Ultrasound Imaging for Diaphragm Dysfunction: A Narrative Literature Review

Vetrugno, Luigi; Guadagnin, Giovanni Maria; Barbariol, Federico; Langiano, Nicola; Zangrillo, Alberto; Bove, Tiziana

doi:10.1053/j.jvca.2019.01.003

Cited by 89 publications

(95 citation statements)

References 80 publications

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“…Diaphragm dysfunction, defined as the inability of the diaphragm to generate reasonable levels of maximal force, is an under-recognized pathological condition in critically ill patients and can render weaning from mechanical ventilation extremely difficult, resulting in protracted mechanical ventilation and prolonged intensive care unit length-of-stay [44]. The prevalence of diaphragm dysfunction in critically ill patients admitted to the intensive care unit and requiring IMV is over 60%, reaching 80% in patients requiring prolonged IMV and experiencing difficult weaning [45].…”

Section: Diaphragm Ultrasound (Dus)mentioning

confidence: 99%

“…Considerable research attention has been focused on diagnosing diaphragm dysfunction over recent years, and there is strong evidence to sustain an association/ correlation between diaphragm dysfunction and weaning failure [45][46][47]. The gold standard for evaluating diaphragm force is the measurement of trans-diaphragmatic pressure (Pdi) [48].…”

Section: Diaphragm Ultrasound (Dus)mentioning

confidence: 99%

“…Two diaphragm sonographic predictors of successful weaning have been proposed [45,[49][50][51][52][53][54][55][56]:…”

Section: Diaphragm Ultrasound (Dus)mentioning

confidence: 99%

“…DE reflects the sum of the patient's inspiratory activity and mechanical ventilatory support, so it only has real value when assessed during a spontaneous breathing trial. Diaphragm displacement is associated with lung volume during the inspiratory phase [57], but it does not correlate with and does not quantify the patient's inspiratory effort [58]; furthermore, its assessment is influenced by numerous factors (see Table 1) [45]. It should also be noted that diaphragmatic excursion can be influenced by PEEP and levels of ventilator support during mechanical ventilation [55]: by increasing lung expiratory volumes, higher levels of PEEP lower the diaphragmatic domes, resulting in a decreased diaphragmatic excursion; during assisted ventilation, diaphragmatic excursion results from ventilator support plus the patient's inspiratory efforts [56].…”

Section: Diaphragm Ultrasound (Dus)mentioning

confidence: 99%

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Mechanical ventilation weaning issues can be counted on the fingers of just one hand: part 1

et al. 2020

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Although mechanical ventilation may be a patient's vital ally during acute illness, it can quickly transform into an enemy during chronic conditions. The weaning process is the fundamental phase that enables the resumption of physiological respiratory function; however, it is also associated with a number of life-threatening complications, and a large percentage of critically ill patients never achieve airway device removal or require the resumption of mechanical ventilation just a few days post-weaning. Indeed, the weaning process is, at present, more of an art than a science. As such, there is urgent need for novel contributions from the scientific literature to abate the growing rates of morbidity and mortality associated with weaning failure. The physician attempting to wean a patient must integrate clinical parameters and common-sense criteria. Numerous studies have striven to identify single predictive factors of weaning failure and sought to standardize the weaning process, but the results are characterized by remarkable heterogeneity. Despite the lack of benchmarks, it is clear that the analysis of respiratory function must include a detailed overview of the five situations described below rather than a single aspect. The purpose of this two-part review is to provide a comprehensive description of these situations to clarify the "arena" physicians are entering when weaning critically ill patients from mechanical ventilation. Publisher's NoteSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Section: Diaphragm Ultrasound (Dus)mentioning

confidence: 99%

Section: Diaphragm Ultrasound (Dus)mentioning

confidence: 99%

“…Two diaphragm sonographic predictors of successful weaning have been proposed [45,[49][50][51][52][53][54][55][56]:…”

Section: Diaphragm Ultrasound (Dus)mentioning

confidence: 99%

Section: Diaphragm Ultrasound (Dus)mentioning

confidence: 99%

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Mechanical ventilation weaning issues can be counted on the fingers of just one hand: part 1

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“…Mechanical ventilation may also lead to a "…loss of diaphragmatic force-generating capacity" [49], causing ventilator-induced diaphragm dysfunction (VIDD) [49]-an underdiagnosed condition in clinical practice. The causes of this type of diaphragmatic weakness may be prolonged inactivity during mandatory or assisted mechanical ventilation (underloading, i.e., due to the use of myorelaxants or excessive positive pressure support) or an excessive workload (overloading; i.e., due to ventilator asynchrony or inadequate pressure support) [50][51][52][53]. Diaphragmatic weakness in critically ill patients in the ICU may also form part of a more general picture of acquired myopathy or polyneuropathy associated with critical illness, or it may present as a single dysfunction in patients who otherwise present no signs of multiple district involvement [54].…”

Section: Ventilator-induced Diaphragm Dysfunctionmentioning

confidence: 99%

Mechanical ventilation weaning issues can be counted on the fingers of just one hand: part 2

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Assessing heart and diaphragm function constitutes only one of the steps to consider along the weaning path. In this second part of the review, we will deal with the more systematic evaluation of the pulmonary parenchyma-often implicated in the genesis of respiratory failure. We will also consider the other possible causes of weaning failure that lie beyond the cardio-pulmonary-diaphragmatic system. Finally, we will take a moment to consider the remaining unsolved problems arising from mechanical ventilation and describe the so-called protective approach to parenchyma and diaphragm ventilation.

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Short‐term effects of a novel bronchial drainage device: A pilot cohort study in subjects with cystic fibrosis

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Toth

Käppler-Schorn

et al. 2022

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Background and Aims In cystic fibrosis (CF) airways, impaired airway mucociliary clearance and mucus accumulation due to cystic fibrosis transmembrane conductance regulator defects contribute to inflammation, progressive structural lung damage, and decline of lung function. Physiotherapy is essential to promote mucus mobilization and removal in CF and is a key element of rehabilitation measures, but conventional techniques may be suboptimal to mobilize viscous mucus. This study aimed to test the specific effects of a novel bronchial drainage device (BDD) (Simeox®; PhysioAssist) in subjects with CF and evaluate lung function, diaphragm mobility, and sputum properties. Methods This prospective monocentric clinical cohort study in the setting of outpatient physiotherapy of CF patients ( n = 21) with stable CF lung disease collected pulmonary lung function tests (PFT), diaphragm mobility, and sputum properties before and after two physiotherapy sessions using the novel BDD. PFT was assessed using spirometry and diaphragm mobility using m‐mode ultrasound analysis. Spontaneous sputum samples were collected before and after using the BDD and analyzed for microstructure and DNA concentrations. Results PFT parameters (FEV 1 , FVC, MEF25/50/75) were not affected by the use of the BDD. Ultrasound analysis of diaphragm mobility revealed an increase in maximum diaphragm excursion upon the intervention. Mucus analysis demonstrated altered microstructure and higher DNA concentrations collected after using the BDD compared to samples collected before. Pearson correlation analysis showed significant correlations between changes in mucus properties and DNA levels in respective mucus samples. Conclusion Our results demonstrate that the novel BDD improves diaphragm mobility and alters sputum properties in subjects with CF. The novel BDD with unique properties may be further studied as a device in CF‐specific physiotherapy to facilitate sputum mobilization of CF patients.

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Ultrasound Imaging for Diaphragm Dysfunction: A Narrative Literature Review

Cited by 89 publications

References 80 publications

Mechanical ventilation weaning issues can be counted on the fingers of just one hand: part 1

Mechanical ventilation weaning issues can be counted on the fingers of just one hand: part 1

Mechanical ventilation weaning issues can be counted on the fingers of just one hand: part 2

Short‐term effects of a novel bronchial drainage device: A pilot cohort study in subjects with cystic fibrosis

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