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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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Milesi J, Boussuges A, Habert P, Bermudez J, Reynaud-Gaubert M, Delliaux S, Bregeon F, Coiffard B. Ultrasound evaluation of diaphragmatic function in patients with idiopathic pulmonary fibrosis: a retrospective observational study. Respir Res 2023; 24:259. [PMID: 37898765 PMCID: PMC10613389 DOI: 10.1186/s12931-023-02577-1] [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: 06/07/2023] [Accepted: 10/23/2023] [Indexed: 10/30/2023] Open
Abstract
INTRODUCTION The diaphragm function assessed by ultrasound has been well-studied in COPD, asthma, and intensive care. However, there are only a few studies on diffuse interstitial lung disease, while dyspnea and quality of life are major issues in the management that may depend on the diaphragm. METHODS We retrospectively included idiopathic pulmonary fibrosis (IPF) patients followed in our center (Marseille, France) between January 2020 and February 2023 who underwent diaphragmatic ultrasound. Our objectives were to describe the diaphragmatic function of IPFs compared to healthy controls and to correlate with clinical, functional, and lung density on CT-scan. RESULTS 24 IPF patients and 157 controls were included. The diaphragmatic amplitude in IPF was increased at rest (median of 2.20 cm vs 1.88 cm on the right, p < 0.007, and 2.30 cm vs 1.91 cm on the left, p < 0.03, in IPF and controls respectively) and decreased in deep breathing (median of 4.85 cm vs 5.45 cm on the right, p < 0.009, and 5.10 cm vs 5.65 cm on the left, p < 0.046, in IPF and controls respectively). Diaphragmatic thickness was significantly reduced at rest on the right side (median of 1.75 mm vs 2.00 mm, p < 0.02, in IPF and controls respectively) and in deep breathing on both sides compared to controls (mean of 3.82 mm vs 4.15 mm on the right, p < 0.02, and 3.53 mm vs 3.94 mm, on the left, p < 0.009, in IPF and controls respectively). Diaphragmatic amplitude in deep breathing was moderate to strongly correlated with FVC, DLCO, and 6MWT and negatively correlated with the dyspnea and lung density on CT scan. CONCLUSION The diaphragmatic amplitude and thickness were impaired in IPF compared to controls. Diaphragmatic amplitude is the parameter best correlated with clinical, functional, and lung density criteria. Further studies are needed to determine if diaphragmatic amplitude can be a prognostic factor in IPF.
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Affiliation(s)
- Jules Milesi
- Department of Respiratory Medicine and Lung Transplantation, Assistance Publique-Hôpitaux de Marseille (AP-HM), Hôpital Nord, Aix-Marseille University, Chemin des Bourrely, 13015, Marseille, France
| | - Alain Boussuges
- Pulmonary Function Testing Laboratory, APHM, Aix-Marseille University, Marseille, France
| | - Paul Habert
- Department of Radiology, APHM, Aix-Marseille University, Marseille, France
- LIIE, Aix-Marseille University, Marseille, France
- CERIMED, Aix-Marseille University, Marseille, France
| | - Julien Bermudez
- Department of Respiratory Medicine and Lung Transplantation, Assistance Publique-Hôpitaux de Marseille (AP-HM), Hôpital Nord, Aix-Marseille University, Chemin des Bourrely, 13015, Marseille, France
| | - Martine Reynaud-Gaubert
- Department of Respiratory Medicine and Lung Transplantation, Assistance Publique-Hôpitaux de Marseille (AP-HM), Hôpital Nord, Aix-Marseille University, Chemin des Bourrely, 13015, Marseille, France
| | - Stéphane Delliaux
- Pulmonary Function Testing Laboratory, APHM, Aix-Marseille University, Marseille, France
| | - Fabienne Bregeon
- Pulmonary Function Testing Laboratory, APHM, Aix-Marseille University, Marseille, France
| | - Benjamin Coiffard
- Department of Respiratory Medicine and Lung Transplantation, Assistance Publique-Hôpitaux de Marseille (AP-HM), Hôpital Nord, Aix-Marseille University, Chemin des Bourrely, 13015, Marseille, France.
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Erfan A, Khalil M, Elmaraghy A, Abd Elkader M. Ultrasonographic assessment of diaphragmatic performance in two chronic obstructive pulmonary disease phenotypes admitted with acute exacerbation and its relation to outcome. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2023. [DOI: 10.4103/ecdt.ecdt_57_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
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Yao Y, He L, Chen W, Zhou H, Lu G, Tao J, Wang S. Predictive Value of Diaphragmatic Ultrasonography for the Weaning Outcome in Mechanically Ventilated Children Aged 1-3 Years. Front Pediatr 2022; 10:840444. [PMID: 35433546 PMCID: PMC9005894 DOI: 10.3389/fped.2022.840444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/15/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There are estimated 20% of mechanically ventilated patients having difficulty in weaning from the ventilators, and the weaning process accounts for 40% of the whole ventilation time. Reliable tools are urgently needed to estimate the weaning outcome. Diaphragmatic ultrasonography, as a relatively good predictive method for the adults, was measured in this study, assessing the value of each indicator of diaphragmatic ultrasonography to predict the outcomes of ventilator weaning from mechanically ventilated children of 1-3 years old. METHODS Between November 2018 and November 2019, children who were mechanically ventilated and ready for weaning in the pediatric intensive care unit (PICU) were enrolled in the study. Diaphragmatic ultrasonography was performed to the children to measure the right diaphragm excursion (DE), contraction velocity, thickness, and diaphragm thickening fraction (DTF), which were recorded followed by spontaneous breathing trial (SBT). The receiver operator characteristic (ROC) curves were also used to assess the value of each indicator to predict the weaning outcome. RESULTS During this study period, a total of 72 children were enrolled, and of them, 56 children passed the weaning process, while 16 children failed. There were significant differences in DE, contraction velocity, thickness, and DTF parameters between the weaning success group and the failure group. The areas under the ROC curves (AUC) and the optimal threshold of the above indicators were as follows: 0.72 and 8.08 mm for DE, 0.71 and 26.1% for right DTF (DTFR), 0.71 and 20.7% for left DTF (DTFL), 0.78 and 14.8% for minimum DTF (DTFMIN), 0.79 and 26.1% for maximum DTF (DTFMAX), 0.71 and 1.24 mm for maximum diaphragm thickness at the end of inspiration (DteiMAX), and 0.65 and 10.0 mm/s for contraction velocity. CONCLUSION Diaphragmatic ultrasonography is feasible in guiding ventilator weaning, and the indicators of DE, DTF, and DteiMAX guide the weaning more accurately. Among them, DTF may act as a more reliable predictor of weaning by avoiding the influence of diaphragm development in children.
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Affiliation(s)
- Yelin Yao
- Department of Rehabilitation, Children's Hospital of Fudan University, Shanghai, China
| | - Liming He
- Pediatric Emergency Critical Care Center, Children's Hospital of Fudan University, Shanghai, China
| | - Weiming Chen
- Pediatric Emergency Critical Care Center, Children's Hospital of Fudan University, Shanghai, China
| | - Hao Zhou
- Department of Rehabilitation, Children's Hospital of Fudan University, Shanghai, China
| | - Guoping Lu
- Pediatric Emergency Critical Care Center, Children's Hospital of Fudan University, Shanghai, China
| | - Jinhao Tao
- Pediatric Emergency Critical Care Center, Children's Hospital of Fudan University, Shanghai, China
| | - SuJuan Wang
- Department of Rehabilitation, Children's Hospital of Fudan University, Shanghai, China
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Rives S, Schmid B, Chaumet G, Brégeon F, Boussuges A. Changes in Diaphragmatic Function Induced by an Increased Inspiratory Load Experienced by Military Divers: An Ultrasound Study. Front Physiol 2021; 12:756533. [PMID: 34916955 PMCID: PMC8670941 DOI: 10.3389/fphys.2021.756533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/09/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Inspiratory loading is experienced by military divers when they use rebreather device. Our objective was to assess the changes in diaphragm function induced by an increase in inspiratory load at values similar to those experienced by divers in real life. Methods: We recorded the excursion and the thickness of the right hemidiaphragm in 22 healthy male volunteers under inspiratory load conditions, using ultrasound in B- and M-mode. The measurements were performed at tidal volume and during breathing at 50% of inspiratory capacity. The breathing rate was regulated and similar in the various sessions with and without load. Results: The rebreather device used by French military divers leads to an increase in inspiratory load of close to 30 cmH2O. Consequently, the session under load was performed using a device set to this threshold. Significant increases in the excursion and the thickening fraction of the diaphragm were observed between the sessions at tidal volume and at high volume. With addition of the inspiratory load, the excursion of the right hemidiaphragm increased significantly from 2.3 to 3.4cm at tidal volume and from 3.9 to 4.7cm at high volume. The thickening fraction increased significantly from 30.4 to 76.6% at tidal volume and from 70 to 123% at high volume. The statistical analysis demonstrated that assessment of the changes of the thickening fraction during breathing at tidal volume was the most relevant marker to assess the impact of the inspiratory load on the diaphragm. Conclusion: Diaphragm ultrasound can be used to assess the changes in the diaphragm contraction pattern secondary to an increase in the respiratory load that can be generated by use a diving apparatus. The recording of the changes of the motion, and more importantly of the thickness of the diaphragm, during the breathing cycle is able to provide relevant information regarding the inspiratory load.
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Affiliation(s)
- Sarah Rives
- ERRSO, Institut de Recherche Biomédicale des Armées (IRBA), Toulon, France.,Center for Cardiovascular and Nutrition Research (C2VN), INSERM, INRAE, Aix Marseille Université, Marseille, France
| | - Bruno Schmid
- ERRSO, Institut de Recherche Biomédicale des Armées (IRBA), Toulon, France
| | | | - Fabienne Brégeon
- Service d'Explorations Fonctionnelles Respiratoires, CHU Nord, Assistance Publique des Hôpitaux de Marseille et Aix Marseille Univ, IRD, APHM, MEPHIIHU-Méditerranée Infection, Marseille, France
| | - Alain Boussuges
- ERRSO, Institut de Recherche Biomédicale des Armées (IRBA), Toulon, France.,Center for Cardiovascular and Nutrition Research (C2VN), INSERM, INRAE, Aix Marseille Université, Marseille, France.,Service d'Explorations Fonctionnelles Respiratoires, CHU Nord, Assistance Publique des Hôpitaux de Marseille et Aix Marseille Univ, IRD, APHM, MEPHIIHU-Méditerranée Infection, Marseille, France
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Koco E, Soilemezi E, Sotiriou P, Savvidou S, Tsagourias M, Pnevmatikos I, Matamis D. Ultrasonographic assessment of diaphragmatic contraction and relaxation properties: correlations of diaphragmatic displacement with oesophageal and transdiaphragmatic pressure. BMJ Open Respir Res 2021; 8:8/1/e001006. [PMID: 34556491 PMCID: PMC8461713 DOI: 10.1136/bmjresp-2021-001006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/30/2021] [Indexed: 11/06/2022] Open
Abstract
Transdiaphragmatic (Pdi) and oesophageal pressures (Pes) are useful in understanding the pathophysiology of the respiratory system. They provide insight into respiratory drive, intrinsic positive end-expiratory pressure, diaphragmatic fatigue and weaning failure.
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Affiliation(s)
- Entela Koco
- Department of Intensive Care Medicine, General Hospital of Thessaloniki Papageorgiou, Thessaloniki, Greece
| | - Eleni Soilemezi
- Department of Intensive Care Medicine, General Hospital of Thessaloniki Papageorgiou, Thessaloniki, Greece
| | - Panagiota Sotiriou
- Department of Intensive Care Medicine, General Hospital of Thessaloniki Papageorgiou, Thessaloniki, Greece
| | - Savvoula Savvidou
- Department of Intensive Care Medicine, General Hospital of Thessaloniki Papageorgiou, Thessaloniki, Greece
| | - Matthew Tsagourias
- Department of Intensive Care Medicine, General Hospital of Thessaloniki Papageorgiou, Thessaloniki, Greece
| | - Ioannis Pnevmatikos
- Department of Intensive Care Medicine, Democritus University of Thrace, Komotini, Greece
| | - Dimitrios Matamis
- Department of Intensive Care Medicine, General Hospital of Thessaloniki Papageorgiou, Thessaloniki, Greece
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Zhu Z, Li J, Yang D, Gao F, Du L, Yang M. Ultrasonographic evaluation of diaphragm thickness and excursion in patients with cervical spinal cord injury. J Spinal Cord Med 2021; 44:742-747. [PMID: 31714188 PMCID: PMC8477968 DOI: 10.1080/10790268.2019.1669955] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective: To evaluate the diaphragm thickness and excursion in patients with cervical spinal cord injury and reliability of diaphragmatic ultrasonography.Design: A Pilot Case-Control Study.Setting: China Rehabilitation Research Center (CRRC) /Beijing BO AI Hospital.Participants: Sixty participants with cervical spinal cord injury and sixty control participants were eligible for inclusion in this study.Interventions: Ultrasonographic evaluation of the diaphragm.Outcome Measures: All demographic data were evaluated. Diaphragm thickness, thickening ratio, and diaphragm excursions were assessed at the end of quiet tidal breathing and maximal inspiration. The reliability of inter- and intra-ultrasonography operators were evaluated.Results: Diaphragm thickness was significantly higher in patients with cervical spinal cord injury than the control group (P < 0.001). Diaphragmatic excursion of the right hemidiaphragm was significantly greater in patients with cervical spinal cord injury than the control group (P < 0.001) at the end of quiet tidal breathing. No difference was found in diaphragmatic excursion between two groups (P = 0.32) at the end of maximal inspiration. No significant difference was shown between two groups in thickening ratio. Intraclass correlation coefficients of inter-and intra-ultrasonography operators for the thickness and excursions of the diaphragm were greater than 0.93.Conclusion: Compared with the control group the diaphragm in patients with cervical spinal cord injury is hypertrophied and the diaphragm excursion is greater. Ultrasound is a highly reliable tool for the evaluation of diaphragm thickness and excursion in patients with cervical spinal cord injury.Trial Registration: This trail was registered in Chinese Clinical Trial Registry (NO. ChiCTR-ROC-17010973).
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Affiliation(s)
- Zhizhong Zhu
- Department of Rehabilitation Medicine, Tianjin Huanhu Hospital, Tianjin, People’s Republic of China,School of Rehabilitation Medicine, Capital Medical University, Beijing, People’s Republic of China,
| | - Jianjun Li
- School of Rehabilitation Medicine, Capital Medical University, Beijing, People’s Republic of China,Department of Spinal and Neural Function Reconstruction, China Rehabilitation Research Center, Beijing, People’s Republic of China,China Rehabilitation Science Institute, Beijing, People’s Republic of China,China Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, People’s Republic of China,Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, People’s Republic of China,Correspondence to: Jianjun Li, School of Rehabilitation Medicine, Capital Medical University, No. 10 Jiaomen North Road, Fengtai District, Beijing100068, People’s Republic of China; +86-13718331416; +86-010-67573428;
| | - Degang Yang
- School of Rehabilitation Medicine, Capital Medical University, Beijing, People’s Republic of China,Department of Spinal and Neural Function Reconstruction, China Rehabilitation Research Center, Beijing, People’s Republic of China,China Rehabilitation Science Institute, Beijing, People’s Republic of China,China Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, People’s Republic of China,Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, People’s Republic of China
| | - Feng Gao
- Department of Spinal and Neural Function Reconstruction, China Rehabilitation Research Center, Beijing, People’s Republic of China
| | - Liangjie Du
- School of Rehabilitation Medicine, Capital Medical University, Beijing, People’s Republic of China,Department of Spinal and Neural Function Reconstruction, China Rehabilitation Research Center, Beijing, People’s Republic of China,China Rehabilitation Science Institute, Beijing, People’s Republic of China,China Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, People’s Republic of China,Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, People’s Republic of China
| | - Mingliang Yang
- School of Rehabilitation Medicine, Capital Medical University, Beijing, People’s Republic of China,Department of Spinal and Neural Function Reconstruction, China Rehabilitation Research Center, Beijing, People’s Republic of China,China Rehabilitation Science Institute, Beijing, People’s Republic of China,China Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, People’s Republic of China,Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, People’s Republic of China
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Boussuges A, Finance J, Chaumet G, Brégeon F. Diaphragmatic motion recorded by M-mode ultrasonography: limits of normality. ERJ Open Res 2021; 7:00714-2020. [PMID: 33778044 PMCID: PMC7983192 DOI: 10.1183/23120541.00714-2020] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/04/2021] [Indexed: 12/21/2022] Open
Abstract
Chest ultrasonography has proven to be useful in the diagnosis of diaphragm dysfunction. The aim of the present study was to determine the normal values of the motion of both hemidiaphragms recorded by M-mode ultrasonography. Healthy volunteers were studied while in a seated position. Diaphragmatic excursions and diaphragm profiles were measured during quiet breathing, voluntary sniffing and deep breathing. Diaphragmatic excursions were assessed by M-mode ultrasonography, using an approach perpendicular to the posterior part of the diaphragm. Anatomical M-mode was used for the recording of the complete excursion during deep breathing. The study included 270 men and 140 women. The diaphragmatic motions during quiet breathing and voluntary sniffing were successfully recorded in all of the participants. The use of anatomical M-mode was particularly suitable for measurement of the entire diaphragmatic excursion during deep breathing. The statistical analysis showed that the diaphragmatic excursions were larger in men compared to women, supporting the determination of normal values based on sex. The lower and upper limits of normal excursion were determined for men and women for both hemidiaphragms during the three manoeuvres that were investigated. The lower limits of normal diaphragmatic excursions during deep breathing should be used to detect diaphragmatic hypokinesia, i.e. 3.3 and 3.2 cm in women and 4.1 and 4.2 cm in men for the right and the left sides, respectively. The normal values of the diaphragmatic motion and the lower and upper limits of normal excursion can be used by clinicians to detect diaphragmatic dysfunction. These normal values of diaphragmatic motion, and the lower and upper limits of normal excursion, can be used by physicians to detect diaphragm hypokinesia and hyperkinesia, and thus diagnose diaphragmatic dysfunctionhttps://bit.ly/35R9OFk
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Affiliation(s)
- Alain Boussuges
- Institut de Recherche Biomédicale des Armées (IRBA), ERRSO, Toulon and Center for Cardiovascular and Nutrition Research (C2VN), Aix Marseille Université, INSERM, INRAE, Marseille, France
| | - Julie Finance
- Service d'Explorations Fonctionnelles Respiratoires, CHU Nord, Assistance Publique des Hôpitaux de Marseille et Aix Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | | | - Fabienne Brégeon
- Service d'Explorations Fonctionnelles Respiratoires, CHU Nord, Assistance Publique des Hôpitaux de Marseille et Aix Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
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Dong Z, Liu Y, Gai Y, Meng P, Lin H, Zhao Y, Xing J. Early rehabilitation relieves diaphragm dysfunction induced by prolonged mechanical ventilation: a randomised control study. BMC Pulm Med 2021; 21:106. [PMID: 33781259 PMCID: PMC8006630 DOI: 10.1186/s12890-021-01461-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 03/09/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Prolonged mechanical ventilation (MV) induces diaphragm dysfunction in patients in the intensive care units (ICUs). Our study aimed to explore the therapeutic efficacy of early rehabilitation therapy in patients with prolonged MV in the ICU. METHODS Eighty eligible patients who underwent MV for > 72 h in the ICU from June 2019 to March 2020 were enrolled in this prospective randomised controlled trial. The patients were randomly divided into a rehabilitation group (n = 39) and a control group (n = 41). Rehabilitation therapy included six levels of rehabilitation exercises. Diaphragm function was determined using ultrasound (US). RESULTS Diaphragmatic excursion (DE) and diaphragm thickening fraction (DTF) were significantly decreased in all patients in both groups after prolonged MV (p < 0.001). The rehabilitation group had significantly higher DTF (p = 0.008) and a smaller decrease in DTF (p = 0.026) than the control group after 3 days of rehabilitation training. The ventilator duration and intubation duration were significantly shorter in the rehabilitation group than in the control group (p = 0.045 and p = 0.037, respectively). There were no significant differences in the duration of ICU stay, proportion of patients undergoing tracheotomy, and proportion of recovered patients between the two groups. CONCLUSIONS Early rehabilitation is feasible and beneficial to ameliorate diaphragm dysfunction induced by prolonged MV and advance withdrawal from the ventilator and extubation in patients with MV. Diaphragm US is suggested for mechanically ventilated patients in the ICU. Trial registration Chinese Clinical Trial Registry, ID: ChiCTR1900024046, registered on 2019/06/23.
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Affiliation(s)
- Zehua Dong
- Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University, No. 16, Jiangsu Road, Qingdao, 266000 Shandong China
| | - Ying Liu
- Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University, No. 16, Jiangsu Road, Qingdao, 266000 Shandong China
| | - Yubiao Gai
- Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University, No. 16, Jiangsu Road, Qingdao, 266000 Shandong China
| | - Pingping Meng
- Department of Rehabilitation Medicine, The Affiliated Hospital of Qingdao University, Qingdao, 266000 Shandong China
| | - Hui Lin
- Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University, No. 16, Jiangsu Road, Qingdao, 266000 Shandong China
| | - Yuxiao Zhao
- Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University, No. 16, Jiangsu Road, Qingdao, 266000 Shandong China
| | - Jinyan Xing
- Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University, No. 16, Jiangsu Road, Qingdao, 266000 Shandong China
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Jonkman AH, Wennen M, Sklar MC, de Korte C, Tuinman PR. Tissue Doppler Imaging of the Diaphragm: A Novel Approach but Too Early for Clinical Implementation? Am J Respir Crit Care Med 2021; 202:1741-1742. [PMID: 32961066 PMCID: PMC7737574 DOI: 10.1164/rccm.202007-2958le] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Annemijn H Jonkman
- Amsterdam University Medical Centers Amsterdam, the Netherlands.,University of Toronto, Toronto Ontario, Canada and
| | - Myrte Wennen
- Amsterdam University Medical Centers Amsterdam, the Netherlands
| | | | - Chris de Korte
- Radboud University Medical Center Nijmegen, the Netherlands
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Boussuges A, Rives S, Finance J, Brégeon F. Assessment of diaphragmatic function by ultrasonography: Current approach and perspectives. World J Clin Cases 2020; 8:2408-2424. [PMID: 32607319 PMCID: PMC7322428 DOI: 10.12998/wjcc.v8.i12.2408] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/19/2020] [Accepted: 06/02/2020] [Indexed: 02/05/2023] Open
Abstract
This article reports the various methods used to assess diaphragmatic function by ultrasonography. The excursions of the two hemidiaphragms can be measured using two-dimensional or M-mode ultrasonography, during respiratory maneuvers such as quiet breathing, voluntary sniffing and deep inspiration. On the zone of apposition to the rib cage for both hemidiaphragms, it is possible to measure the thickness on expiration and during deep breathing to assess the percentage of thickening during inspiration. These two approaches make it possible to assess the quality of the diaphragmatic function and the diagnosis of diaphragmatic paralysis or dysfunction. These methods are particularly useful in circumstances where there is a high risk of phrenic nerve injury or in diseases affecting the contractility or the motion of the diaphragm such as neuro-muscular diseases. Recent methods such as speckle tracking imaging and ultrasound shear wave elastography should provide more detailed information for better assessment of diaphragmatic function.
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Affiliation(s)
- Alain Boussuges
- Institut de Recherche Biomédicale des Armées, ERRSO, Toulon 83800, France
- Center for Cardiovascular and Nutrition Research (C2VN), Aix Marseille Université, INSERM (1260), INRAE (1263), Toulon 83800, France
| | - Sarah Rives
- Institut de Recherche Biomédicale des Armées, ERRSO, Toulon 83800, France
| | - Julie Finance
- Service d’Explorations Fonctionnelles Respiratoires, CHU Nord, Assistance Publique des Hôpitaux de Marseille et Aix Marseille Université, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille 13015, France
| | - Fabienne Brégeon
- Service d’Explorations Fonctionnelles Respiratoires, CHU Nord, Assistance Publique des Hôpitaux de Marseille et Aix Marseille Université, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille 13015, France
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12
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Santana PV, Cardenas LZ, de Albuquerque ALP, de Carvalho CRR, Caruso P. Diaphragmatic ultrasound findings correlate with dyspnea, exercise tolerance, health-related quality of life and lung function in patients with fibrotic interstitial lung disease. BMC Pulm Med 2019; 19:183. [PMID: 31638951 PMCID: PMC6802109 DOI: 10.1186/s12890-019-0936-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 09/11/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Fibrotic interstitial lung disease (FILD) patients are typically dyspneic and exercise-intolerant with consequent impairment of health-related quality of life (HRQoL). Respiratory muscle dysfunction is among the underlying mechanisms of dyspnea and exercise intolerance in FILD but may be difficult to diagnose. Using ultrasound, we compared diaphragmatic mobility and thickening in FILD cases and healthy controls and correlated these findings with dyspnea, exercise tolerance, HRQoL and lung function. METHODS We measured diaphragmatic mobility and thickness during quiet (QB) and deep breathing (DB) and calculated thickening fraction (TF) in 30 FILD cases and 30 healthy controls. We correlated FILD cases' diaphragmatic findings with dyspnea, exercise tolerance (six-minute walk test), lung function and HRQoL (St. George's Respiratory Questionnaire). RESULTS Diaphragmatic mobility was similar between groups during QB but was lower in FILD cases during DB when compared to healthy controls (3.99 cm vs 7.02 cm; p < 0.01). FILD cases showed higher diaphragm thickness during QB but TF was lower in FILD when compared to healthy controls (70% vs 188%, p < 0.01). During DB, diaphragmatic mobility and thickness correlated with lung function, exercise tolerance and HRQoL, but inversely correlated with dyspnea. Most FILD cases (70%) presented reduced TF, and these patients had higher dyspnea and exercise desaturation, lower HRQoL and lung function. CONCLUSION Compared to healthy controls, FILD cases present with lower diaphragmatic mobility and thickening during DB that correlate to increased dyspnea, decreased exercise tolerance, worse HRQoL and worse lung function. FILD cases with reduced diaphragmatic thickening are more dyspneic and exercise-intolerant, have lower HRQoL and lung function.
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Affiliation(s)
- Pauliane Vieira Santana
- Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. .,Intensive Care Unit, AC Camargo Cancer Center, São Paulo, Brazil.
| | - Leticia Zumpano Cardenas
- Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Intensive Care Unit, AC Camargo Cancer Center, São Paulo, Brazil
| | - André Luis Pereira de Albuquerque
- Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Hospital Sírio Libanês, São Paulo, Brazil
| | - Carlos Roberto Ribeiro de Carvalho
- Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Pedro Caruso
- Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Intensive Care Unit, AC Camargo Cancer Center, São Paulo, Brazil
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13
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Wangüemert Pérez AL, Cases Viedma E. La ecografía transtorácica: presente y futuro. Arch Bronconeumol 2019; 55:455-456. [DOI: 10.1016/j.arbres.2019.02.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 02/22/2019] [Accepted: 02/26/2019] [Indexed: 12/15/2022]
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14
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Zhu Z, Li J, Yang D, Du L, Yang M. Ultrasonography of Diaphragm Can Predict Pulmonary Function in Spinal Cord Injury Patients: A Pilot Case-Control Study. Med Sci Monit 2019; 25:5369-5374. [PMID: 31324750 PMCID: PMC6662942 DOI: 10.12659/msm.917992] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Ultrasonography of the diaphragm is an under-utilized instrument in cervical spinal cord injury patients. We conducted a pilot study to first compare the difference of diaphragm thickness and the excursion between patients with cervical spinal cord injury and healthy volunteers, and second to correlate diaphragmic ultrasonography and pulmonary function in cervical spinal cord injury patients. MATERIAL AND METHODS Thirty patients with C4-C5 cervical spinal cord injury of more than 1 year and thirty healthy volunteers were included in this study. All demographic data were evaluated. All participants underwent diaphragmic ultrasonography evaluation and pulmonary function test. Diaphragm thickness of both sides and diaphragm excursions of the right hemi-diaphragm were obtained at the end of quiet tidal breathing and maximal inspiration. We compared diaphragmatic thickness and excursions, and we analyzed the relationship between diaphragmatic ultrasonography and pulmonary function. RESULTS All spinal cord injury patients had restrictive pulmonary dysfunction compared to the control group of healthy volunteers. Diaphragm thickness on both sides was significantly increased in spinal cord injury patients. Diaphragmatic excursion in spinal cord injury patients was increased on the right hemi-diaphragm during tidal breathing. However, the right hemi-diaphragmatic excursion was no difference in both groups during maximal inspiration. Right hemi-diaphragmatic excursion during deep breathing correlated positively with expiratory volume in 1 second (P<0.01) and forced vital capacity (P<0.01). Right hemi-diaphragm thickness at end of maximum inspiration correlated positively with expiratory volume in 1 second (P<0.01) and forced vital capacity (P<0.01). Left hemi-diaphragm thickness at end of maximum inspiration correlated positively with expiratory volume in 1 second (P<0.01) and forced vital capacity (P<0.01). CONCLUSIONS Diaphragm thickness and motion of the cervical spinal cord injury patients were different from controls. Pulmonary function was impaired in spinal cord injury patients. Ultrasonography of the diaphragm as a non-invasive method that is correlated with pulmonary function.
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Affiliation(s)
- Zhizhong Zhu
- Department of Spinal and Neural Function Reconstruction, China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing, China (mainland).,Department of Rehabilitation Medicine, Tianjin Huanhu Hospital, Tianjin, China (mainland)
| | - Jianjun Li
- Department of Spinal and Neural Function Reconstruction, China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing, China (mainland).,Department of Spinal and Neural Function Reconstruction, China Rehabilitation Research Center, Beijing, China (mainland).,China Rehabilitation Science Institute, Beijing, China (mainland).,China Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China (mainland).,Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China (mainland)
| | - Degang Yang
- Department of Spinal and Neural Function Reconstruction, China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing, China (mainland).,Department of Spinal and Neural Function Reconstruction, China Rehabilitation Research Center, Beijing, China (mainland).,China Rehabilitation Science Institute, Beijing, China (mainland).,China Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China (mainland).,Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China (mainland)
| | - Liangjie Du
- Department of Spinal and Neural Function Reconstruction, China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing, China (mainland).,Department of Spinal and Neural Function Reconstruction, China Rehabilitation Research Center, Beijing, China (mainland).,China Rehabilitation Science Institute, Beijing, China (mainland).,China Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China (mainland).,Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China (mainland)
| | - Mingliang Yang
- Department of Spinal and Neural Function Reconstruction, China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing, China (mainland).,Department of Spinal and Neural Function Reconstruction, China Rehabilitation Research Center, Beijing, China (mainland).,China Rehabilitation Science Institute, Beijing, China (mainland).,China Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China (mainland).,Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China (mainland)
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15
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Palkar A, Narasimhan M, Greenberg H, Singh K, Koenig S, Mayo P, Gottesman E. Diaphragm Excursion-Time Index: A New Parameter Using Ultrasonography to Predict Extubation Outcome. Chest 2018; 153:1213-1220. [PMID: 29353023 DOI: 10.1016/j.chest.2018.01.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 11/11/2017] [Accepted: 01/02/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The diaphragmatic response to increased mechanical load following withdrawal of mechanical ventilation is critical in determining the outcome of extubation. Using ultrasonography, we aimed to evaluate the performance of the excursion-time (E-T) index-a product of diaphragm excursion and inspiratory time, to predict the outcome of extubation. METHODS Right hemidiaphragm excursion, inspiratory time, and E-T index were measured by ultrasonography during mechanical ventilation: (1) on assist-control (A/C) mode during consistent patient-triggered ventilation, (2) following 30 min during a spontaneous breathing trial (SBT), and (3) between 4 and 24 h following extubation. These measurements were correlated with the outcome of extubation. Patients in the "failure" group required reintubation or noninvasive ventilation within 48 h of extubation. RESULTS Of the 73 patients studied, 20 patients failed extubation. During SBT, diaphragm excursion was 1.65 ± 0.82 and 2.1 ± 0.9 cm (P = .06), inspiratory time was 0.89 ± 0.30 and 1.11 ± 0.39 s (P = .03), and the E-T index was 1.64 ± 1.19 and 2.42 ± 1.55 cm-s (P < .03) in the "failure" and "success" groups, respectively. The mean change in E-T index between A/C and SBT was -3.9 ± 57.8% in the failure group and 59.4 ± 74.6% in the success group (P < .01). A decrease in diaphragmatic E-T index less than 3.8% between A/C and SBT had a sensitivity of 79.2% and a specificity of 75%, to predict successful extubation. CONCLUSIONS Diaphragm E-T index measured during SBT may help predict the outcome of extubation. Maintenance or increase in diaphragm E-T index between A/C and SBT increases the likelihood of successful extubation.
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Affiliation(s)
- Atul Palkar
- Pulmonary Physicians of Norwich, Norwich, CT.
| | - Mangala Narasimhan
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Hofstra-Northwell School of Medicine, New Hyde Park, NY
| | - Harly Greenberg
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Hofstra-Northwell School of Medicine, New Hyde Park, NY
| | - Karan Singh
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Hofstra-Northwell School of Medicine, New Hyde Park, NY
| | - Seth Koenig
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Hofstra-Northwell School of Medicine, New Hyde Park, NY
| | - Paul Mayo
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Hofstra-Northwell School of Medicine, New Hyde Park, NY
| | - Eric Gottesman
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Hofstra-Northwell School of Medicine, New Hyde Park, NY
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Banerjee A, Mehrotra G. Comparison of Lung Ultrasound-based Weaning Indices with Rapid Shallow Breathing Index: Are They Helpful? Indian J Crit Care Med 2018; 22:435-440. [PMID: 29962745 PMCID: PMC6020643 DOI: 10.4103/ijccm.ijccm_331_17] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background and Aims: The diaphragm is considered the main respiratory muscle and difficulty in weaning can occur because of impaired diaphragmatic function. Hence, monitoring diaphragmatic function is important. The aim of this study is to assess the ability of various lung ultrasound (US) indices and the rapid shallow breathing index (RSBI) to predict the outcome of the weaning process and compare them with RSBI. Materials and Methods: This was a prospective study conducted on patients admitted to critical care unit at a tertiary care hospital in north India from February 2017 to June 2017. Patients were put to spontaneous breathing trial (SBT) when they met the weaning criteria. Initial US was done immediately after putting the patient on SBT to check anatomy of the diaphragm and rule out patients according to exclusion criteria. This was followed by complete lung US (LUS) after 20 min of SBT. Results: The RSBI performed better than all other parameters, with an area under the curve (AUC) of 0.996. The sensitivity and specificity is 100%. Only comparable to RSBI is the speed of diaphragmic contraction (DC) which has AUC of 0.93. All other parameters had an AUC <0.8. Moreover, the DC and LUS score are strongly positively correlated with RSBI, whereas diaphragmic excursion and diaphragmic thickness fraction (DTF %) are weakly correlated. Conclusion: In Intensive Care Unit, RSBI is the best clinical tool for weaning, and DC is found to be the best parameter for weaning among the US-based weaning parameters. It can even be a substitute for RSBI, in today's world of real-time monitoring methods.
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Affiliation(s)
- Abhinav Banerjee
- Department of Anesthesiology and Critical Care, Tata Main Hospital, Jamshedpur, Jharkhand, India
| | - Gesu Mehrotra
- Department of Anesthesiology and Critical Care, Tata Main Hospital, Jamshedpur, Jharkhand, India
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17
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Loizou CP, Matamis D, Minas G, Kyprianou T, Loizou CD, Soilemezi E, Kotco E, Pattichis CS. A New Method for Diaphragmatic Maximum Relaxation Rate Ultrasonographic Measurement in the Assessment of Patients With Diaphragmatic Dysfunction. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2018; 6:2700710. [PMID: 30405977 PMCID: PMC6204329 DOI: 10.1109/jtehm.2018.2868671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/05/2018] [Accepted: 08/29/2018] [Indexed: 11/30/2022]
Abstract
Measurements of ultrasound diaphragmatic motion, amplitude, force, and velocity of contraction may provide important and essential information about diaphragmatic fatigue, weakness, or paralysis. In this paper, we propose and evaluate a semi-automated analysis system for measuring the diaphragmatic motion and estimating the maximum relaxation rate (MRR_SAUS) from ultrasound M-mode images of the diaphragmatic muscle. The system was evaluated on 27 M-mode ultrasound images of the diaphragmatic muscle [20 with no resistance (NRES) and 7 with resistance (RES)]. We computed semi-automated ultrasound MRR measurements on all NRES/RES images, using the proposed system (MRR_SAUS = 3.94 ± 0.91/4.98 ± 1.98 [1/s]), and compared them with the manual measurements made by a clinical expert (MRR_MUS = 2.36 ± 1.19/5.8 ± 2.1 [1/s],) and those made by a reference manual method (MRR_MB = 3.93 ± 0.89/3.73 ± 0.52 [1/sec], performed manually with the Biopac system. MRR_SAUS and MRR_MB measurements were not statistically significantly different for NRES and RES subjects but were significantly different with the MRR-MUS measurements made by the clinical expert. It is anticipated that the proposed system might be used in the future in the clinical practice in the assessment and follow up of patients with diaphragmatic weakness or paralysis. It may thus potentially help to understand post-operative pulmonary dysfunction or weaning failure from mechanical ventilation. Further validation and additional experimentation in a larger sample of images and different patient groups is required for further validating the proposed system.
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18
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Richard P. [Exploring the diaphragm: Ultrasound is essential]. Rev Mal Respir 2017; 34:645-660. [PMID: 28502520 DOI: 10.1016/j.rmr.2017.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 03/17/2016] [Indexed: 11/29/2022]
Abstract
The diaphragm is the muscle most implicated in breathing. Its morphological exploration usually depends on pulmonary radiography, fluoroscopy, CT-scanning and MRI. Its function is evaluated by the classical respiratory functional tests, the measurement of maximum inspiratory and expiratory pressures, the transdiaphragmatic pressure and even an electromyogram. Ultrasound is a technique still insufficiently used in respiratory medicine. It offers, however, many advantages: it is easy to implement, there is no irradiation, it is usable at the bedside, particularly when the patient is immobile or in intensive care. The results of the examination are immediately available. It allows morphological and dynamic study of each hemidiaphragm as well as providing invaluable information on the thoracic and subdiaphragmatic environment. Its field of exploration is extremely wide: raised hemidiaphragm, dyspnea following a stroke or a surgical procedure (thoracic or abdominal), road accident trauma, diagnosis and follow-up of a paresis or paralysis, evaluation of diaphragmatic mobility during the course of COPD (Chronic Obstructive Pulmonary Disease) and many other pathologies. Ultrasound is insufficiently used in pleural disease and even less so in the evaluation of the morphology and function of the diaphragm.
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Affiliation(s)
- P Richard
- Service de pneumologie, centre hospitaliser de la région de Saint-Omer, route de Blendecques, BP 60357, 62570 Helfaut, France.
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19
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de la Quintana Gordon FDB, Nacarino Alcorta B, Fajardo Pérez M. Ultrasound evaluation of diaphragm function and its application in critical patients, mechanical ventilation and brachial plexus block. ACTA ACUST UNITED AC 2017; 64:513-521. [PMID: 28343681 DOI: 10.1016/j.redar.2017.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 01/02/2017] [Accepted: 01/03/2017] [Indexed: 01/09/2023]
Abstract
Before diaphragm ultrasonography, assessment of diaphragm function was very difficult due to the complex nature of its exploration. The use of this new technique has shed light on diagnostic problems and treatment with an improvement in final outcomes for critically ill patients, in whom the incidence of diaphragm weakness or dysfunction has been underestimated. Better knowledge of diaphragm function enables us earlier diagnosis by quantification of diaphragm contractile activity or evaluation of functional status after delivery of plexus block anaesthesia, facilitating therapeutic decisions. It is also being used as a guide in the process of weaning from mechanical ventilation or as the safest approach for braquial plexus block. In this review we present how to perform a systematic exploration of diaphragm function and its clinical implications.
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Affiliation(s)
- F de B de la Quintana Gordon
- Servicio de Anestesia Reanimación y Tratamiento del Dolor, Hospital Universitario de Móstoles, Móstoles Madrid, España.
| | - B Nacarino Alcorta
- Servicio de Anestesia Reanimación y Tratamiento del Dolor, Hospital Universitario de Móstoles, Móstoles Madrid, España
| | - M Fajardo Pérez
- Servicio de Anestesia Reanimación y Tratamiento del Dolor, Hospital Universitario de Móstoles, Móstoles Madrid, España
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Lui JK, Banauch GI. Diagnostic Bedside Ultrasonography for Acute Respiratory Failure and Severe Hypoxemia in the Medical Intensive Care Unit: Basics and Comprehensive Approaches. J Intensive Care Med 2016; 32:355-372. [PMID: 27402396 DOI: 10.1177/0885066616658475] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Bedside goal-directed ultrasound is a powerful tool for rapid differential diagnosis and monitoring of cardiopulmonary disease in the critically ill patient population. The bedside intensivist is in a unique position to integrate ultrasound findings with the overall clinical situation. Medically critically ill patients who require urgent bedside diagnostic assessment fall into 2 categories: (1) acute respiratory failure and (2) hemodynamic derangements. The first portion of this review outlines the diagnostic role of bedside ultrasound in the medically critically ill patient population for the diagnosis and treatment of acute respiratory failure, acute respiratory distress, and severe hypoxemia. The second portion will focus on the diagnostic role of ultrasound for the evaluation and treatment of shock states, as well as describe protocolized approaches for evaluation of shock during cardiopulmonary resuscitation. Different respiratory system pathologies that result in acute respiratory failure (such as increased interstitial fluid, alveolar consolidation, pleural effusion) cause characteristic ultrasonographic findings; diaphragmatic assessment may also add information. Intracardiac shunting can cause severe hypoxemia. Protocolized approaches for the evaluation of patients with acute respiratory failure or distress are discussed.
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Affiliation(s)
- Justin K Lui
- 1 Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Gisela I Banauch
- 1 Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA.,2 Division of Pulmonary Medicine, University of Massachusetts Medical School, Worcester, MA, USA
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Le Neindre A, Mongodi S, Philippart F, Bouhemad B. Thoracic ultrasound: Potential new tool for physiotherapists in respiratory management. A narrative review. J Crit Care 2015; 31:101-9. [PMID: 26613650 DOI: 10.1016/j.jcrc.2015.10.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 10/20/2015] [Accepted: 10/23/2015] [Indexed: 01/15/2023]
Abstract
The use of diagnostic ultrasound by physiotherapists is not a new concept; it is frequently performed in musculoskeletal physiotherapy. Physiotherapists currently lack accurate, reliable, sensitive, and valid measurements for the assessment of the indications and effectiveness of chest physiotherapy. Thoracic ultrasound may be a promising tool for the physiotherapist and could be routinely performed at patients' bedsides to provide real-time and accurate information on the status of pleura, lungs, and diaphragm; this would allow for assessment of lung aeration from interstitial syndrome to lung consolidation with much better accuracy than chest x-rays or auscultation. Diaphragm excursion and contractility may also be assessed by ultrasound. This narrative review refers to lung and diaphragm ultrasound semiology and describes how physiotherapists could use this tool in their clinical decision-making processes in various cases of respiratory disorders. The use of thoracic ultrasound semiology alongside typical examinations may allow for the guiding, monitoring, and evaluating of chest physiotherapy treatments. Thoracic ultrasound is a potential new tool for physiotherapists.
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Affiliation(s)
- Aymeric Le Neindre
- Intensive Care Unit and Department of Critical Care Medicine, Groupe Hospitalier Paris Saint-Joseph, Paris, France.
| | - Silvia Mongodi
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Department of Anesthesia and Intensive Care, Fondazione IRCCS Policlinico S Matteo, Pavia, Italy
| | - François Philippart
- Intensive Care Unit and Department of Critical Care Medicine, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Bélaïd Bouhemad
- Department of Anesthesia and Surgical Intensive Care Unit, C.H.U. de Dijon, Dijon, France; Faculty of Medicine, University of Burgundy, Dijon, France
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22
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Umbrello M, Formenti P, Longhi D, Galimberti A, Piva I, Pezzi A, Mistraletti G, Marini JJ, Iapichino G. Diaphragm ultrasound as indicator of respiratory effort in critically ill patients undergoing assisted mechanical ventilation: a pilot clinical study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:161. [PMID: 25886857 PMCID: PMC4403842 DOI: 10.1186/s13054-015-0894-9] [Citation(s) in RCA: 183] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 03/23/2015] [Indexed: 11/22/2022]
Abstract
Introduction Pressure-support ventilation, is widely used in critically ill patients; however, the relative contribution of patient’s effort during assisted breathing is difficult to measure in clinical conditions. Aim of the present study was to evaluate the performance of ultrasonographic indices of diaphragm contractile activity (respiratory excursion and thickening) in comparison to traditional indices of inspiratory muscle effort during assisted mechanical ventilation. Method Consecutive patients admitted to the ICU after major elective surgery who met criteria for a spontaneous breathing trial with pressure support ventilation were enrolled. Patients with airflow obstruction or after thoracic/gastric/esophageal surgery were excluded. Variable levels of inspiratory muscle effort were achieved by delivery of different levels of ventilatory assistance by random application of pressure support (0, 5 and 15 cmH2O). The right hemidiaphragm was evaluated by B- and M-mode ultrasonography to record respiratory excursion and thickening. Airway, gastric and oesophageal pressures, and airflow were recorded to calculate indices of respiratory effort (diaphragm and esophageal pressure–time product). Results 25 patients were enrolled. With increasing levels of pressure support, parallel reductions were found between diaphragm thickening and both diaphragm and esophageal pressure–time product (respectively, R = 0.701, p < 0.001 and R = 0.801, p < 0.001) during tidal breathing. No correlation was found between either diaphragm or esophageal pressure–time product and diaphragm excursion (respectively, R = −0.081, p = 0.506 and R = 0.003, p = 0.981), nor was diaphragm excursion correlated to diaphragm thickening (R = 0.093, p = 0.450) during tidal breathing. Conclusions In patients undergoing in assisted mechanical ventilation, diaphragm thickening is a reliable indicator of respiratory effort, whereas diaphragm excursion should not be used to quantitatively assess diaphragm contractile activity. Electronic supplementary material The online version of this article (doi:10.1186/s13054-015-0894-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michele Umbrello
- Unità Operativa di Anestesia e Rianimazione, Azienda Ospedaliera San Paolo - Polo Universitario, Via A. Di Rudinì, 8-20142, Milano, Italy. .,Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milano, Italy.
| | - Paolo Formenti
- Unità Operativa di Anestesia e Rianimazione, Azienda Ospedaliera San Paolo - Polo Universitario, Via A. Di Rudinì, 8-20142, Milano, Italy.
| | - Daniela Longhi
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milano, Italy.
| | - Andrea Galimberti
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milano, Italy.
| | - Ilaria Piva
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milano, Italy.
| | - Angelo Pezzi
- Unità Operativa di Anestesia e Rianimazione, Azienda Ospedaliera San Paolo - Polo Universitario, Via A. Di Rudinì, 8-20142, Milano, Italy.
| | - Giovanni Mistraletti
- Unità Operativa di Anestesia e Rianimazione, Azienda Ospedaliera San Paolo - Polo Universitario, Via A. Di Rudinì, 8-20142, Milano, Italy. .,Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milano, Italy.
| | - John J Marini
- Department of Pulmonary and Critical Care, University of Minnesota, Regions Hospital, St Paul, MN, USA.
| | - Gaetano Iapichino
- Unità Operativa di Anestesia e Rianimazione, Azienda Ospedaliera San Paolo - Polo Universitario, Via A. Di Rudinì, 8-20142, Milano, Italy. .,Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milano, Italy.
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23
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Piper A, Song Y, Eves ND, Maher TM. Year in review 2013: Acute lung injury, interstitial lung diseases, sleep and physiology. Respirology 2014; 19:428-37. [PMID: 24708032 PMCID: PMC7169150 DOI: 10.1111/resp.12254] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 01/14/2014] [Indexed: 12/11/2022]
Affiliation(s)
- Amanda Piper
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia; Woolcock Institute of Medical Research, Sydney Medical School, Camperdown, New South Wales, Australia
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