Diaphragm dysfunction assessed by ultrasonography: Influence on weaning from mechanical ventilation*

Kim, Won Young; Suh, Hee Jung; Hong, Sang‐Bum; Koh, Younsuck; Lim, Chae‐Man

doi:10.1097/ccm.0b013e3182266408

Cited by 439 publications

(451 citation statements)

References 19 publications

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“…First, although debate exists, several studies reveal that inspiratory muscle endurance is decreased in patients during prolonged MV and that maximal inspiratory pressure generation is lower in patients that experience difficult weaning compared with patients that are successfully weaned (14,15,17,55). Furthermore, a recent study reveals that patients with diaphragmatic contractile dysfunction exhibit a high incidence of weaning failures compared with patients with normal diaphragm function (51). Finally, a growing number of studies suggest that inspiratory muscle training, designed to increase diaphragm strength and endurance, increases weaning success in patients who previously failed repeated weaning attempts by conventional methods (3,65,66,104).…”

Section: Contribution Of Vidd To Weaning Failurementioning

confidence: 99%

Ventilator-induced diaphragm dysfunction: cause and effect

Powers

Wiggs

Sollanek

et al. 2013

American Journal of Physiology-Regulatory, Integrative and Comp

143

156

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Powers SK, Wiggs MP, Sollanek KJ, Smuder AJ. Ventilator-induced diaphragm dysfunction: cause and effect. Am J Physiol Regul Integr Comp Physiol 305: R464 -R477, 2013. First published July 10, 2013 doi:10.1152/ajpregu.00231.2013 is used clinically to maintain gas exchange in patients that require assistance in maintaining adequate alveolar ventilation. Common indications for MV include respiratory failure, heart failure, drug overdose, and surgery. Although MV can be a life-saving intervention for patients suffering from respiratory failure, prolonged MV can promote diaphragmatic atrophy and contractile dysfunction, which is referred to as ventilator-induced diaphragm dysfunction (VIDD). This is significant because VIDD is thought to contribute to problems in weaning patients from the ventilator. Extended time on the ventilator increases health care costs and greatly increases patient morbidity and mortality. Research reveals that only 18 -24 h of MV is sufficient to develop VIDD in both laboratory animals and humans. Studies using animal models reveal that MV-induced diaphragmatic atrophy occurs due to increased diaphragmatic protein breakdown and decreased protein synthesis. Recent investigations have identified calpain, caspase-3, autophagy, and the ubiquitin-proteasome system as key proteases that participate in MV-induced diaphragmatic proteolysis. The challenge for the future is to define the MV-induced signaling pathways that promote the loss of diaphragm protein and depress diaphragm contractility. Indeed, forthcoming studies that delineate the signaling mechanisms responsible for VIDD will provide the knowledge necessary for the development of a pharmacological approach that can prevent VIDD and reduce the incidence of weaning problems. respiratory muscle; atrophy; mechanical ventilation; weaning; muscle wasting MECHANICAL VENTILATION (MV) is used clinically to achieve sufficient pulmonary gas exchange in patients unable to sustain adequate alveolar ventilation on their own. Common indications for MV include respiratory failure due to chronic obstructive pulmonary disease, status asthmaticus, and/or heart failure. In addition, MV is often an essential intervention in patients suffering from acute drug overdose, neuromuscular diseases, sepsis, and during surgery along with postsurgical recovery.The number of patients receiving prolonged MV in the United States exceeds more than 300,000 each year in the intensive care unit (ICU) (20). Although MV can be a lifesaving measure, prolonged MV results in the rapid development of diaphragmatic weakness due to both atrophy and contractile dysfunction. This detrimental impact of prolonged MV on the diaphragm has been termed ventilator-induced diaphragmatic dysfunction (VIDD) and VIDD is predicted to be a major contributor to problems in weaning patients from the ventilator (26, 114). Although previous reports describing the impact of prolonged MV on the diaphragm have appeared in the literature, advances in our understanding of the mechanisms responsible for VIDD h...

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Section: Contribution Of Vidd To Weaning Failurementioning

confidence: 99%

Ventilator-induced diaphragm dysfunction: cause and effect

Powers

Wiggs

Sollanek

et al. 2013

American Journal of Physiology-Regulatory, Integrative and Comp

143

156

View full text Add to dashboard Cite

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“…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. 86 Thickening during active breathing has been proposed to reflect the magnitude of diaphragm effort, similar to an ejection fraction of the heart.…”

Section: Bedside Ultrasonography In Critically Ill Patientsmentioning

confidence: 99%

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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“…Diaphragmatic dysfunction induced by mechanical ventilation or iatrogenic phrenic nerve injury is an underappreciated cause of weaning failure. 32 Diminished or paradoxical diaphragmatic motion may be observed easily with transthoracic US but less so with TELU. Moreover, ultrasonography may allow clinicians to observe de-recruitment with the lung aeration score, which is derived from the presence of B-lines and atelectasis.…”

Section: Integrated Cardiopulmonary Approach To Hypoxemia and Other Cmentioning

confidence: 99%

Transesophageal lung ultrasonography: a novel technique for investigating hypoxemia

Cavayas

Girard

Desjardins

et al. 2016

Can J Anesth/J Can Anesth

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Background Acute deterioration in respiratory status commonly occurs in patients who cannot be transported for imaging studies, particularly during surgical procedures and in critical care settings. Transthoracic lung ultrasonography has been developed to allow rapid diagnosis of respiratory conditions at the bedside. Nevertheless, the thorax is not always accessible, especially in the perioperative setting. Transesophageal lung ultrasonography (TELU) can be used to circumvent this problem. Purpose The aim of this narrative review is to provide a complete description of the TELU technique by summarizing the existing literature on the subject and describing our own experience that extrapolates from transthoracic lung ultrasonography. Principal findings The use of TELU can provide point-ofcare real-time information for quickly establishing the etiology of acute hypoxemia. The transesophageal probe is placed in close proximity to the posterior regions of the lungs where lung consolidation and pleural effusions are most often seen; however, most of the artefacts relied on by transthoracic ultrasound have yet to be validated with TELU. Moreover, the relative invasiveness of TELU compared with transthoracic ultrasonography may limit its use to specific situations when the probe is already in place, as during cardiac anesthesia or when the anterior thorax is inaccessible. The main advantage of TELU may lie in the ability to integrate both cardiac and pulmonary assessments in one single examination. Conclusion Anesthesiologists and intensivists who already use transesophageal echocardiography on a regular basis should consider adding TELU to their clinical assessment of hypoxemia and related pulmonary pathologies. Nevertheless, the literature specifically supporting TELU is relatively limited, and further validation studies are needed. RésuméContexte Des détériorations aiguës de l'état respiratoire de patients qui ne peuvent être transportés pour des examens d'imagerie sont fréquentes, particulièrement lors d'interventions chirurgicales ainsi que dans le contexte des soins intensifs. L'échographie pulmonaire transthoracique a été mise au point afin de permettre de diagnostiquer rapidement la cause d'une détérioration respiratoire au chevet du patient. Or, le thorax n'est pas toujours accessible, particulièrement dans un contexte périopératoire.L'échographie transoesophagienne pulmonaire (ETOP) peut alors être utilisée pour pallier ce problème.

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Diaphragm dysfunction assessed by ultrasonography: Influence on weaning from mechanical ventilation*

Cited by 439 publications

References 19 publications

Ventilator-induced diaphragm dysfunction: cause and effect

Ventilator-induced diaphragm dysfunction: cause and effect

Ultrasonographic Assessment of Diaphragm Function in Critically Ill Subjects

Transesophageal lung ultrasonography: a novel technique for investigating hypoxemia

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