicine, Rehabilitation Hospital, Pusan National University Yangsan, Yangsan, South Korea ,grid.262229.f0000 0001 0719 8572Pusan National University School of Medicine, Yangsan, South Korea
| | - Onyu Park
- grid.412591.a0000 0004 0442 9883College of Nursing, Pusan National University, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Seung Eun Lee
- grid.412591.a0000 0004 0442 9883Division of Respiratory, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University Yangsan Hospital and Pusan National University School of Medicine, Geumo-ro 20, Beomeo-ri, Yangsan-si, Gyeongsangnam-do 50612 Republic of Korea ,grid.412591.a0000 0004 0442 9883BioMedical Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
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