Effects of diaphragm thickness on rehabilitation outcomes in post-ICU patients with spinal cord and brain injury

Abstract

Background Intensive care unit (ICU) complications affect outcomes but it remains unknown if the diaphragm thickness affects rehabilitation outcomes after ICU. We conducted a pilot study to evaluate the effect of diaphragm thickness on rehabilitation outcomes of post-ICU patients with spinal cord injury (SCI) and traumatic brain injury (TBI) and to evaluate factors that may be associated with diaphragm atrophy. Materials and methods Fifty-one patients (26 SCI, 25 TBI) who admitted to the rehabilitation clinic from the ICU included in this study. All demographic data were recorded. All participants underwent diaphragmatic ultrasonography evaluation before and after 12 weeks of neurologic rehabilitation program. The diaphragm thickness and outcome parameters were compared in all patient groups and in each patient subgroups. Evaluation parameters of patients before and after treatment were compared in patient subgroups. Results Diaphragm atrophy was found in 14 patients (64%) in TBI group and 12 patients (46%) in SCI group. The diaphragm thickness negatively correlated with the ICU length of stay and positively correlated with the before/after rehabilitation functional scores and the change in functional independence measure scores (p < 0.05). According to the regression analysis; the change in functional independence measure scores was found to be affected by the diaphragm thickness (p < 0.05). Conclusions The diaphragm thickness may be an effective factor on the rehabilitation process.

Outcomes in critically ill patients after diaphragmatic stimulation on ventilator-induced diaphragmatic dysfunction: a systematic review

“…Diaphragm atrophy can easily be assessed by ultrasound in the ICU setting to predict weaning outcomes. 39 Patients without diaphragm atrophy have a higher rate of liberation from MV, 40 shorter ICU length of stay 41 and shorter MV time in the ICU setting. 7 , 9 , 13 , 42 - 44 Diaphragm ultrasound can assess diaphragm thickness, a known predictor of MV time.…”

Ultrasound assessment of diaphragmatic dysfunction in non-critically ill patients: relevant indicators and update

“…In anesthesiology, diaphragm ultrasound helps determine the residual muscle relaxation in patients under general anesthesia, addressing the complexities and interferences associated with the gold standard train-of-four ratio procedure ( 53 ), it is possible to predict and prevent postoperative pulmonary complications in surgical patients, including those undergoing heart surgery, thoracic surgery, and upper abdominal surgery ( 34 , 54–58 ). In rehabilitation medicine, diaphragm thickness is positively correlated with patients’ functional scores and functional independence scores before and after rehabilitation, suggesting that diaphragm thickness can influence patients’ rehabilitation progress ( 59 ). Overall, diaphragm ultrasound has become a valuable tool in routine clinical practice, particularly for assessing diaphragmatic function in various medical conditions.…”

Ultrasound Assessment of Diaphragm Function in Traumatic Brain Injury: A Prospective Observational Study

“…3 In a pilot study, it was found that as many as 64% of patients with TBI had diaphragm atrophy. 4 The pathophysiology of VIDD is poorly understood. Studies have shown that increased proteolysis of muscle fibers, decrease blood supply to the diaphragm, or oxidative stress may be responsible for VIDD.…”