Measuring diaphragm thickness with ultrasound in mechanically ventilated patients: feasibility, reproducibility and validity

Goligher, Ewan C.; Laghi, Franco; Detsky, Michael E.; Farías, Paulina; Murray, Alistair; Brace, Deborah; Brochard, Laurent; Sebastien-Bolz, Steffen; Rubenfeld, Gordon D.; Kavanagh, Brian P.; Ferguson, Niall D.

doi:10.1007/s00134-015-3687-3

Cited by 347 publications

(425 citation statements)

References 36 publications

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“…87 A number of recent studies have employed ultrasound to measure diaphragm thickness and inspiratory thickening in ventilated subjects. Some of them focused on the feasibility and reproducibility of the technique, 88,89 whereas another 90 showed how with increasing levels of pressure support ventilation, parallel reductions were found between diaphragm thickening and both the diaphragm and esophageal pressure-time product, suggesting that diaphragm thickening is a reliable indicator of respiratory effort. Fig.…”

Section: Bedside Ultrasonography In Critically Ill Patientsmentioning

confidence: 99%

“…At relatively low inspiratory volumes (Ͻ50% of inspiratory capacity), thickening of the diaphragm during inspiration arises from muscle contraction rather than from increasing thoracic volume. 89 Accordingly, a given inspiratory thickening fraction value does not imply the same transdiaphragmatic pressure swing across different patients, thus limiting the utility of this measurement for precise interpatient comparison. Considering the wide variability of diaphragm thickness and thickening fraction values, these measurements are therefore best suited for qualitative comparisons of inspiratory muscle activity between patients and for quantitative comparisons of changes in inspiratory muscle activity within patients.…”

Section: B-modementioning

confidence: 99%

“…3). Goligher et al 89 have suggested the measurement of end expiration and peak inspiration diaphragm thickness on 2 breaths visualized in a single M-mode image and demonstrated the high reproducibility of this technique in mechanically ventilated subjects. 67 Healthy, SB; P di sniff Observational P di sniff is a reliable quantitative method for assessment of diaphragm strength (continued)…”

Section: M-modementioning

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: B-modementioning

confidence: 99%

Section: M-modementioning

confidence: 99%

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Ultrasonographic Assessment of Diaphragm Function in Critically Ill Subjects

Umbrello

Formenti

2016

Respir Care

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“…This is unlikely the result of muscle atrophy or hypertrophy. Another article by the same author already suggested, that for this reason thickness and thickening aren't feasible for interpatient comparison (9).…”

Section: Accuracymentioning

confidence: 99%

Ultrasound to assess diaphragmatic function in the critically ill—a critical perspective

2017

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Ultrasound of the diaphragm in critically ill patients has become a diagnostic technique of emerging interest among clinicians and scientists. The advantages include that it is widely available, noninvasive and examination can be performed after relatively short training and at low costs. It is used to estimate muscle mass by measurement of muscle thickness and diagnose weakness by the assessment of diaphragm movement during unassisted breathing. Thickening of the muscle during inspiration has been used to quantify force generation. The enthusiasm that surrounds this topic is shared by many clinicians and we agree that ultrasound is a valuable tool to screen for diaphragm dysfunction in intensive care unit (ICU) patients. However, in our opinion much more studies are required to validate ultrasound as a tool to quantify breathing effort. More sophisticated ultrasound techniques, such as speckle tracking imaging are promising techniques to evaluate respiratory muscle function in patients, including the critically ill.

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“…Bu noktada diyafragma karaciğerin hemen üzerinde görece olarak non-ekojenik üç katmanlı bir kas yapısı olarak gözükmektedir. Diyafragma kalınlaşması M-modda ekspiryum sonu kalınlık ve inspiryum sonu kalın-lık olarak ölçülmekte ve diyafragma kalınlık fraksiyonu (inspiryum sonundaki kalınlık -ekspiryum sonundaki kalınlık / ekspiryum sonundaki kalınlık) ve yüzde olarak ifade edilmektedir (4,7). Kullanımının yaygınlaş-ması özellikle YBÜKG olan hastalarda weaning yönetiminde yol gösteri-ci olabilir.…”

Section: Yorumunclassified

Diaphragmatic Dysfunction in Patients with ICU-Acquired Weakness and its Impact on Extubation Failure

Yıldırım¹

2016

Yoğun Bakim Derg

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GirişYoğun bakım ünitesinde kazanılmış güçsüzlük (YBÜKG), yoğun bakım hastalarında görülen miyopati ve nöropatinin eşlik ettiği bir komplikasyondur. İnsidansı değişmekle birlikte çoklu organ yetmezliği olan hastalarda %100'e çıkabilmektedir. Mekanik ventilasyondan (MV) weaningde gecikmeyle, YBÜ kalış süresinde uzamayla, frajilite ve kötü sonuçlarla ilişkili olduğu belirtilmektedir. Diyafragma ana inspirasyon kası olup, kritik hastalıkta o da etkilenmektedir. Mekanik ventilasyonun kendisi de diyafragma gücünü azaltmaktadır (mekanik ventilatörün indüklediği diyafragma disfonksiyonu terimi de kullanılmaktadır) ve yoğun bakım hastalarında ekstremite kaslarını etkilemeden diyafragma atrofisine sebep olmaktadır. YBÜ hastalarında MV'den weaning zor olabilmektedir, bu nedenle bu hastalarda potansiyel diyafragma disfonksiyonu araştırma konusu olmaktadır. Şimdiye kadar iki çalışma yatak başında solunum fonksiyon testi (maksimum inspiratuar basınç-MİP) ve elektromiyografiyi kullanarak YBÜ hastalarında YBÜKG ile diyafragma fonksiyonları arasındaki ilişkiyi araştırmıştır ve sonuçları tartışmalıdır. Bu çalışma, spontan solunum denemesi (SBT) uygulanan hastalarda frenik sinirin magnetik stimülasyonu, diyafragma ultrasonografisi, pulmoner fonksiyon testinden oluşan üçlü model kullanıla-rak yatak başında diyafragma disfonksiyonunu değerlendirmek için dizayn edilmiştir. Hipotezi "diyafragma disfonksiyonu YBÜKG ile ilişki li olabilir" dir. Gereç ve YöntemlerFizyolojik, prospektif bu çalışma Mayıs-Kasım 2013 arasında 6 aylık periyodda, 16 yataklı medikal ve cerrahi YBÜ'de yapıldı. Kullanılan tanı-sal ya da tedavi edici stratejilerde değişiklik yapılmadı. Medikal Research Council Skoru (MRC) <48 olan, YBÜKG tanısı olan ve en az 48 saat süreyle MV uygulanan ve spontan solunum denemesi yapılan hastalar çalışmaya dahil edildi. Burada adı geçen MRC değerlendirmesi fizyoterapistler tarafından yıllardır YBÜ'de yapılan bir skorlamadır.Frenik sinir magnetik stimülasyonu için kontreendikasyonu olan hastalar (kalp pili, implante defibrilatör, servikal implant), daha önce nöromüsküler hastalığı olan hastalar, servikal kolon hasarı olan hastalar, bihemisferik ya da beyin sapı lezyonu olan hastalar, ekstremitelerde kas gücünün değerlendirmesi mümkün olmayan hastalar (ampütasyon ya da immobilizasyon nedeniyle) çalışma dışı bırakıldı.Demografik veriler, ciddiyet skorları, komorbiditeler, YBÜKG için risk faktörleri, YBÜ'ye kabul nedenleri ve MV başlangıç sebepleri prospektif olarak kaydedildi. MV süresi, YBÜ'de kalış süresi ve YBÜ mortalitesi kaydedildi.

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Measuring diaphragm thickness with ultrasound in mechanically ventilated patients: feasibility, reproducibility and validity

Cited by 347 publications

References 36 publications

Ultrasonographic Assessment of Diaphragm Function in Critically Ill Subjects

Ultrasonographic Assessment of Diaphragm Function in Critically Ill Subjects

Ultrasound to assess diaphragmatic function in the critically ill—a critical perspective

Diaphragmatic Dysfunction in Patients with ICU-Acquired Weakness and its Impact on Extubation Failure

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