Can Diaphragm Dysfunction Be Reliably Evaluated with Pocket-Sized Ultrasound Devices in Intensive Care Unit?

Abstract

Background Diaphragm dysfunction (DD) is frequently seen in critically ill patients, and ultrasound could be a useful tool to detect it and to predict extubation success or failure in mechanically ventilated patients. Besides, it would also be useful in differential diagnosis of dyspnea and respiratory failure. The aim of this study is to evaluate usefulness and accuracy of pocket-sized ultrasound devices (PSDs) in assessment of DD in intensive care unit (ICU) patients in comparison with standard ultrasound devices (SD). Methods In this prospective observational study, we compared the performance of PSD and SD in visualization of diaphragm, detection of paradoxical movement, measurement of tidal and maximal thickness, tidal and maximal excursion, and calculation of thickening fraction (TF) of the diaphragm. We used Bland and Altman test for agreement and bias analysis and intraclass correlation analysis to evaluate interobserver variability. Results Thirty-nine patients were included in the study. In 93% of the patients, diaphragm was visualized with PSD. There was very good agreement between the measurements of the devices, and there was no proportional bias in the measurements of tidal inspiratory and expiratory thickness, tidal TF, tidal excursion, and maximal inspiratory thickness. In interobserver reliability analysis of all measurements for both devices, ICC coefficients were higher than 0.8. Total diaphragm examination times of the devices were similar (p > 0.05). Conclusion These results suggest that PSD can be useful in ICU patients for evaluating DD. But further studies are required to determine the exact place of these devices in evaluation of DD in ICU patients.

Hand-Held Ultrasound Devices Compared with High-End Ultrasound Systems: A Systematic Review

“…Two articles not included in this review showed good overall agreement for detecting B-lines in patients with heart failure, as well as for visualising the diaphragm [37,38]. Some articles concerning hand-held ultrasound in abdominal pathology were not limited to comparing hand-held ultrasound devices with a specific high-end system [29,39,40,41], but were compared with other diagnostic measures, such as physical examination, CT and MRI, as well as US and were not included in this paper.…”

Assessment of peripheral muscle thickness and architecture in healthy volunteers using hand-held ultrasound devices; a comparison study with standard ultrasound

“…The Vscan has been has used in a previous study to assess its accuracy in the measurement of diaphragm thickness at both tidal and maximal end points of respiration [26]. The authors found that measurements of muscle thickness at both inspiration and expiration gave ICC values of greater than 0.9, at both tidal and maximal volumes.…”

Validity and reliability of pocket-sized ultrasound devices in measurement of optic nerve sheath diameter in ICU patients

“…For example, the use of PSUDs (for lung, heart and inferior vena cava USG) in the evaluation of patients who are admitted to emergency services with acute respiratory problems is feasible, reliable, and beneficial for high yield and speed [12]. Similarly, PSUDs are also found to be as efficient as SUDs in the evaluation of thickening and excursion of the diaphragm in ICU patients, but the quality of the image is low in obese and edematous patients [13]. Also, PSUDs are reliable in demonstrating proximal deep venous thrombosis compared to venous duplex USG [19].…”

“…With the development of technology, the USG devices are getting smaller and handheld or pocket-sized USG devices (PSUD) are in use. The number of studies investigating their accuracy and reliability in the evaluation of various organ systems in ICU patients has been increasing day by day [12][13][14]. Their validity has been tested for cardiac, abdominal, and vascular (IVC, lower extremity venous Doppler, jugular cannulation e.g.)…”