Ultrasonographic assessment of parasternal intercostal muscles during mechanical ventilation

Abstract

Although mechanical ventilation is a lifesaving treatment, abundant evidence indicates that its prolonged use (1 week or more) promotes respiratory muscle weakness due to both contractile dysfunction and atrophy. Along with the diaphragm, the intercostal muscles are one of the most important groups of respiratory muscles. In recent years, muscular ultrasound has become a useful bedside tool for the clinician to identify patients with respiratory muscle dysfunction related to critical illness and/or invasive mechanical ventilation. Images obtained over the course of illness can document changes in muscle dimension and can be used to estimate changes in function. Recent evidence suggests the clinical usefulness of ultrasound imaging in the assessment of intercostal muscle function. In this narrative review, we summarize the current literature on ultrasound imaging of the parasternal intercostal muscles as used to assess the extent of muscle activation and muscle weakness and its potential impact during discontinuation of mechanical ventilation. In addition, we proposed a practical flowchart based on recent evidence and experience of our group that can be applied during the weaning phase. This approach integrates multiple predictive parameters of weaning success with respiratory muscle ultrasound.

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

“…The characteristics of the patients are shown in Table 1 (IQR, [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. The HFNC duration was 2 days (IQR, 2-3 days), which was due to post-extubation (29 patients, 73%) and respiratory failure types I (10 patients, 25%) and II (1 patient, 3%).…”

Urinary Titin N-Fragment as a Biomarker of Muscle Atrophy, Intensive Care Unit-Acquired Weakness, and Possible Application for Post-Intensive Care Syndrome

“…In addition to the diaphragm muscle, intercostal muscle atrophy is also observed in patients with mechanical ventilation [ 62 ], and is associated with prolonged mechanical ventilation and prolonged ICU stay [ 42 ]. Moreover, muscle atrophy occurs in other expiratory muscles, including the obliquus interna, obliquus externa, transversus abdominis, and rectus abdominis muscles [ 63 ].…”

Diaphragm Satellite Cells Isolation by Optimized MACS and the Effect of Mechanical Ventilation on their Proliferation and Differentiation Characteristics through MyoD and Myogenin Pathways

“…The matrigel medium was prepared and kept at 4℃. After the cell number was determined, the diaphragm satellite cells were seeded into 12-well plates at a density of 1.5×10 4 per well with 400 μL medium. The cells were cultured at 37 ℃ for 4 days.…”

“…Moreover, weaning failure is associated with increased morbidity and mortality, exposing patients to life-threatening complications again [3]. Accumulating evidence has indicated that the prolonged MV (1 week or longer) promotes respiratory muscle weakness due to both contractile dysfunction and atrophy, especially in the diaphragm [4][5][6][7], indicating that diaphragm dysfunction plays a key role in weaning failure from MV. Petrof BJ and Vassilakopoulo have termed such a condition as ventilatorinduced diaphragmatic dysfunction (VIDD) [8,9].…”