Role of Bedside Ultrasonography in Assessment of Diaphragm Function as a Predictor of Success of Weaning in Mechanically Ventilated Patients

Elshazly, Mostafa; Kamel, Khaled Mahmoud; El-Korashy, Reem I.; Ismail, Mohamed; Ismail, Jumana H.; Assal, Hebatallah Hany

doi:10.4046/trd.2020.0045

Cited by 11 publications

(19 citation statements)

References 24 publications

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“…In the present study, LMWH inhibited oxidative stress, inflammation, and apoptosis and increased antioxidant activity, eventually leading to recovery from pathological impairment through repressing HIF-1α. Furthermore, LMWH improved the contractile excursion and thickening fraction of damaged diaphragms; these parameters are commonly employed in the evaluation of diaphragm dysfunction in clinical practice [ 48 , 49 ].…”

Section: Discussionmentioning

confidence: 99%

“…This finding can be explained by prolonged MV evoking significant declines in both passive and active diaphragm contractile force by increasing proteolysis and reducing the generation of myofibrillar proteins [ 61 ]. Mounting studies describing the application of bedside ultrasonography assessment of the diaphragm in the process of discontinuing ventilator use suggest that both methods of measuring the thickening fraction of diaphragm muscles and excursion are reliable predictors of ventilator liberation and extubation outcomes [ 9 , 48 , 49 ].…”

Section: Discussionmentioning

confidence: 99%

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Suppression of Hypoxia-Inducible Factor 1α by Low-Molecular-Weight Heparin Mitigates Ventilation-Induced Diaphragm Dysfunction in a Murine Endotoxemia Model

Huang

et al. 2021

IJMS

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Mechanical ventilation (MV) is required to maintain life for patients with sepsis-related acute lung injury but can cause diaphragmatic myotrauma with muscle damage and weakness, known as ventilator-induced diaphragm dysfunction (VIDD). Hypoxia-inducible factor 1α (HIF-1α) plays a crucial role in inducing inflammation and apoptosis. Low-molecular-weight heparin (LMWH) was proven to have anti-inflammatory properties. However, HIF-1α and LMWH affect sepsis-related diaphragm injury has not been investigated. We hypothesized that LMWH would reduce endotoxin-augmented VIDD through HIF-1α. C57BL/6 mice, either wild-type or HIF-1α–deficient, were exposed to MV with or without endotoxemia for 8 h. Enoxaparin (4 mg/kg) was administered subcutaneously 30 min before MV. MV with endotoxemia aggravated VIDD, as demonstrated by increased interleukin-6 and macrophage inflammatory protein-2 levels, oxidative loads, and the expression of HIF-1α, calpain, caspase-3, atrogin-1, muscle ring finger-1, and microtubule-associated protein light chain 3-II. Disorganized myofibrils, disrupted mitochondria, increased numbers of autophagic and apoptotic mediators, substantial apoptosis of diaphragm muscle fibers, and decreased diaphragm function were also observed (p < 0.05). Endotoxin-exacerbated VIDD and myonuclear apoptosis were attenuated by pharmacologic inhibition by LMWH and in HIF-1α–deficient mice (p < 0.05). Our data indicate that enoxaparin reduces endotoxin-augmented MV-induced diaphragmatic injury, partially through HIF-1α pathway inhibition.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Suppression of Hypoxia-Inducible Factor 1α by Low-Molecular-Weight Heparin Mitigates Ventilation-Induced Diaphragm Dysfunction in a Murine Endotoxemia Model

Huang

et al. 2021

IJMS

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“…Negligible to moderate correlations with spirometry (32,77), respiratory distress (20,32,33,39) Negligible correlation with MV duration, dynamic compliance (53) and ICU length of stay (39) Negligible correlation with ventilator-derived diaphragmatic measures (32) or muscle strength…”

Section: Diaphragm Thickening Fractionmentioning

confidence: 99%

“…Negligible to low correlations with spirometry (32, 62), cough peak flow (31), respiratory distress (32,33), dynamic lung compliance (53) and magnetic stimulated diaphragmatic measures (56) High correlation with ventilator-derived diaphragmatic measures (32) Low to moderate correlations with diaphragm thickening fraction (61,63) Low correlation with severity of illness and MV duration (53) Moderate correlation between left and right measurements (49)…”

Section: Diaphragm Excursionmentioning

confidence: 99%

Methodological and Clinimetric Evaluation of Inspiratory Respiratory Muscle Ultrasound in the Critical Care Setting: A Systematic Review and Meta-Analysis

Truong

Abo

Whish-Wilson

et al. 2023

Critical Care Medicine

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in the Critical Care Setting: A Systematic Review and Meta-Analysis OBJECTIVE: Significant variations exist in the use of respiratory muscle ultrasound in intensive care with no society-level consensus on the optimal methodology. This systematic review aims to evaluate, synthesize, and compare the clinimetric properties of different image acquisition and analysis methodologies.DATA SOURCES: Systematic search of five databases up to November 24, 2021. STUDY SELECTION:Studies were included if they enrolled at least 50 adult ICU patients, reported respiratory muscle (diaphragm or intercostal) ultrasound measuring either echotexture, muscle thickness, thickening fraction, or excursion, and evaluated at least one clinimetric property. Two independent reviewers assessed titles, abstracts, and full text against eligibility.DATA EXTRACTION: Study demographics, ultrasound methodologies, and clinimetric data.DATA SYNTHESIS: Sixty studies, including 5,025 patients, were included with 39 studies contributing to meta-analyses. Most commonly measured was diaphragm thickness (DT) or diaphragm thickening fraction (DTF) using a linear transducer in B-mode, or diaphragm excursion (DE) using a curvilinear transducer in M-mode. There are significant variations in imaging methodology and acquisition across all studies. Inter-and intrarater measurement reliabilities were generally excellent, with the highest reliability reported for DT (ICC, 0.98; 95% CI, 0.94-0.99). Pooled data demonstrated acceptable to excellent accuracy for DT, DTF, and DE to predicting weaning outcome after 48 to 72 hours postextubation (DTF AUC, 0.79; 95% CI, 0.73-0.85). DT imaging was responsive to change over time. Only three eligible studies were available for intercostal muscles. Intercostal thickening fraction was shown to have excellent accuracy of predicting weaning outcome after 48-hour postextubation (AUC, 0.84; 95% CI, 0.78-0.91). CONCLUSIONS:Diaphragm muscle ultrasound is reliable, valid, and responsive in ICU patients, but significant variation exists in the imaging acquisition and analysis methodologies. Future work should focus on developing standardized protocols for ultrasound imaging and consider further research into the role of intercostal muscle imaging.

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“…However, another study showed that LUS before SBT failed to predict SBT failure [ 31 ] which highlights the fact that not one method should be used in isolation to make decisions regarding critically ill patients. Although out of scope of this review, ultrasound of the heart, diaphragm and pleura may also be useful in detecting obstacles to successful extubation [ 32 , 33 ].…”

Section: Weaning From Mechanical Ventilationmentioning

confidence: 99%

Lung Ultrasound as a Monitoring Tool

Lee

2020

Tuberc Respir Dis

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Lung ultrasound has proven to be useful in detecting pneumothorax, interstitial syndrome, and lung consolidations. It is easily applied at the bedside, real time and free of radiation hazards. Recently, the use of lung ultrasound has moved from being a diagnostic tool to a monitoring tool for lung aeration quantification. This article reviews the use of lung ultrasound in monitoring acute pulmonary edema, acute respiratory distress syndrome and pneumonia, and how it can be used to monitor changes during application of mechanical ventilation or other treatment for respiratory failure.

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Role of Bedside Ultrasonography in Assessment of Diaphragm Function as a Predictor of Success of Weaning in Mechanically Ventilated Patients

Cited by 11 publications

References 24 publications

Suppression of Hypoxia-Inducible Factor 1α by Low-Molecular-Weight Heparin Mitigates Ventilation-Induced Diaphragm Dysfunction in a Murine Endotoxemia Model

Suppression of Hypoxia-Inducible Factor 1α by Low-Molecular-Weight Heparin Mitigates Ventilation-Induced Diaphragm Dysfunction in a Murine Endotoxemia Model

Methodological and Clinimetric Evaluation of Inspiratory Respiratory Muscle Ultrasound in the Critical Care Setting: A Systematic Review and Meta-Analysis

Lung Ultrasound as a Monitoring Tool

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