Ultrasonographic Assessment of Diaphragmatic Function and Its Clinical Application in the Management of Patients with Acute Respiratory Failure

Abstract

Acute respiratory failure (ARF) is a common life-threatening medical condition, with multiple underlying etiologies. In these cases, many factors related to systemic inflammation, prolonged use of steroids, and lung mechanical abnormalities (such as hyperinflation or increased elastic recoil due to pulmonary oedema or fibrosis) may act as synergic mechanisms leading to diaphragm dysfunction. The assessment of diaphragm function with ultrasound has been increasingly investigated in the emergency department and during hospital stay as a valuable tool for providing additional anatomical and functional information in many acute respiratory diseases. The diaphragmatic ultrasound is a noninvasive and repeatable bedside tool, has no contraindications, and allows the physician to rapidly assess the presence of diaphragmatic dysfunction; this evaluation may help in estimating the need for mechanical ventilation (and the risk of weaning failure), as well as the risk of longer hospital stay and higher mortality rate. This study presents an overview of the recent evidence regarding the evaluation of diaphragmatic function with bedside ultrasound and its clinical applications, including a discussion of real-life clinical cases.

Diaphragm Ultrasound in Critically Ill Patients on Mechanical Ventilation—Evolving Concepts

“…In critically ill patients, a recent expert consensus indicates that unilateral assessment of the right hemidiaphragm is an acceptable substitute for the entire diaphragm, except in cases of suspected unilateral involvement, when then there is a need for bilateral assessment of the diaphragm [ 48 ]. Ultrasound can also be limited due to a poor acoustic window for the visualization of the diaphragm in obese patients [ 47 , 131 , 132 ]. Finally, although a correlation between the thickening fraction and inspiratory strength has been observed in healthy subjects [ 57 ], the DUS does not provide a direct measure of ventilatory force, probably because the other inspiratory muscles of the ribcage may partially contribute to ventilation, interfering with the contribution of the diaphragm [ 51 ].…”

A Review on Nursing Care of Severe Head Injury Patients Who Undergo Late Versus Early Tracheostomy

“…It is unfortunate that tracheostomy placement has been linked to a sixfold increase in the chance of developing ventilator-associated pneumonia because tracheostomy placement does not guarantee a reduction in nosocomial pneumonia incidents. (Ibrahim et al, 2001;Saad et al, 2023). Similarly, patients with tracheostomies tend to have a longer duration of stay in the ICU and hospitals, and although ICU mortality is found to be reduced, more crucially, no reduction in hospital mortality has been recorded among tracheostomy patients (Fernando et al, 2019).…”

MicroRNAs participate in the regulation of apoptosis and oxidative stress-related gene expression in rabbits infected with Lagovirus europaeus GI.1 and GI.2 genotypes

“…Apoptosis and oxidative balance maintain cell homeostasis and play an essential role in viral infections (Thomson, 2001;Santus et al, 2022). Many cells undergo apoptosis in response to viral infection, reducing the release of progeny virus.…”