Diaphragm and Phrenic Nerve Ultrasound in <scp>COVID</scp>‐19 Patients and Beyond

Patel, Zaid; Franz, Colin K.; Bharat, Ankit; Walter, James M.; Wolfe, Lisa F.; Koralnik, Igor J.; Deshmukh, Swati

doi:10.1002/jum.15706

Cited by 29 publications

(18 citation statements)

References 46 publications

(106 reference statements)

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“…Regarding prognostic tools, diaphragm ultrasound can be utilized to diagnose diaphragm dysfunction, assess severity, and monitor disease progression and could be beneficial both in pneumonia and COVID-19 [16,139]. Advances have also been made regarding better diagnosis of long-term structural-functional complications and a better follow-up of sequelae by standardising prognostic measures such as quality of life and social impact [140][141][142].…”

Section: Advances In Diagnostic Tools To Predict Severitymentioning

confidence: 99%

Advances in diagnostic tools for respiratory tract infections: from tuberculosis to COVID-19 – changing paradigms?

Stojanović

Gonçalves-Carvalho²,

Marín³

et al. 2022

ERJ Open Res

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Respiratory tract infections (RTI) are one of the commonest reasons for seeking healthcare, but are amongst the most challenging diseases in terms of clinical decision making. Proper and timely diagnosis is critical in order to optimize management and prevent further emergence of antimicrobial resistance by misuse, or overuse of antibiotics. Diagnostic tools for RTI include those involving syndromic and etiological diagnosis: from clinical and radiological features to laboratory methods targeting both pathogen detection and host biomarkers, as well as their combinations in terms of clinical algorithms. They also include tools for predicting severity and monitoring treatment response. Unprecedented milestones have been achieved in the context of the COVID-19 pandemic, involving the most recent applications of diagnostic technologies both at genotypic and phenotypic level, which have changed paradigms in infectious respiratory diseases in terms of why, how and where diagnostics are performed. The aim of this review is to discuss advances in diagnostic tools that impact clinical decision making, surveillance and follow-up of RTI and tuberculosis. If properly harnessed, recent advances in diagnostic technologies, including omics and digital transformation emerge as an unprecedented opportunity to tackle ongoing and future epidemics while handling antimicrobial resistance from a One Health perspective.

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Section: Advances In Diagnostic Tools To Predict Severitymentioning

confidence: 99%

Advances in diagnostic tools for respiratory tract infections: from tuberculosis to COVID-19 – changing paradigms?

Stojanović

Gonçalves-Carvalho²,

Marín³

et al. 2022

ERJ Open Res

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“…TF is defined as a fraction of diaphragm thickness at the end of maximal inspiration (TDinsp) and at the end of maximal expiration (TDexp): TF=(T end-inspiration − T end-expiration )/T end-expiration [ 14 , 20 ]. The lower limit of normal (LLN) of TF is defined as 0.20 mm and of TDexp 0.15 mm [ 18 ]. Measurements of the diaphragm function were performed in duplicate by two investigators with training and experience in ultrasound of the diaphragm.…”

Section: Methodsmentioning

confidence: 99%

“…Diaphragm thickness was measured with the patient in supine position and the ultrasound probe perpendicular to the diaphragm between the intercostal approaches at the right mid-axillary line around the tenth intercostal space, the zone of apposition (Figure 1). (13,(17)(18)(19) The same location was used for sonographic follow-up. Primary outcome parameter was diaphragm thickening fraction (TF) as a quantitative measure of diaphragm strength.…”

Section: Primary Outcome: Diaphragm Assessmentmentioning

confidence: 99%

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Sonographic follow-up of diaphragm function in COVID-19: an exploratory study

et al. 2023

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IntroductionSurvivors of COVID-19 frequently endure chronic disabilities. We hypothesize that diaphragm function has a long recovery time after COVID-19 hospitalization, and may play a role in post-COVID syndrome. The aim of this study was to assess diaphragm function during COVID-19 hospitalization and during recovery.MethodsWe conducted a prospective single-center cohort study in 49 patients enrolled, of which 28 completed one-year follow-up. Participants were evaluated for diaphragm function. Diaphragm function was assessed using ultrasound measuring of diaphragm thickening fraction (TF) within 24 h after admission, after 7 days of admission or at discharge, whichever came first, and three and twelve months after hospital admission.ResultsEstimated mean TF increased from 0.56 (95% CI 0.46–0.66) on admission to 0.78 (95% CI 0.65–0.89) at discharge or seven days after admission, to 1.05 (95% CI 0.83–1.26) three months after admission to 1.54 (95% CI 1.31–1.76) twelve months after admission. The improvements from admission to discharge, 3 months and 12 months were all significant (linear mixed modeling; p=0.020, p<0.001, and p<0.001, respectively) and the improvement from discharge to three months follow-up was borderline significant (p<0.1).ConclusionDiaphragm function was impaired during hospitalization for COVID-19. During recovery in hospital and up to one-year follow-up, diaphragm TF improved, suggesting a long recovery time of the diaphragm. Diaphragm ultrasound may be a valuable modality in the screening and follow-up of (post-)COVID-19 patients for diaphragm dysfunction.

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“…A diaphragmatic ultrasound evaluation is a useful tool to assess diaphragmatic thickness and excursion. Diaphragmatic dysfunction is frequently seen in patients with chronic lung diseases such as lung fibrosis, www.co-criticalcare.com but other factors, such as critical illness polyneuropathy, critical illness myopathy, medications, prolonged ventilation, metabolic disarrangements [19] and myopathy, and neuropathy secondary to COVID-19 infection, play an important role in the cause of diaphragmatic dysfunction in ICU patients [20][21][22]. Still, presence of long-term diaphragmatic function after severe COVID-19 infection and whether these abnormalities are reversible is unknown.…”

Section: Andandmentioning

confidence: 99%

Lung transplantation in patients with lung disease secondary to coronavirus disease 2019 infection

Avella

Bharat

2022

Current Opinion in Critical Care

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Purpose of reviewIn this article, we describe preoperative patient selection and outcomes of patients with lung disease secondary to infection from COVID-19 who receive lung transplantation.Recent findingsLung transplants for patients with lung disease secondary to infection from COVID-19 have been performed successfully in over 200 patients in the United States. The preoperative course of these patients is somewhat atypical in comparison with patients who have had lung transplants related to chronic lung diseases, where there are more traditional indications for lung transplants. COVID-19 patients have more severe pulmonary disease often requiring mechanical ventilation and extracorporeal mechanical ventilation (ECMO), frequent nosocomial infections, and renal and cardiac dysfunction. The intraoperative course of these COVID-19 patients is often longer and requires increased transfusions of blood products in comparison with non-COVID-19 patients. Additionally, in the postoperative period, COVID-19 patients more frequently require mechanical ventilation and ECMO support. However, the survival rate of such patients at 6 months is greater than 90%.SummaryPatients with respiratory failure secondary to COVID-19 infection that require a lung transplant generally have a complicated preoperative course and the operations are more complex, but the long-term outcomes are excellent.

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Diaphragm and Phrenic Nerve Ultrasound in COVID‐19 Patients and Beyond

Cited by 29 publications

References 46 publications

Advances in diagnostic tools for respiratory tract infections: from tuberculosis to COVID-19 – changing paradigms?

Advances in diagnostic tools for respiratory tract infections: from tuberculosis to COVID-19 – changing paradigms?

Sonographic follow-up of diaphragm function in COVID-19: an exploratory study

Lung transplantation in patients with lung disease secondary to coronavirus disease 2019 infection

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