Diaphragm Ultrasound in Weaning From Mechanical Ventilation

Kilaru, Deepti; Panebianco, Nova L.; Baston, Cameron

doi:10.1016/j.chest.2020.12.003

Cited by 16 publications

(30 citation statements)

References 20 publications

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“…Thirdly, this study only included patients with initial SBT, which might result in inaccurate assessment of difficult-towean patients. Fourthly, the correlation between diaphragm function and pendelluft needed more parameters of diaphragm function, such as ultrasound (Kilaru, Panebianco, and Baston, 2021). Finally, Frontiers in Physiology frontiersin.org…”

Section: Study Limitationsmentioning

confidence: 99%

Pendelluft as a predictor of weaning in critically ill patients: An observational cohort study

Wang

Ning

et al. 2023

Front. Physiol.

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Objective: Weaning failure is associated with adverse clinical outcomes. This study aimed to evaluate the accuracy of pendelluft during the spontaneous breathing trials (SBT) as a predictor of weaning outcome of patients with mechanical ventilation.Methods: An observational cohort study included 60 critically ill patients who were eligible for extubation. Pendelluft and electrical activity of the diaphragm (Edi) were monitored at baseline and every 10 minutes for the first 30 min of SBT denoted as T0, T1, T2, and T3. The pendelluft was measured using electrical impedance tomography (EIT), and Edi parameters were collected by Edi catheter. Patients were followed up after extubation and were divided into success group and failure group. Pendelluft, Edi parameters, respiratory parameters, and clinical outcomes such as intensive care units (ICU) stay, mortality, and 28-day ventilator-free days were compared between the two groups. Receiver operating characteristic (ROC) curves were constructed to evaluate the ability of pendelluft to predict weaning outcome.Results: Fifty patients (50/60) were successfully weaned from the machine and 10 (10/60) failed, with weaning failure rate of 16.7%. Respiratory parameters such as rapid shallow breathing index (RSBI), respiratory rate (RR) and Edi parameters such as maximum value of Edi (Edimax), Edi variation between a maximum and minimum(ΔEdi) in the failure group were higher than those in the success group. The ICU stay and the 28-day ventilator-free days in the failure group were significantly longer than those in the success group. The 28-day mortality rate was higher in the failure group. The pendelluft mainly occurred in the early stage of SBT. Ventral pendelluft and total pendelluft in the failure group were higher than those in the success group at T1. Edimax and ΔEdi were positively correlated with pendelluft. The area under ROC curve (AUC) showed moderate predictive ability for ventral pendelluft in predicting weaning failure at T1 (AUC 0.76, 95% CI 0.58–0.94, cut-off value > 3% global tidal variation).Conclusion: Pendelluft is one of the factors leading to weaning failure, which may be related to diaphragm function. Measuring pendelluft volume maybe helpful to predict weaning.

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Section: Study Limitationsmentioning

confidence: 99%

Pendelluft as a predictor of weaning in critically ill patients: An observational cohort study

Wang

Ning

et al. 2023

Front. Physiol.

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“…In addition to determining the cause of respiratory failure/ ventilator dependence, diaphragm ultrasound is now being used to help predict successful extubation based on either the thickening ratio or excursion, with sensitivities and specificities comparable with other methods in common use, such as a spontaneous breathing trial and use of clinical parameters including rapid shallow breathing index, comorbidities, and risk factors. 16 Critical care physicians are using ultrasound to assess accessory respiratory muscles such as the sternocleidomastoid, scalenes, intercostals, and abdominals, using contractility (thickening seen on ultrasound) to measure the work of breathing and identify ventilator over and under assist (Figure 6). 7).…”

Section: Normal Valuesmentioning

confidence: 99%

Electrodiagnostic and ultrasound evaluation of respiratory weakness

Boon,

Litchy

2023

Muscle and Nerve

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Phrenic nerve conduction studies (NCSs) and needle electromyography (EMG) can provide important information on the underlying pathophysiology in patients presenting with unexplained shortness of breath, failure to wean from the ventilator, or consideration of phrenic nerve pacemaker implantation. However, these techniques are often technically challenging, require experience, can lack sensitivity and specificity, and, in the case of diaphragm EMG, involve some degree of risk. Diagnostic high‐resolution ultrasound has been introduced in recent years as an adjuvant technique readily available at the bedside that can increase the overall sensitivity and specificity of the neurophysiologic evaluation of respiratory symptoms. Two‐dimensional ultrasound in the zone of apposition can identify atrophy and evaluate contractility of the diaphragm, in addition to localizing a safe zone for needle EMG. M‐mode ultrasound can identify decreased excursion or paradoxical motion of the diaphragm and can increase the reliability of phrenic NCSs. When used in combination, ultrasound, phrenic NCSs and EMG of the diaphragm can differentiate neuropathic, myopathic, and central disorders, and can offer aid in prognosis that is difficult to arrive at solely from clinical examination. This article will review techniques to successfully perform phrenic NCSs, needle EMG of the diaphragm, and ultrasound of the diaphragm. The discussion will include technical pitfalls and clinical pearls as well as future directions and clinical indications.

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“…La ultrasonografía es un método más económico, sin efectos secundarios, permitiendo una detección temprana ( 16) libre de radiación ionizante, sin trasladar el paciente (17)(18)(19), es un método no invasivo siendo de gran utilidad especialmente en niños (16,17,(20)(21)(22), con una sensibilidad y especificidad en parálisis hemidiafragmática del 100% y 81%, respectivamente (7). Ecográficamente en el diafragma se observan tres capas: 2 ecogénicas de peritoneo y pleura, intercaladas con una capa más hipoecoica del músculo localizado debajo de los músculos intercostales.…”

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Incidencia de parálisis diafragmática secundaria a bloqueo supraclavicular de plexo braquial medida por ecografía en una institución de cuarto nivel

Saba-Santiago

Orduz

Archila-Tibaduiza

et al. 2022

MedUNAB

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Introducción. La anestesia regional es una técnica importante, innovadora y popular para el manejo anestésico y analgésico. En el bloqueo supraclavicular del plexo braquial existe incidencia 50-60% de parálisis diafragmática. La presentación clínica es variable de acuerdo con factores externos e internos del paciente. Existen múltiples técnicas radiológicas en el diagnóstico, siendo de gran utilidad la ecografía por su fácil acceso. El objetivo es determinar la incidencia de parálisis diafragmática secundaria a bloqueo supraclavicular del plexo braquial guiado por ecografía en una institución de cuarto nivel. Metodología. Estudio analítico, longitudinal, prospectivo; se seleccionaron 110 pacientes. Criterios de inclusión: pacientes mayores de 18 años sometidos a cirugía de miembro superior con bloqueo supraclavicular de plexo braquial. Criterios exclusión: pacientes ASA (American Society of anesthesiologist) 4 y 5, gestantes, IMC >35 kg/m2, pacientes con antecedentes neuromusculares, enfermedad pulmonar restrictiva u obstructiva, parálisis nervio frénico o disfunción diafragmática. Se realizó un análisis mediante test estadísticos, describiendo los diferentes grados de parálisis diafragmática. Resultados. En los pacientes que cumplieron con los criterios de inclusión, la incidencia de parálisis diafragmática fue de 65% (37% parálisis total y 28% parcial), el 1.81% presentó síntomas respiratorios sin cambios hemodinámicos. Discusión. El bloqueo del plexo braquial por vía supraclavicular es una técnica relacionada con parálisis diafragmática, la ecografía ha permitido reducir la incidencia de esta complicación, es un método útil en el diagnóstico postoperatorio. Conclusiones. La parálisis diafragmática post bloqueo plexo braquial supraclavicular es una complicación observada principalmente en pacientes con previo compromiso pulmonar, por lo cual es de importancia la vigilancia estricta.

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Diaphragm Ultrasound in Weaning From Mechanical Ventilation

Cited by 16 publications

References 20 publications

Pendelluft as a predictor of weaning in critically ill patients: An observational cohort study

Pendelluft as a predictor of weaning in critically ill patients: An observational cohort study

Electrodiagnostic and ultrasound evaluation of respiratory weakness

Incidencia de parálisis diafragmática secundaria a bloqueo supraclavicular de plexo braquial medida por ecografía en una institución de cuarto nivel

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