A method for morphometric study of the intercostal muscles by high-resolution ultrasound

Diab, Khaled; Shalabi, Adel; Sevastik, J.; Güntner, Peter

doi:10.1007/s005860050061

Cited by 9 publications

(13 citation statements)

References 20 publications

(19 reference statements)

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“…In an animal model, ultrasound morphometric assessment of the intercostal parasternal muscle was similar to measurement performed directly on the specimen, demonstrating the ability of ultrasound to accurately estimate the anatomical structure of the parasternal intercostal muscle. 29 In addition, the good interobserver repeatability of the ultrasound measurement of parasternal intercostal muscle thickness has also been reported in humans, 10,29,30 and is in line with our own reproducibility findings. It suggests that ultrasound measurement of parasternal intercostal thickness and thickening fraction is feasible and reproducible, and that the technique can reliably be employed.…”

Section: Parasternal Intercostal Muscle Thickening As a Bedside Indicsupporting

confidence: 87%

“…In our patients, this value appeared lower than the bilateral phrenic nerve stimulation threshold that classically defines diaphragm dysfunction. This finding suggests that the recruitment of parasternal intercostal muscle may start before diaphragm dysfunction-as it is classically defined 28,29 -is fully constituted. Subsequently, documenting such recruitment by ultrasound may encourage clinicians to raise the hypothesis of a diaphragm dysfunction.…”

Section: Relationship Between Parasternal Intercostal Muscle Thickenimentioning

confidence: 75%

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Usefulness of Parasternal Intercostal Muscle Ultrasound during Weaning from Mechanical Ventilation

et al. 2020

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Background The assessment of diaphragm function with diaphragm ultrasound seems to bring important clinical information to describe diaphragm work and weakness. When the diaphragm is weak, extradiaphragmatic muscles may play an important role, but whether ultrasound can also assess their activity and function is unknown. This study aimed to (1) evaluate the feasibility of measuring the thickening of the parasternal intercostal and investigate the responsiveness of this muscle to assisted ventilation; and (2) evaluate whether a combined evaluation of the parasternal and the diaphragm could predict failure of a spontaneous breathing trial. Methods First, an exploratory evaluation of the parasternal in 23 healthy subjects. Second, the responsiveness of parasternal to several pressure support levels were studied in 16 patients. Last, parasternal activity was compared in presence or absence of diaphragm dysfunction (assessed by magnetic stimulation of the phrenic nerves and ultrasound) and in case of success/failure of a spontaneous breathing trial in 54 patients. Results The parasternal was easily accessible in all patients. The interobserver reproducibility was good (intraclass correlation coefficient, 0.77 (95% CI, 0.53 to 0.89). There was a progressive decrease in parasternal muscle thickening fraction with increasing levels of pressure support (Spearman ρ = −0.61 [95% CI, −0.74 to −0.44]; P < 0.0001) and an inverse correlation between parasternal muscle thickening fraction and the pressure generating capacity of the diaphragm (Spearman ρ = −0.79 [95% CI, −0.87 to −0.66]; P < 0.0001). The parasternal muscle thickening fraction was higher in patients with diaphragm dysfunction: 17% (10 to 25) versus 5% (3 to 8), P < 0.0001. The pressure generating capacity of the diaphragm, the diaphragm thickening fraction and the parasternal thickening fraction similarly predicted failure or the spontaneous breathing trial. Conclusions Ultrasound assessment of the parasternal intercostal muscle is feasible in the intensive care unit and provides novel information regarding the respiratory capacity load balance. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Section: Parasternal Intercostal Muscle Thickening As a Bedside Indicsupporting

confidence: 87%

Section: Relationship Between Parasternal Intercostal Muscle Thickenimentioning

confidence: 75%

Usefulness of Parasternal Intercostal Muscle Ultrasound during Weaning from Mechanical Ventilation

et al. 2020

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“…Chest ultrasound is already in routine clinical use for the investigation and management of pleural and parenchymal lung disease 18 – 22 . In healthy volunteers, ultrasound has been used to study intercostal muscles in the easily-accessible anterior parasternal region, but is yet to be applied to patients with COPD 23 , 24 .…”

Section: Introductionmentioning

confidence: 99%

Parasternal intercostal muscle ultrasound in chronic obstructive pulmonary disease correlates with spirometric severity

Wallbridge

Parry

Das

et al. 2018

Sci Rep

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In chronic obstructive pulmonary disease (COPD), loss of computed tomography (CT)-measured intercostal mass correlates with spirometric severity. Intercostal muscle ultrasound offers a repeatable and radiation-free alternative, however requires validation. We aimed to determine the reliability of parasternal intercostal muscle ultrasound, and the concurrent validity of parasternal ultrasound with clinicometric parameters. Twenty stable COPD patients underwent ultrasound measurement of thickness and echogenicity of 2nd and 3rd parasternal intercostal muscles, dominant pectoralis major and quadriceps, and diaphragm thickness; spirometry; and chest CT. Intra-rater intraclass correlation (ICC) for ultrasound intercostal thickness was 0.87–0.97 depending on site, with echogenicity ICC 0.63–0.91. Inter-rater ICC was fair to excellent. Ultrasound intercostal thickness moderately correlated with FEV1% predicted (r = 0.33) and quadriceps thickness (r = 0.31). Echogenicity correlated negatively with FEV1% predicted (r = −0.32). CT-measured lateral intercostal mass correlate negatively with parasternal ultrasound intercostal thickness. These data confirm ultrasound of parasternal intercostal musculature is reproducible. Lower intercostal muscle quantity and quality reflects greater COPD spirometric severity. This novel tool may have biomarker potential for both the systemic effects of COPD on muscle as well as local disruption of respiratory mechanics. The negative correlation between CT and ultrasound measurements may reflect complex site-dependent interactions between respiratory muscles and the chest wall.

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“…In addition, ultrasound has already been used to assess the relationship between muscles and chest wall motion [33,34]. An animal model demonstrated the ability of ultrasound to accurately estimate the cross-sectional area of the parasternal intercostal muscles, comparing it with the measurement directly performed on the specimen [35]. In healthy volunteers, ultrasound has been used to investigate parasternal intercostal muscles in the easily accessible anterior parasternal region [35,36].…”

Section: Ultrasound Measurements Of Intercostal Musclementioning

confidence: 99%

“…An animal model demonstrated the ability of ultrasound to accurately estimate the cross-sectional area of the parasternal intercostal muscles, comparing it with the measurement directly performed on the specimen [35]. In healthy volunteers, ultrasound has been used to investigate parasternal intercostal muscles in the easily accessible anterior parasternal region [35,36]. Conversely, in the lateral and in the posterior part of the intercostal space, the internal and external intercostal muscles often overlap, making the ultrasound detection of both muscle layers impossible.…”

Section: Ultrasound Measurements Of Intercostal Musclementioning

confidence: 99%

Ultrasonographic assessment of parasternal intercostal muscles during mechanical ventilation

Formenti

Umbrello

Dres

et al. 2020

Ann. Intensive Care

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Although mechanical ventilation is a lifesaving treatment, abundant evidence indicates that its prolonged use (1 week or more) promotes respiratory muscle weakness due to both contractile dysfunction and atrophy. Along with the diaphragm, the intercostal muscles are one of the most important groups of respiratory muscles. In recent years, muscular ultrasound has become a useful bedside tool for the clinician to identify patients with respiratory muscle dysfunction related to critical illness and/or invasive mechanical ventilation. Images obtained over the course of illness can document changes in muscle dimension and can be used to estimate changes in function. Recent evidence suggests the clinical usefulness of ultrasound imaging in the assessment of intercostal muscle function. In this narrative review, we summarize the current literature on ultrasound imaging of the parasternal intercostal muscles as used to assess the extent of muscle activation and muscle weakness and its potential impact during discontinuation of mechanical ventilation. In addition, we proposed a practical flowchart based on recent evidence and experience of our group that can be applied during the weaning phase. This approach integrates multiple predictive parameters of weaning success with respiratory muscle ultrasound.

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A method for morphometric study of the intercostal muscles by high-resolution ultrasound

Cited by 9 publications

References 20 publications

Usefulness of Parasternal Intercostal Muscle Ultrasound during Weaning from Mechanical Ventilation

Usefulness of Parasternal Intercostal Muscle Ultrasound during Weaning from Mechanical Ventilation

Parasternal intercostal muscle ultrasound in chronic obstructive pulmonary disease correlates with spirometric severity

Ultrasonographic assessment of parasternal intercostal muscles during mechanical ventilation

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