Incidence and predictive factors of diaphragmatic dysfunction in acute stroke

Abstract

Background: The most characteristic clinical signs of stroke are motor and/or sensory involvement of one side of the body. Respiratory involvement has also been described, which could be related to diaphragmatic dysfunction contralateral to the brain injury. Our objective is to establish the incidence of diaphragmatic dysfunction in ischaemic stroke and analyse the relationship between this and the main prognostic markers. Methods: A prospective study of 60 patients with supratentorial ischaemic stroke in the first 48 h. Demographic and clinical factors were recorded. A diaphragmatic ultrasound was performed for the diagnosis of diaphragmatic dysfunction by means of the thickening fraction, during normal breathing and after forced inspiration. Diaphragmatic dysfunction was considered as a thickening fraction lower than 20%. The appearance of respiratory symptoms, clinical outcomes and mortality were recorded for 6 months. A bivariate and multivariate statistical analysis was designed to relate the incidence of respiratory involvement with the diagnosis of diaphragmatic dysfunction and with the main clinical determinants. Results: An incidence of diaphragmatic dysfunction of 51.7% was observed. 70% (23 cases) of these patients developed symptoms of severe respiratory compromise during follow-up. Independent predictors were diaphragmatic dysfunction in basal respiration (p = 0.026), hemiparesis (p = 0.002) and female sex (p = 0.002). The cutoff point of the thickening fraction with greater sensitivity (75.75%) and specificity (62.9%) was 24% (p = 0.003). Conclusions: There is a high incidence of diaphragmatic dysfunction in patients with supratentorial ischaemic stroke which can be studied by calculating the thickening fraction on ultrasound. Among these patients we have detected a higher incidence of severe respiratory involvement.

Measuring and Monitoring Skeletal Muscle Mass and Dysfunction After Stroke

“…Intraobserver and interobserver correlation coefficients were 0.95-0.99 and 0.58-0.99, respectively, in excursion measurements [51]. Diaphragm dysfunction can be clearly distinguished when patients are asked to force-fully breathe instead of normal breathing [54].…”

“…Diaphragm thickness is thinner on the affected side than that on the unaffected side at end expiration [55], and diaphragm dysfunction was observed in 51.7% of affected limbs and 1.7% of unaffected limbs [54]. Diaphragm dysfunction was not only observed in patients with hemiparesis but also observed in 24% of patients without hemiparesis [56].…”

“…Although the left hemidiaphragm is not routinely assessed for diaphragm function, examining bilateral hemidiaphragm functions after stroke is better. Especially, diaphragm dysfunction needs to be evaluated in patients with middle cerebral artery occlusion because the occurrence rate of diaphragm dysfunction was 62.5% among them [54].…”

Platypnea orthodeoxia syndrome after recent stroke: a case report of a sandwiched right atrium

“…A possible explanation in this case is that right hemidiaphragm paralysis was a consequence of the stroke of the left hemisphere, which has been described in literature. 7 …”

Neck Stabilization Exercises Enhance Respiratory Function after Stroke: Respiratory Function Index Change Trajectory Analyzed Using a Hierarchical Linear Model

“…More than 70% of stroke patients develop chronic disability due to general muscle weakness; this affects even the respiratory muscles, such as the diaphragm and intercostal muscles, with invasion of these principal respiratory muscles typically seen on the paralyzed side of stroke patients [1,2]. The diaphragm is the inspiratory muscle responsible for most of the total ventilation of an individual in the sitting and lying positions, and its paralysis causes dysfunction in 51.7% of stroke patients as it leads to a marked decrease in respiratory function [3]. At the same time, a secondary problem caused by muscle paralysis is that the lungs and chest cage fail to achieve sufficient inflation, which leads to asymmetric respiration due to the following: decreased lung compliance, abnormal chest expansion, increased sensitivity to carbon dioxide, and decreased voluntary respiration [4,5].…”