Diaphragm Ultrasound in Cardiac Surgery: State of the Art

Fayssoil, Abdallah; Mansencal, Nicolas; Nguyen, Lee S.; David, Olivier; Prigent, Hélène; Bergounioux, Jean; Annane, Djillali; Lofaso, Frédéric

doi:10.3390/medicines9010005

Cited by 4 publications

(2 citation statements)

References 53 publications

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“…Extra-cardiac factors can also make weaning difficult, such as pneumonia, pneumothorax, pleural effusion, or phrenic nerve palsy/injury [ 2 , 32 , 33 ]. Hence, Mayo et al claim an extensive use of ultrasonography to assess not only cardiac function but also lung parenchyma, pleura, and diaphragm function [ 32 ].…”

Section: Monitoring the Weaning And Assessing Causes Of Sbt Failurementioning

confidence: 99%

Difficult Respiratory Weaning after Cardiac Surgery: A Narrative Review

Nicolotti

Grossi

Nicolini

et al. 2023

JCM

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Respiratory weaning after cardiac surgery can be difficult or prolonged in up to 22.7% of patients. The inability to wean from a ventilator within the first 48 h after surgery is related to increased short- and long-term morbidity and mortality. Risk factors are mainly non-modifiable and include preoperative renal failure, New York Heart Association, and Canadian Cardiac Society classes as well as surgery and cardio-pulmonary bypass time. The positive effects of pressure ventilation on the cardiovascular system progressively fade during the progression of weaning, possibly leading to pulmonary oedema and failure of spontaneous breathing trials. To prevent this scenario, some parameters such as pulmonary artery occlusion pressure, echography-assessed diastolic function, brain-derived natriuretic peptide, and extravascular lung water can be monitored during weaning to early detect hemodynamic decompensation. Tracheostomy is considered for patients with difficult and prolonged weaning. In such cases, optimal patient selection, timing, and technique may be important to try to reduce morbidity and mortality in this high-risk population.

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Section: Monitoring the Weaning And Assessing Causes Of Sbt Failurementioning

confidence: 99%

Difficult Respiratory Weaning after Cardiac Surgery: A Narrative Review

Nicolotti

Grossi

Nicolini

et al. 2023

JCM

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“…2); тем не менее нормативы этих показателей остаются предметом дискуссий [2]. Считается, что экскурсия диафрагмы < 10-14 мм и ее утолщение < 20-36 % во время дыхательного цикла указывают на диафрагмальную дисфункцию и являются предикторами несо стоятельности отлучения от респиратора и экстубации [9]. Нес мотря на различия в измеряемой при ультразвуковом исследовании толщине диафрагмы между мужчинами и женщинами, этот показатель признан простым и воспроизводимым в об щей популяции [10].…”

Section: Introductionunclassified

Treatment option for diaphragm dysfunction after cardiac surgery: a review and a clinical case

Paromov

Svirskii

Kirov

2022

Annals of Critical Care

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INTRODUCTION. Dysfunction of diaphragm postoperatively is associated with worsened quality of life and increased health care costs due to prolonged respiratory support and morbidity. After cardiac operations, dysfunction of diaphragm can take place in up to 10 % of patients but often remains underdiagnosed. At the same time, histologically revealed changes, such as muscle atrophy in the diaphragm, start within 12 hours of mechanical ventilation. The therapy of diaphragm weakness is not well established and has a limited efficacy. Current analytic review describes therapeutic option for treatment ventilator-induced diaphragm dysfunction with emphasis on electric neuromodulation of phrenic nerve. OBJECTIVE. To optimize respiratory function by bilateral electrostimulation of phrenic nerves on the neck level in patient with diaphragm dysfunction after cardiac operation. MATERIALS AND METHODS. 82-year-old female patient after elective aortic valve replacement was diagnosed with dysfunction of diaphragm and respiratory failure. These changes caused the weaning failure from respirator and led to prolonged ventilator support. On the 20, 22, 24 and 26 days of postoperative period we performed invasive bilateral phrenic nerve stimulation on the neck level for 10 minutes with ultrasound navigation. RESULTS. After electrical modulation of phrenic nerves, diaphragm excursion, detected by ultrasound, was improved. After four procedures, duration of spontaneous breathing trial increased from 1 to 12 hours. On postoperative day 30, the patient was successfully weaned from respiratory support and decannulated without recurrent respiratory failure. There were no any complications during procedure, it was well-tolerated and associated with emotional improvement. CONCLUSIONS. Phrenic nerve stimulation on the neck level can be a valuable option in selected patients with respiratory failure and difficulties with ventilator weaning.

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