Diaphragm ultrasound as a predictor of successful extubation from mechanical ventilation

DiNino, Ernest; Gartman, Eric; Sethi, Jigme M.; McCool, F. Dennis

doi:10.1136/thoraxjnl-2013-204111

Cited by 364 publications

(342 citation statements)

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“…86 Thickening during active breathing has been proposed to reflect the magnitude of diaphragm effort, similar to an ejection fraction of the heart. 87 A number of recent studies have employed ultrasound to measure diaphragm thickness and inspiratory thickening in ventilated subjects. Some of them focused on the feasibility and reproducibility of the technique, 88,89 whereas another 90 showed how with increasing levels of pressure support ventilation, parallel reductions were found between diaphragm thickening and both the diaphragm and esophageal pressure-time product, suggesting that diaphragm thickening is a reliable indicator of respiratory effort.…”

Section: Bedside Ultrasonography In Critically Ill Patientsmentioning

confidence: 99%

“…Other authors reported how left hemidiaphragm measurements could not be consistently obtained, whereas right hemidiaphragm thickness measurements are highly reproducible, particularly after marking the location of the probe. 87 Some authors evaluated the variation of thickness at different lung volumes from RV to TLC in normal subjects, [90][91][92][93] suggesting the use of this maximal contractile capacity of the diaphragm. Another study measured diaphragm thickness in subjects with diaphragm paralysis to monitor recovery of the muscle over time.…”

Section: B-modementioning

confidence: 99%

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Ultrasonographic Assessment of Diaphragm Function in Critically Ill Subjects

Umbrello

Formenti

2016

Respir Care

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The majority of patients admitted to the ICU require mechanical ventilation as a part of their process of care. However, mechanical ventilation itself or the underlying disease can lead to dysfunction of the diaphragm, a condition that may contribute to the failure of weaning from mechanical ventilation. However, extended time on the ventilator increases health-care costs and greatly increases patient morbidity and mortality. Nevertheless, symptoms and signs of muscle disease in a bedridden (or bed rest-only) ICU patient are often difficult to assess because of concomitant confounding factors. Conventional assessment of diaphragm function lacks specific, noninvasive, time-saving, and easily performed bedside tools or requires patient cooperation. Recently, the use of ultrasound has raised great interest as a simple, noninvasive method of quantification of diaphragm contractile activity. In this review, we discuss the physiology and the relevant pathophysiology of diaphragm function, and we summarize the recent findings concerning the evaluation of its (dys)function in critically ill patients, with a special focus on the role of ultrasounds. We describe how to assess diaphragm excursion and diaphragm thickening during breathing and the meaning of these measurements under spontaneous or mechanical ventilation as well as the reference values in health and disease. The spread of ultrasonographic assessment of diaphragm function may possibly result in timely identification of patients with diaphragm dysfunction and to a potential improvement in the assessment of recovery from diaphragm weakness.

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Section: Bedside Ultrasonography In Critically Ill Patientsmentioning

confidence: 99%

Section: B-modementioning

confidence: 99%

Ultrasonographic Assessment of Diaphragm Function in Critically Ill Subjects

Umbrello

Formenti

2016

Respir Care

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“…[1][2][3] We seek to understand how diaphragmatic atrophy is associated with duration and mode of mechanical ventilation. 4 Among noninvasive methods for measuring muscle dimensions, ultrasonography is preferred over radiography or computed tomography because it avoids radiation exposure [5][6][7] (Appendix 1). Studies requiring serial evaluations demand a technique that eliminates the risk of repetitive radiation exposure; thus ultrasound is the most appropriate choice.…”

mentioning

confidence: 99%

Ultrasonographic Evaluation of Diaphragm Thickness During Mechanical Ventilation in Intensive Care Patients

Francis

Hoffer

Reynolds

2016

American Journal of Critical Care

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Background Mechanical ventilation is associated with atrophy and weakness of the diaphragm. Ultrasound is an easy noninvasive way to track changes in thickness of the diaphragm. Objective To validate ultrasound as a means of tracking thickness of the diaphragm in patients undergoing mechanical ventilation by evaluating interobserver and interoperator reliability and to collect initial data on the relationship of mode of ventilation to changes in the diaphragm. Methods Daily ultrasound images of the quadriceps and the right side of the diaphragm were acquired in 8 critically ill patients receiving various modes of mechanical ventilation. Thickness of the diaphragm and the quadriceps was measured, and changes with time were noted. Interoperator and interobserver reliability were measured. Results Intraclass correlation coefficients between operators and between observers for thickness of the diaphragm and quadriceps were greater than 0.95, indicating excellent interoperator and interobserver reliability. Patients receiving assist-control ventilation (n = 4) showed a mean decline in diaphragm thickness of 4.7% per day. Patients receiving pressure support ventilation (n = 8) showed a mean increase in diaphragm thickness of 1.5% per day. Quadriceps thickness declined in all participants (n = 8) at a mean rate of 2.0% per day. Conclusions Use of ultrasound to measure thickness of the diaphragm in 8 intensive care patients undergoing various modes of mechanical ventilation was feasible and yielded reproducible results. Ultrasound tracking of changes in thickness of the diaphragm in this small sample indicated that the thickness decreased during assist-control mode and increased during pressure support mode. (American Journal of Critical Care. 2016;25:e1-e8)

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“…TF was calculated as (thickness at end inspiration-thickness at end expiration)/ (thickness at end expiration) [15]. The assessment of TF by US performed as effective as the other weaning indexes in intensive care units [1,2,15].…”

Section: Discussionmentioning

confidence: 99%

“…There are ongoing studies about diaphragmatic thickness evaluation in search for the correct timing for discontinuation of mechanical ventilation and adjustment of ventilator settings [1,2].…”

Section: Introductionmentioning

confidence: 99%

Ultrasound assessment of diaphragm thickness in COPD

Çimşit¹,

Bekir²,

Karakurt³

et al. 2016

MMJ

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Objective: Thickness of the diaphragm was evaluated by B-mode ultrasonography (US) in chronic obstructive pulmonary disease (COPD) to determine the relationship between diaphragm thickness measurement, pulmonary function tests, and symptom scores.Patients and Methods: Fifty-three clinically stable patients with COPD were enrolled in this study for diaphragmatic thickness evaluation with B-mode US. The severity of COPD was determined by spirometric measurements in terms of %FEV1. Patients were also analyzed according to GOLD criteria. Correlation between diaphragm thickness and symptom scores like Medical Research Council (mMRC), COPD Assessment Test (CAT), composite scores and body mass index (BMI) were sought. Results:There was a moderate correlation between diaphragmatic muscle thickness and %FEV1 in mild COPD patients (r=0.62, p=0.017<0.05). No significant difference in diaphragmatic thicknesses of GOLD subgroups was found. There were no correlations between diaphragmatic muscle thickness, symptom scores, BMI, age, and gender. Conclusion:No correlation was found between diaphragmatic thickness in COPD patients and pulmonary function tests except for %FEV1 in mild COPD patients. There were no correlations between diaphragmatic muscle thickness and symptom scores. Further US studies should take place for functional evaluation of the diaphragm in COPD subgroups.Keywords: Diaphragm, Ultrasonography, Chronic obstructive pulmonary disease, Thickness. ÖZAmaç: Kronik obstruktive akciğer hastalığı (KOAH) olan hastaların, diyafram kalınlıklarını ultrasonografi ile ölçerek solunum fonksiyon testleri ve semptom skorları ile ilişkisinin araştırılmasıdır. Gereç ve Yöntem:KOAH nedeniyle takip edilmekte olan, son iki aydır klinik olarak stabil seyirli 53 hasta çalışmamıza dahil edildi. Bronkodilatör sonrası FEV1 değerlerinde %12 artış, çalışmada uygulanan testlerden herhangi birine uyumsuzluk, oksijen bağımlılığı, abdominal ya da torasik cerrahi geçirme hikayeleri çalışmadan dışlanma kriterleri olarak belirlendi. KOAH düzeyi spirometri ölçümlerine ve GOLD kriterlerine göre sınıflandırıldı.Hayat kalitesi değerlendirmesi için mMRC ve CAT semptom skorları testleri ile kompozit KOAH skor ölçümü hesaplanması için alevlenme sayıları sorularak kaydedildi. Bulgular: KOAH düzeyi hafif olan hastalarda FEV1 % ile diyafram kalınlığı arasında anlamlı ilişki bulundu (r=0.62, p=0,017<0,05). Diyafram kalınlığı ile GOLD alt grupları, semptom skorları, BMI , yaş ve cinsiyet gibi parametreler arasında anlamlı ilişki bulunamadı.Sonuç: KOAH hastalarında ultrasonografi ile ölçülen diyafram kalınlığı ile solunum fonksiyon testleri arasında hafif KOAH'lı hasta grubu haricinde anlamlı ilişki gösterilememiştir. Diyafram kalınlığı ile semptom skorları arasında anlamlı ilişki bulunamadı. Ultrasonografi ile planlanacak yeni çalışmalarda, KOAH alt gruplarında diyafram fonksiyonunu yansıtacak diyafram kalınlık oranları irdelenmelidir.

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Diaphragm ultrasound as a predictor of successful extubation from mechanical ventilation

Cited by 364 publications

References 31 publications

Ultrasonographic Assessment of Diaphragm Function in Critically Ill Subjects

Ultrasonographic Assessment of Diaphragm Function in Critically Ill Subjects

Ultrasonographic Evaluation of Diaphragm Thickness During Mechanical Ventilation in Intensive Care Patients

Ultrasound assessment of diaphragm thickness in COPD

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