Sonographic evaluation of the diaphragm in critically ill patients. Technique and clinical applications

Matamis, Dimitrios; Soilemezi, Eleni; Tsagourias, Matthew; Akoumianaki, Evangelia; Dimassi, Sarra; Boroli, Filippo; Richard, Jean-Christophe M.; Brochard, Laurent

doi:10.1007/s00134-013-2823-1

Cited by 444 publications

(379 citation statements)

References 52 publications

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“…Bedside ultrasonography, which is already crucial in several aspects of critically illness, 81,82 has recently been proposed as a simple, noninvasive method of quantification of diaphragm contractile activity. 4 Ultrasound can be used to determine diaphragm excursion, 83,84 which may help to identify patients with diaphragm dysfunction. 85 Ultrasonographic examination can also allow for the direct visualization of diaphragm thickness in its zone of apposition.…”

Section: Bedside Ultrasonography In Critically Ill Patientsmentioning

confidence: 99%

“…The latter is defined as a loss of diaphragm force-generating capacity specifically related to the use of mechanical ventilation. 3,4 The major clinical implication of ventilator-induced diaphragm dysfunction is that even when used for relatively short periods, mechanical ventilation can lead to substantial diaphragm weakness and could delay the process of weaning from the ventilator. 5 Diseases that interfere with diaphragm innervations, contractile properties, or mechanical coupling to the chest wall can result in diaphragm dysfunction.…”

Section: Introductionmentioning

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: Introductionmentioning

confidence: 99%

Ultrasonographic Assessment of Diaphragm Function in Critically Ill Subjects

Umbrello

Formenti

2016

Respir Care

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“…La 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 13 variación del grosor diafragmático puede utilizarse como un indicador de la capacidad diafragmática para generar presión 52, 75 . Una variación <20% podría ser considerada como un predictor de fracaso de la desconexión de la VM 54 , con una mejor predicción que el uso del índice de Tobin 76 .…”

Section: Ultrasonografíaunclassified

Disfunción diafragmática: una realidad en el paciente ventilado mecánicamente

Dot

Samper

Masclans

2017

Archivos de Bronconeumología

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3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 1 ResumenLa afectación muscular del paciente crítico está presente en la mayoría de pacientes que ingresan en el Servicio de Medicina Intensiva (SMI). La alteración, en particular, del músculo diafragmático, inicialmente englobada en esta categoría, se ha diferenciado en los últimos años y se ha demostrado la existencia de una disfunción muscular propia de los pacientes sometidos a ventilación mecánica. En este subgrupo de pacientes, encontramos una disfunción muscular que aparece de manera precoz después del inicio de la ventilación mecánica y que se relaciona, principalmente, con el uso de modalidades control, la presencia de sepsis y/o de fracaso multiorgánico. Aunque se desconoce la etiología concreta que desencadena el proceso, el músculo presenta procesos de estrés oxidativo y alteración mitocondrial, que provocan un desequilibrio en la síntesis proteica, con el resultado de atrofia y alteración de la contractilidad y, como consecuencia, una menor funcionalidad. No fue, de hecho, hasta 2004 cuando Vassilakopoulos et al describieron el término "Disfunción diafragmática asociada a ventilación mecánica" que junto a la lesión por sobre distensión pulmonar y por barotrauma, representan un reto en el día a día de los pacientes ventilados.La disfunción diafragmática tiene influencia en el pronóstico, retardando la extubación, aumentando la estancia hospitalaria y afectando la calidad de vida de estos pacientes en los años siguientes al alta hospitalaria. La ecografía, como técnica no invasiva y accesible en la mayoría de Unidades, podría ser de utilidad en el diagnóstico precoz para iniciar, de forma avanzada, la rehabilitación e influir positivamente en el pronóstico de estos enfermos.Palabras clave: Diafragma, disfunción diafragmática, ventilación mecánica, ecografía. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 2 *Manuscrito (sin información de autores) AbstractThe critical patient muscle involvement is present in most patients admitted to the intensive care unit (ICU). Specifically the diaphragmatic muscle alteration, initially considered in this category, has been differentiated in recent years, and it has been demonstrated the existence of this muscular dysfunction during mechanical ventilation. In this subgroup of patients, we found that this muscle dysfunction appears at an early stage after the start of mechanical ventilation, which is mainly related to the use of modalities control, and also in presence of sepsis and/or multi-organ failure. Although the specific etiology that triggers the processes unknown, the muscle has processes oxidative stress and mitochond...

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“…In a review article, Matamis et al [18] describe the technique and the clinical applications of ultrasonography in the evaluation of diaphragmatic function in ICU patients. Ultrasonography can assess the characteristics of diaphragmatic movement such as amplitude, force, and velocity of contraction, special patterns of motion, and changes in diaphragmatic thickness during inspiration.…”

Section: Noninvasive and Invasive Mechanical Ventilation Tracheostommentioning

confidence: 99%