Diaphragmatic Function Assessed by Bed Side Ultrasonography in Patients with Sepsis or Septic Shock Admitted to Intensive Care Unit

Abstract

BACKGROUND: Sepsis and septic shock are major problems faced the healthcare systems all over the world every year. The ultrasound (US) is a simple, non-invasive, easily accessible technique, and showed great accuracy in diaphragm assessment. AIM: We evaluated the diaphragmatic function assessed by US in patients with sepsis and septic shock and correlated these assessments with different parameters. MATERIALS AND METHODS: A prospective observational study carried out on 30 patients admitted to the intensive care unit (ICU) diagnosed with sepsis and/or septic shock. Both diaphragmatic excursion (DE) and thickness fraction (diaphragm thickening fraction [TDI] %) were assessed by US on admission and every 48 h along the patients’ ICU stay. RESULTS: In the current study, there was a statistically significant reverse relationship between mortality and the different diaphragmatic function parameters (DE on admission, average DE, on admission TDI%, average TDI%). On the other hand, the DE (on admission and average) showed a statistically significant reverse relation with the need and duration of mechanical ventilation (MV) while the TDI% showed a statistically significant reverse relation only with the duration of MV. Besides, there was a statistically significant direct relationship between successful weaning from MV and all the measured parameters. CONCLUSION: We proposed that the diaphragmatic function parameters (DE on admission, average DE, on admission TDI% and average TDI%) assessed by US of septic ICU patients could be used as a predictor of the need, duration, and successful weaning from MV and also as a predictor of mortality.

Ultrasonographic evaluation of the diaphragm in critically ill patients to predict invasive mechanical ventilation

“…In our population, respiratory rate was high, and accessory muscle used that indicated high respiratory effort was included in the inclusion criteria. However, low RDE was associated with requiring IMV, which results similar results to previous study [ 40 – 42 , 45 ]. Therefore, the evidence of diaphragmatic ultrasound needs evaluation and validation in requiring intubation in sepsis.…”

“…Therefore, diaphragmatic evaluation may consider monitoring to choose ventilatory support to prevent worsening outcomes in delayed intubation and diaphragmatic weakness in mechanical ventilation [ 8 , 22 ]. A previous study evaluated the performance of diaphragmatic function was found low diaphragmatic excursion values associated need for IMV, prolonged IMV, and mortality in sepsis [ 45 ]. Similarly, this study found RDE was a good performance to predict IMV within 48 h and mortality.…”