Point of Care Ultrasound to Identify Diaphragmatic Dysfunction after Thoracic Surgery

Spadaro, Savino; Grasso, Salvatore; Dres, Martin; Fogagnolo, Alberto; Corte, Francesca Dalla; Tamburini, Nicola; Maniscalco, Pio; Cavallesco, Giorgio; Alvisi, Valentina; Stripoli, Tania; Camillis, E. De; Ragazzi, Riccardo; Volta, Carlo Alberto

doi:10.1097/aln.0000000000002774

Cited by 53 publications

(72 citation statements)

References 39 publications

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“…In light of these advantages, this study applied US to evaluate the diaphragm function of patients who underwent rehabilitation therapy. DE and DTF have been frequently proposed as an indicator of diaphragmatic contractile activity [30][31][32][33] or weaning predictor [34][35][36]. In this study, we found DTF, but not DE, was significantly reduced in the rehabilitation group compared to that in the control group.…”

Section: Discussionsupporting

confidence: 43%

Early rehabilitation relieves diaphragm dysfunction induced by prolonged mechanical ventilation: a randomised control study

et al. 2021

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Background Prolonged mechanical ventilation (MV) induces diaphragm dysfunction in patients in the intensive care units (ICUs). Our study aimed to explore the therapeutic efficacy of early rehabilitation therapy in patients with prolonged MV in the ICU. Methods Eighty eligible patients who underwent MV for > 72 h in the ICU from June 2019 to March 2020 were enrolled in this prospective randomised controlled trial. The patients were randomly divided into a rehabilitation group (n = 39) and a control group (n = 41). Rehabilitation therapy included six levels of rehabilitation exercises. Diaphragm function was determined using ultrasound (US). Results Diaphragmatic excursion (DE) and diaphragm thickening fraction (DTF) were significantly decreased in all patients in both groups after prolonged MV (p < 0.001). The rehabilitation group had significantly higher DTF (p = 0.008) and a smaller decrease in DTF (p = 0.026) than the control group after 3 days of rehabilitation training. The ventilator duration and intubation duration were significantly shorter in the rehabilitation group than in the control group (p = 0.045 and p = 0.037, respectively). There were no significant differences in the duration of ICU stay, proportion of patients undergoing tracheotomy, and proportion of recovered patients between the two groups. Conclusions Early rehabilitation is feasible and beneficial to ameliorate diaphragm dysfunction induced by prolonged MV and advance withdrawal from the ventilator and extubation in patients with MV. Diaphragm US is suggested for mechanically ventilated patients in the ICU. Trial registration Chinese Clinical Trial Registry, ID: ChiCTR1900024046, registered on 2019/06/23.

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Section: Discussionsupporting

confidence: 43%

Early rehabilitation relieves diaphragm dysfunction induced by prolonged mechanical ventilation: a randomised control study

et al. 2021

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“…Importantly, a recent study has suggested that diaphragm function is predominantly a key determinant for the outcome of the spontaneous breathing trial rather than the outcome of extubation. Secondly, diaphragm dysfunction has been associated with complications such as reintubation, tracheostomy and prolonged ventilation (2), and postoperative complications (8,9). It is also associated with ICU mortality (7).…”

Section: Diaphragm Dysfunction Is a Major Concernmentioning

confidence: 99%

Monitoring diaphragm function in the ICU

Dres

Demoule

2020

Current Opinion in Critical Care

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This article reviews the clinical problem of diaphragm function in critically ill patients and describes recent advances in bedside monitoring of diaphragm function. Recent findings Diaphragm weakness, a consequence of diaphragm dysfunction and atrophy, is a common condition in the intensive care unit and is associated with serious clinical consequences. Bedside diaphragm function monitoring can now be performed by means of two approaches: diaphragm electrical activity and diaphragm ultrasound. The use of ultrasound to assess diaphragm structure (thickness, thickening) and mobility (caudal displacement) appears to be feasible and reproducible, but no large-scale "real-life" study is available. Diaphragm ultrasound can also be used to evaluate diaphragm muscle stiffness by means of shear wave elastography and strain by means of speckle tracking, both of which are correlated with diaphragm function in healthy subjects. Electrical activity of the diaphragm is correlated with diaphragm function during brief airway occlusion, but the repeatability of these measurements exhibits high within-subject variability.

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“…The criteria for the diagnosis of diaphragmatic paralysis by M-mode ultrasonography have been reported, previously [1][2]. The study of the diaphragmatic motion has demonstrated its relevance in various conditions such as after thoracic surgery [3] and in patients suffering from neuromuscular diseases [4][5].…”

Section: Introductionmentioning

confidence: 99%

Diaphragmatic motion recorded by M-mode ultrasonography: limits of normality

Boussuges

Finance

Chaumet³

2021

ERJ Open Res

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BackgroundChest ultrasonography has proven to be useful in the diagnosis of diaphragm dysfunction. The aim of the present study was to determine the normal values of the motion of both hemidiaphragms recorded by M-mode ultrasonography.MethodsHealthy volunteers were studied while in a seated position. Diaphragmatic excursions and diaphragm profiles were measured during quiet breathing, voluntary sniffing, and deep breathing. Diaphragmatic excursions were assessed by M-mode ultrasonography, using an approach perpendicular to the posterior part of the diaphragm. Anatomical M-mode was used for the recording of the complete excursion during deep breathing.ResultsThe study included 270 men and 140 women. The diaphragmatic motions during quiet breathing and voluntary sniffing were successfully recorded in all of the participants. The use of anatomical M-mode was particularly suitable for measurement of the entire diaphragmatic excursion during deep breathing. The statistical analysis showed that the diaphragmatic excursions were larger in men compared to women, supporting the determination of normal values based on gender. The lower and upper limits of normal excursion were determined for men and women for both hemidiaphragms during the three maneuvers that were investigated. The lower limits of normal diaphragmatic excursions during deep breathing should be used to detect diaphragmatic hypokinesia, i.e., 3.3 and 3.2 cm in women and 4.1 and 4.2 cm in men for the right and the left sides, respectively.ConclusionThe normal values of the diaphragmatic motion and the lower and upper limits of normal excursion can be used by clinicians to detect diaphragmatic dysfunction.

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Point of Care Ultrasound to Identify Diaphragmatic Dysfunction after Thoracic Surgery

Abstract: Point of care ultrasound can be used to evaluate postoperative diaphragmatic function. On the first postoperative day, diaphragmatic dysfunction was less common after video-assisted than after the thoracotomic surgery and is associated with postoperative pulmonary complications.

Cited by 53 publications

References 39 publications

Early rehabilitation relieves diaphragm dysfunction induced by prolonged mechanical ventilation: a randomised control study

Early rehabilitation relieves diaphragm dysfunction induced by prolonged mechanical ventilation: a randomised control study

Monitoring diaphragm function in the ICU

Diaphragmatic motion recorded by M-mode ultrasonography: limits of normality

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