Diaphragm thickening in cardiac surgery: a perioperative prospective ultrasound study

Abstract

Background Diaphragm paresis is common after cardiac surgery and may delay the weaning from the ventilator. Our objective was to evaluate diaphragm thickening during weaning and secondly the muscle thickness as a marker of myotrauma. Methods Patients undergoing elective cardiac surgery were prospectively included. Ultrasonic index of right hemidiaphragm thickening fraction (TF) was measured as a surrogate criterion of work of breathing. A TF < 20% was defined as a low diaphragm thickening. Measurements of TF were performed during three periods to study diaphragm thickening evolution defined by the difference between two consecutive time line point: preoperative ( D − 1), during a spontaneous breathing trial (SBT) in the intensive care unit and postoperative ( D + 1). We studied three patterns of diaphragm thickness at end expiration evolution from D − 1 to D + 1: > 10% decrease, stability and > 10% increase. Demographical data, length of surgery, type of surgery, ICU length of stay (LOS) and extubation failure were collected. Results Of the 100 consecutively included patients, 75 patients had a low diaphragm thickening during SBT. Compared to TF values at D − 1 (36% ± 18), TF was reduced during SBT (17% ± 14) and D + 1 (12% ± 11) ( P < 0.0001). Thickness and TF did not change according to the type of surgery or cooling method. TF at SBT was correlated to the length of surgery (both r = − 0.4; P < 0.0001). Diaphragm thickness as continuous variable did not change over time. Twenty-eight patients (42%) had a > 10% decrease thickness, 19 patients (29%) stability and 19 patients (28%) in > 10% increase, and this thickness evolution pattern was associated with: a longer LOS 3 days [2–5] versus 2 days [2–4] and 2 days [2], respectively (ANOVA P = 0.046), and diaphragm thickening evolution (ANOVA P = 0.02). Two patients experience extubation failure. Conclusion These findings indicate that diaphragm thickening is frequently decreased after elective cardiac surgery without impact on respiratory outcome, whereas an altered thickness pattern was associated with a longer length of stay in the ICU. Contractile activity influenced thickness evolution. Trial registry number ClinicalTrial.gov ID NCT02208479 Electronic supplementary material The online version of this article (10.1186/s13613-019-0521-z) contains supplementary material, which is available to authorized users.

ICU-acquired weakness, diaphragm dysfunction and long-term outcomes of critically ill patients

“…Nevertheless, as expected, the co-existence of these two conditions was associated with a poor survival. The presence of diaphragm dysfunction in critically ill patients has been associated with poor short-term prognosis in some studies [11,13,14,28], but not in others [29,30].…”

Monitoring diaphragm function in the ICU

“…Importantly, a recent study has suggested that diaphragm function is predominantly a key determinant for the outcome of the spontaneous breathing trial rather than the outcome of extubation. Secondly, diaphragm dysfunction has been associated with complications such as reintubation, tracheostomy and prolonged ventilation (2), and postoperative complications (8,9). It is also associated with ICU mortality (7).…”

Nursing Intervention of Nonstop Minimally Invasive Tricuspid Valve Forming with Simultaneous Atrial Flutter After Secondary Cardiac Surgery: A Case Report

“…It has been reported in the literature that the risk and mortality of multiple operations is significantly higher than that of the initial operation [4,5]. The doctors often use continuous extracorporeal circulation video-assisted tricuspid valvuloplasty surgical method to treat the patients who have severe tricuspid regurgitation after cardiac surgery without severe pleural adhesion [6,7].…”