Assessment of diaphragmatic dysfunction in the critically ill patient with ultrasound: a systematic review

Zambon, Massimo; Greco, Massimiliano; Bocchino, Speranza; Cabrini, Luca; Beccaria, Paolo; Zangrillo, Alberto

doi:10.1007/s00134-016-4524-z

Cited by 255 publications

(273 citation statements)

References 39 publications

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“…Ultrasound evaluation of the diaphragm is simple, non-invasive, readily available at the bedside and increasingly used both in the clinical and research settings [116]. The main variables that can be assessed using this technique include the static measurement of diaphragm thickness (Tdi) and the more dynamic evaluation of inspiratory diaphragm thickening fraction (TFdi) and excursion (EXdi).…”

Section: Clinical Presentation and Diagnosismentioning

confidence: 99%

Diaphragm Dysfunction: Diagnostic Approaches and Management Strategies

Dubé

Dres

2016

JCM

136

109

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The diaphragm is the main inspiratory muscle, and its dysfunction can lead to significant adverse clinical consequences. The aim of this review is to provide clinicians with an overview of the main causes of uni- and bi-lateral diaphragm dysfunction, explore the clinical and physiological consequences of the disease on lung function, exercise physiology and sleep and review the available diagnostic tools used in the evaluation of diaphragm function. A particular emphasis is placed on the clinical significance of diaphragm weakness in the intensive care unit setting and the use of ultrasound to evaluate diaphragmatic action.

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Section: Clinical Presentation and Diagnosismentioning

confidence: 99%

Diaphragm Dysfunction: Diagnostic Approaches and Management Strategies

Dubé

Dres

2016

JCM

136

109

View full text Add to dashboard Cite

show abstract

“…22 Although the use of intercostal windows has been well described and avoids the challenges associated with utilizing the hepatic or splenic acoustic window methods (such as poor reproduction and dependence on operator experience), it is important to point out that there are no published data or evidence comparing the effectiveness of the 2 approaches. 23 Thus, further well-designed clinical studies will be needed to determine the superiority and clinical merit of these techniques. In the following sections of this article, we briefly highlight 2 separate approaches to viewing the diaphragm using different acoustic windows.…”

Section: Lus To Evaluate For Diaphragmatic Paresismentioning

confidence: 99%

“…In the following sections of this article, we briefly highlight 2 separate approaches to viewing the diaphragm using different acoustic windows. However, we refer the reader to more in-depth articles 16,19,23 to obtain a further understanding of the complex 3-dimensional anatomy of the diaphragmatic curvature and its movement, as well as to appreciate how to effectively place and manipulate the probe and interpret the images and movements.…”

Section: Lus To Evaluate For Diaphragmatic Paresismentioning

confidence: 99%

Lung Ultrasound for the Regional Anesthesiologist and Acute Pain Specialist

Haskins

Tsui

Nejim

et al. 2017

Regional Anesthesia and Pain Medicine

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In this article, we discuss the emerging role of lung point-of-care ultrasonography for regional anesthesiologists and pain management specialists. Lung ultrasonography is a well-established clinical tool that is used on a routine basis in emergency rooms and critical care units internationally to evaluate patients with respiratory distress; however, its benefits to the regional anesthesiologist and pain specialist are not as well known and are practiced less frequently. This review article covers the clinical evidence in support of lung point-of-care ultrasonography as a rapid and superior tool to traditional imaging modalities such as chest radiography and fluoroscopy. As anesthesiologists routinely perform nerve blocks that put patients at potential risk of complications such as pneumothorax or diaphragmatic paresis, it is important to understand how to use lung ultrasonography to evaluate for these conditions, as well as to differentiate between other potential causes of respiratory distress, such as interstitial syndrome and pleural effusions. This article describes the normal and pathological findings that can be used to quickly and confidently evaluate a patient for these conditions.

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“…Recently, a systematic review on the role of US to assess diaphragm function in critically ill patients has been published by Zambon and colleagues (1). In their study, they included 20 studies totalling a sum of 875 patients.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound to assess diaphragmatic function in the critically ill—a critical perspective

2017

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Ultrasound of the diaphragm in critically ill patients has become a diagnostic technique of emerging interest among clinicians and scientists. The advantages include that it is widely available, noninvasive and examination can be performed after relatively short training and at low costs. It is used to estimate muscle mass by measurement of muscle thickness and diagnose weakness by the assessment of diaphragm movement during unassisted breathing. Thickening of the muscle during inspiration has been used to quantify force generation. The enthusiasm that surrounds this topic is shared by many clinicians and we agree that ultrasound is a valuable tool to screen for diaphragm dysfunction in intensive care unit (ICU) patients. However, in our opinion much more studies are required to validate ultrasound as a tool to quantify breathing effort. More sophisticated ultrasound techniques, such as speckle tracking imaging are promising techniques to evaluate respiratory muscle function in patients, including the critically ill.

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Assessment of diaphragmatic dysfunction in the critically ill patient with ultrasound: a systematic review

Abstract: Current literature suggests that DU could be a useful and accurate tool to detect diaphragmatic dysfunction in critically ill patients, to predict extubation success or failure, to monitor respiratory workload, and to assess atrophy in patients who are mechanically ventilated.

Cited by 255 publications

References 39 publications

Diaphragm Dysfunction: Diagnostic Approaches and Management Strategies

Diaphragm Dysfunction: Diagnostic Approaches and Management Strategies

Lung Ultrasound for the Regional Anesthesiologist and Acute Pain Specialist

Ultrasound to assess diaphragmatic function in the critically ill—a critical perspective

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