1
|
Qu LL, Zhao WP, Li JP, Zhang W. Predictive value of diaphragm ultrasound for mechanical ventilation outcome in patients with acute exacerbation of chronic obstructive pulmonary disease. World J Clin Cases 2024; 12:5893-5900. [PMID: 39286369 PMCID: PMC11287505 DOI: 10.12998/wjcc.v12.i26.5893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/07/2024] [Accepted: 07/01/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is often combined with respiratory failure, which increases the patient's morbidity and mortality. Diaphragm ultrasound (DUS) has developed rapidly in the field of critical care in recent years. Studies with DUS monitoring diaphragm-related rapid shallow breathing index have demonstrated important results in guiding intensive care unit patients out of the ventilator. Early prediction of the indications for withdrawal of non-invasive ventilator and early evaluation of patients to avoid or reduce disease progression are very important. AIM To explore the predictive value of DUS indexes for non-invasive ventilation outcome in patients with AECOPD. METHODS Ninety-four patients with AECOPD who received mechanical ventilation in our hospital from January 2022 to December 2023 were retrospectively analyzed, and they were divided into a successful ventilation group (68 cases) and a failed ventilation group (26 cases) according to the outcome of ventilation. The clinical data of patients with successful and failed noninvasive ventilation were compared, and the independent predictors of noninvasive ventilation outcomes in AECOPD patients were identified by multivariate logistic regression analysis. RESULTS There were no significant differences in gender, age, body mass index, complications, systolic pressure, heart rate, mean arterial pressure, respiratory rate, oxygen saturation, partial pressure of oxygen, oxygenation index, or time of inspiration between patients with successful and failed mechanical ventilation (P > 0.05). The patients with successful noninvasive ventilation had shorter hospital stays and lower partial pressure of carbon dioxide (PaCO2) than those with failed treatment, while potential of hydrogen (pH), diaphragm thickening fraction (DTF), diaphragm activity, and diaphragm movement time were significantly higher than those with failed treatment (P < 0.05). pH [odds ratio (OR) = 0.005, P < 0.05], PaCO2 (OR = 0.430, P < 0.05), and DTF (OR = 0.570, P < 0.05) were identified to be independent factors influencing the outcome of mechanical ventilation in AECOPD patients. CONCLUSION The DUS index DTF can better predict the outcome of non-invasive ventilation in AECOPD patients.
Collapse
Affiliation(s)
- Lei-Lei Qu
- The First Department of Respiratory and Critical Care Medical Center, The First People's Hospital of Baiyin City, Baiyin 730900, Gansu Province, China
| | - Wen-Ping Zhao
- Department of Nursing, The First People's Hospital of Baiyin City, Baiyin 730900, Gansu Province, China
| | - Ji-Ping Li
- The First Department of Respiratory and Critical Care Medical Center, The First People's Hospital of Baiyin City, Baiyin 730900, Gansu Province, China
| | - Wei Zhang
- The First Department of Respiratory and Critical Care Medical Center, The First People's Hospital of Baiyin City, Baiyin 730900, Gansu Province, China
| |
Collapse
|
2
|
Song F, Ding K, Qi W, Sun W, Xiang H, Sun M, Xia R. Effects of Baduanjin Exercise on lung function and 6 min walk in COPD patients: a systematic review and meta-analysis. Sci Rep 2024; 14:17788. [PMID: 39090183 PMCID: PMC11294359 DOI: 10.1038/s41598-024-68581-7] [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: 04/06/2024] [Accepted: 07/25/2024] [Indexed: 08/04/2024] Open
Abstract
COPD is a public health problem of global concern, which seriously affects the quality of life of patients and is also the third leading cause of death from non-communicable diseases. To investigate the effect of Ba duan jin exercise on lung function and the results of a 6-min walking trial in patients with stable COPD. Literature databases such as Web of Science, Embase, PubMed, Cochrane Library, Chinese Biomedical Literature (CBM), CNKI, Wanfang Data and VIP were searched by computer, the search period is up to January 2024. Literature screening, quality evaluation and data extraction were carried out independently by two researchers. And use RevMan 5.3 software and StataMP 18 (64-bit) software to process the relevant outcome indicators. A total of 16 RCT studies with 1184 patients were included. The meta-analysis results showed that compared with the control group, Ba Duan Jin exercise could improve FEV1 (MD = 0.29, 95% CI (0.20, 0.37), P < 0.0001), FEV1/FVC (%) (MD = 3.86, 95% CI (2.24, 5.47), P < 0.00001), and 6-min walking distance (MD = 45.41, 95% CI (33.93, 56.89), P < 0.00001) in stable COPD patients. The results of subgroup analysis based on the duration of the intervention cycle, research quality, and intervention frequency showed that periodic Ba Duan Jin exercise can significantly improve the relevant lung function levels to varying degrees. At the same time, the intervention effect of Ba Duan Jin exercise during the implementation process is also affected by the duration of the exercise cycle, exercise frequency, and the completion of the exercise plan. Ba Duan Jin exercise has a positive improvement effect on lung function and 6-min walking distance in stable COPD patients. In the process of exercise implementation, attention should be paid to cultivating exercise habits, stabilizing and improving attendance rates, and strictly implementing training techniques to achieve the best clinical outcomes for these patients.
Collapse
Affiliation(s)
- Feiyun Song
- Department of Sports Rehabilitation, College of Physical Education, Anqing Normal University, Anqing, 246133, China
| | - Kexin Ding
- Department of Sports Rehabilitation, College of Physical Education, Anqing Normal University, Anqing, 246133, China
| | - Wei Qi
- Department of Sports Rehabilitation, College of Physical Education, Anqing Normal University, Anqing, 246133, China
| | - Wen Sun
- Department of Sports Rehabilitation, College of Physical Education, Anqing Normal University, Anqing, 246133, China
| | - Heping Xiang
- Department of Sports Rehabilitation, College of Physical Education, Anqing Normal University, Anqing, 246133, China.
| | - Mingyun Sun
- Department of Sports Rehabilitation, College of Physical Education, Anqing Normal University, Anqing, 246133, China.
| | - Rui Xia
- School of Physical Education, Chaohu University, Hefei, 238000, China
| |
Collapse
|
3
|
Siniscalchi C, Nouvenne A, Cerundolo N, Meschi T, Ticinesi A. Diaphragm Ultrasound in Different Clinical Scenarios: A Review with a Focus on Older Patients. Geriatrics (Basel) 2024; 9:70. [PMID: 38920426 PMCID: PMC11202496 DOI: 10.3390/geriatrics9030070] [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: 04/15/2024] [Revised: 05/08/2024] [Accepted: 05/28/2024] [Indexed: 06/27/2024] Open
Abstract
Diaphragm muscle dysfunction is increasingly recognized as a fundamental marker of several age-related diseases and conditions including chronic obstructive pulmonary disease, heart failure and critical illness with respiratory failure. In older individuals with physical frailty and sarcopenia, the loss of muscle mass and function may also involve the diaphragm, contributing to respiratory dysfunction. Ultrasound has recently emerged as a feasible and reliable strategy to visualize diaphragm structure and function. In particular, it can help to predict the timing of extubation in patients undergoing mechanical ventilation in intensive care units (ICUs). Ultrasonographic evaluation of diaphragmatic function is relatively cheap, safe and quick and can provide useful information for real-time monitoring of respiratory function. In this review, we aim to present the current state of scientific evidence on the usefulness of ultrasound in the assessment of diaphragm dysfunction in different clinical settings, with a particular focus on older patients. We highlight the importance of the qualitative information gathered by ultrasound to assess the integrity, excursion, thickness and thickening of the diaphragm. The implementation of bedside diaphragm ultrasound could be useful for improving the quality and appropriateness of care, especially in older subjects with sarcopenia who experience acute respiratory failure, not only in the ICU setting.
Collapse
Affiliation(s)
- Carmine Siniscalchi
- Department of Continuity of Care and Multicomplexity, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (C.S.); (A.N.); (N.C.); (T.M.)
| | - Antonio Nouvenne
- Department of Continuity of Care and Multicomplexity, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (C.S.); (A.N.); (N.C.); (T.M.)
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
| | - Nicoletta Cerundolo
- Department of Continuity of Care and Multicomplexity, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (C.S.); (A.N.); (N.C.); (T.M.)
| | - Tiziana Meschi
- Department of Continuity of Care and Multicomplexity, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (C.S.); (A.N.); (N.C.); (T.M.)
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
| | - Andrea Ticinesi
- Department of Continuity of Care and Multicomplexity, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (C.S.); (A.N.); (N.C.); (T.M.)
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
| | | |
Collapse
|
4
|
Song F, Ding K, Sun M, Xia R. Effect of 12-week head-down strong abdominal breathing on cognitive function in patients with stable chronic obstructive pulmonary disease: a single-centre randomised controlled trial protocol. Trials 2024; 25:351. [PMID: 38816733 PMCID: PMC11140949 DOI: 10.1186/s13063-024-08193-8] [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: 09/26/2023] [Accepted: 05/23/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) often suffer from a combination of mild cognitive impairment (MCI) and a significant reduction in their quality of life. In the exercise programme of pulmonary rehabilitation (PR), pulmonary rehabilitation intervention is often carried out by enhancing respiratory function. Strong abdominal breathing is a kind of breathing method, through which the diaphragm can be exercised, thereby enhancing the deflection distance of the diaphragm during breathing and improving respiratory function. The inversion trainer can meet the different angles of head-down training and also has the characteristics of low cost, easy to operate, and use a wide range of scenarios. According to currently available data, strong abdominal breathing in combination with head-down position has not yet been used in pulmonary rehabilitation in this type of rehabilitation programme. It is valuable to use this device to study PR of cognitive function in patients with COPD. METHODS This study was a 12-week single-centre randomised controlled trial and blinding the assessors and data processors of the test. Recruitment is planned for January 1, 2024. It is expected that 81 patients with stable COPD combined with MCI will be recruited and randomly assigned to the head-down strong abdominal breathing group (HG), the fitness qigong eight-duanjin group (BDJ), and the control group (CG) in a 1:1:1 ratio. Using fNIRS (functional near-infrared spectroscopy) to assess brain oxygen availability before and after pulmonary rehabilitation in three periods: before, during and after the intervention. Cognitive functioning is also assessed using the Overall Cognitive Assessment Scale, the Specific Cognitive Functioning Assessment Scale and the Cognitive Behavioural Ability Test. TRIAL REGISTRATION The Specialised Committee on Scientific Research and Academic Ethics of the Academic Committee of Anqing Normal University approved the project (ANU2023001). China Clinical Trial Registry approved the study (ChiCTR2300075400) with a registration date of 2023/09/04. DISCUSSION The aim of this study was to explore novel exercise rehabilitation methods to improve cognitive function in COPD patients. It results in a lower financial burden and higher participation in pulmonary rehabilitation and improves the quality of survival of patients with COPD.
Collapse
Affiliation(s)
- Feiyun Song
- Department of Sports Rehabilitation, School of Physical Education, Anqing Normal University, Anhui, China
| | - Kexin Ding
- Department of Sports Rehabilitation, School of Physical Education, Anqing Normal University, Anhui, China
| | - Mingyun Sun
- Department of Sports Rehabilitation, School of Physical Education, Anqing Normal University, Anhui, China.
| | - Rui Xia
- School of Physical Education of Chaohu University, Anhui, China.
| |
Collapse
|
5
|
Li C, Liu Y, Dong R, Zhang T, Song Y, Zhang Q. Deep learning radiomics on shear wave elastography and b-mode ultrasound videos of diaphragm for weaning outcome prediction. Med Eng Phys 2024; 123:104090. [PMID: 38365343 DOI: 10.1016/j.medengphy.2023.104090] [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: 09/26/2023] [Revised: 11/17/2023] [Accepted: 12/16/2023] [Indexed: 02/18/2024]
Abstract
PURPOSE We proposed an automatic method based on deep learning radiomics (DLR) on shear wave elastography (SWE) and B-mode ultrasound videos of diaphragm for two classification tasks, one for differentiation between the control and patient groups, and the other for weaning outcome prediction. MATERIALS AND METHODS We included a total of 581 SWE and B-mode ultrasound videos, of which 466 were from the control group of 179 normal subjects, and 115 were from the patient group of 35 mechanically ventilated subjects in the intensive care unit (ICU). Among the patient group, 17 subjects successfully weaned and 18 failed. The deep neural network of U-Net was utilized to automatically segment diaphragm regions in dual-modal videos of SWE and B-mode. High-throughput radiomics features were then extracted, the statistical test and least absolute shrinkage and selection operator (LASSO) were applied for feature dimension reduction. The optimal classification models for the two tasks were established using the support vector machine (SVM). RESULTS The automatic segmentation model achieved Dice score of 87.89 %. A total of 4524 radiomics features were extracted, 10 and 20 important features were left after feature dimension reduction for constructing the two classification models. The best areas under receiver operating characteristic curves of the two models reached 84.01 % and 94.37 %, respectively. CONCLUSIONS Our proposed DLR methods are innovative for automatic segmentation of diaphragm regions in SWE and B-mode videos and deep mining of high-throughput radiomics features from dual-modal images. The approaches have been proved to be effective for prediction of weaning outcomes.
Collapse
Affiliation(s)
- Changchun Li
- The SMART (Smart Medicine and AI-based Radiology Technology) Lab, Shanghai Institute for Advanced Communication and Data Science, Shanghai University, Shanghai, China; School of Communication and Information Engineering, Shanghai University, Shanghai, China
| | - Yan Liu
- Department of Ultrasonography, Zhoupu Hospital Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Rui Dong
- Department of Ultrasonography, Zhoupu Hospital Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Tianjie Zhang
- Department of Ultrasonography, Zhoupu Hospital Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Ye Song
- Department of Ultrasonography, Zhoupu Hospital Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai, China.
| | - Qi Zhang
- The SMART (Smart Medicine and AI-based Radiology Technology) Lab, Shanghai Institute for Advanced Communication and Data Science, Shanghai University, Shanghai, China; School of Communication and Information Engineering, Shanghai University, Shanghai, China.
| |
Collapse
|