Effect of controlled ventilation during assist-control ventilation on diaphragm thickness : a post hoc analysis of an observational study

Itagaki, Taiga; Nakanishi, Nobuto; Takashima, Takuya; Ueno, Yoshio; Tane, Natsuki; Tsunano, Yumiko; Nunomura, Toshiyuki; Oto, Jun

doi:10.2152/jmi.67.332

Cited by 4 publications

(3 citation statements)

References 28 publications

(47 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The measurement technique was performed as previously described. 11 The patient was placed in the 30° lateral decubitus position, and a 3.5-MHz ultrasound probe was placed between the midaxillary line and the posterior axillary line at the patient’s right costal margin, with the liver as the detection window. This position was considered optimal for monitoring diaphragm activity.…”

Section: Methodsmentioning

confidence: 99%

Predictive value of diaphragmatic thickness fraction and integrated pulmonary index on extubation outcome in patients with severe acute pancreatitis

Fu,

Luo,

Zhang

et al. 2024

J Int Med Res

View full text Add to dashboard Cite

Objective This study was performed to explore the predictive value of the diaphragmatic thickness fraction (DTF) combined with the integrated pulmonary index (IPI) for the extubation outcome in patients with severe acute pancreatitis (SAP). Methods This prospective study involved 93 patients diagnosed with SAP and treated with mechanical ventilation in our hospital from October 2020 to September 2023. The patients were divided into a successful extubation group (61 patients) and an extubation failure group (32 patients) based on the extubation outcomes. The predictive value of the DTF, IPI, and their combination for extubation failure was analyzed. Results The DTF and IPI were independent risk factors for extubation failure in patients with SAP undergoing mechanical ventilation. In addition, the combination of the DTF and IPI showed predictive value for extubation failure in these patients. Conclusion The DTF and IPI hold predictive value for extubation failure in patients with SAP undergoing mechanical ventilation, and their combined use may improve the predictive efficiency.

show abstract

Section: Methodsmentioning

confidence: 99%

Predictive value of diaphragmatic thickness fraction and integrated pulmonary index on extubation outcome in patients with severe acute pancreatitis

Fu,

Luo,

Zhang

et al. 2024

J Int Med Res

View full text Add to dashboard Cite

show abstract

“…Consequently, to preserve spontaneous effort, most critically ill patients who require mechanical ventilation receive assisted and spontaneous modalities (10,15) ; however, in recent clinical trials, atrophy developed during both controlled and assisted ventilation (10,12,16). Itagaki et al reported that the proportion of controlled ventilation during the early-phase of ACV was not associated with maximum variation in diaphragm thickness (63). The mechanism that explains why assisted breaths are diaphragm-protective is unknown (64).…”

Section: Mode Of Mechanical Ventilationmentioning

confidence: 99%

Diaphragm-protective mechanical ventilation in acute respiratory failure

Itagaki

2022

J. Med. Invest.

View full text Add to dashboard Cite

Mechanical ventilation injures not only the lungs but also the diaphragm, resulting in dysfunction associated with poor outcomes. The chief mechanisms of ventilator-induced diaphragm dysfunction are : disuse atrophy due to insufficient contraction and excessive ventilatory support ; concentric load-induced injury due to excessive contraction and insufficient ventilatory support ; eccentric load-induced injury due to contraction during the expiratory phase ; and longitudinal atrophy caused by high positive end-expiratory pressure. To protect the diaphragm during mechanical ventilation, maintaining proper levels of diaphragm contraction is paramount ; thus, monitoring of respiratory effort and finely tuned ventilator settings are necessary. Furthermore, maintaining of synchronization between the patient and the ventilator is also important. As diaphragm dysfunction is more likely to occur in critically ill patients, diaphragm-protective mechanical ventilation strategies are essential to reduce the mortality rate of intensive care unit patients. This review outlines clinical evidence of ventilator-induced diaphragm dysfunction and its underlying mechanisms, and strategies to facilitate diaphragm-protective mechanical ventilation.

show abstract

“…Several strategies, such as ventilator settings, exist to prevent diaphragm atrophy and dysfunctions (5,6). The strategy of ventilator setting is termed as diaphragm protective ventilation, which requires the preservation of spontaneous breathing and the reduction of excessive pressure support (7).…”

mentioning

confidence: 99%

The effect of high-flow nasal cannula on diaphragm dysfunction including paradoxical diaphragmatic contraction in the intensive care unit

et al. 2021

Self Cite

View full text Add to dashboard Cite

Background : Diaphragm dysfunction is a serious problem. However, a few management techniques exist for diaphragm dysfunction. Methods : Adult patients treated with high-flow nasal cannula (HFNC) in the intensive care unit were included in this study. The diaphragm function was evaluated using ultrasound measurement of thickening fraction before and after HFNC liberation. Normal diaphragm contraction was defined as thickening fraction ≥ 15% without HFNC, whereas decreased or paradoxical diaphragm contractions were 0%-15% or < 0%, respectively. Results : Forty patients were enrolled, and 16 (40%) had normal diaphragm contraction, whereas 19 (48%) or 5 (13%) had decreased or paradoxical diaphragm contractions, respectively. Thickening fraction increased after HFNC liberation (27.0% ± 25.7% vs. 38.8% ± 34.5%, p = 0.03 in HFNC vs. no HFNC) in patients without diaphragm dysfunction. In patients with decreased diaphragm contraction, thickening fraction did not change with or without HFNC (8.9% ± 11.7% vs. 6.7% ± 5.2%, p = 0.35), whereas paradoxical contraction decreased with HFNC (1.0% ± 10.2% vs. -10.3% ± 2.7%, p = 0.04) in patients with paradoxical diaphragm contraction. Conclusions : The work of breathing decreased with HFNC in patients without diaphragm dysfunction, but did not decrease in patients with decreased diaphragm contraction. Paradoxical diaphragm contraction decreased with HFNC.

show abstract

Effect of controlled ventilation during assist-control ventilation on diaphragm thickness : a post hoc analysis of an observational study

Cited by 4 publications

References 28 publications

Predictive value of diaphragmatic thickness fraction and integrated pulmonary index on extubation outcome in patients with severe acute pancreatitis

Predictive value of diaphragmatic thickness fraction and integrated pulmonary index on extubation outcome in patients with severe acute pancreatitis

Diaphragm-protective mechanical ventilation in acute respiratory failure

The effect of high-flow nasal cannula on diaphragm dysfunction including paradoxical diaphragmatic contraction in the intensive care unit

Contact Info

Product

Resources

About