Ultrasound assessment of the diaphragm during the first days of mechanical ventilation compared to spontaneous respiration: a comparative study
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Abstract
Introduction: In critically ill patients, the diaphragm is subject to several aggressions mainly those induced by mechanical ventilation (MV). Currently, diaphragmatic ultrasound has become the most useful bedside for the clinician to evaluate diaphragm contractility.
Aim: To examine the effects of MV on the diaphragm contractility during the first days of ventilation.
Methods: Two groups of subjects were studied: a study group (n=30) of adults receiving MV versus a control group (n=30) of volunteers on spontaneous ventilation (SV). Using an ultrasound device, we compared the diaphragmatic thickening fraction (DTF). Secondly, we analysed the relationship between DTF and weaning.
Results: comparatively to SV group, patients of MV group have a higher end expiratory diameter (EED) (2.09 ± 0.6 vs. 1.76 ± 0.32 mm, p=0.01) and a lower DTF (39.9 ± 12.5% vs. 49.0 ± 20.5%, p=0.043). Fourteen among the 30 ventilated patients successfully weaned. No significant correlation was shown between DTF and weaning duration (Rho= - 0.464, p=0.09). A DTF value > 33% was near to be significantly associated with weaning success (OR=2; 95% CI= [1.07-3.7], p=0.05) with a sensitivity at 85.7%.
Conclusions: diaphragmatic contractility was altered from the first days of MV. A DTF value >32,7% was associated to the weaning success and that may be useful to predict successful weaning with sensitivity at 85.7%.
Keywords:
Respiratory mechanics, ultrasound, inspiratory muscle, ICU, weaning##plugins.themes.academic_pro.article.details##
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
- 1. Zhou C, Wu L, Ni F, Ji W, Wu J, Zhang H. Critical illness polyneuropathy and myopathy: a systematic review. Neural Regen Res. 2014;9(1):101-10. 2. Dekhuijzen PN, Gayan-Ramirez G, Bisschop A, De Bock V, Dom R, Decramer M. Corticosteroid treatment and nutritional deprivation cause a different pattern of atrophy in rat diaphragm. J Appl Physiol. 1995;78:629-37. 3. Dres M, Demoule A. Diaphragm dysfunction during weaning from mechanical ventilation: an underestimated phenomenon with clinical implications. Crit Care. 2018;22:73. 4. Jung B, Moury PH, Mahul M, de Jong A, Galia F, Prades A, et al. Diaphragmatic dysfunction in patients with ICU-acquired weakness and its impact on extubation failure. Intensive Care Med. 2016;42(5):853 61. 5. Dres M, Dubé BP, Mayaux J, Delemazure J, Reuter D, Brochard L, et al. Coexistence and impact of limb muscle and diaphragm weakness at time of liberation from mechanical ventilation in medical intensive care unit patients. Am J Respir Crit Care Med. 2017;195(1):57 66 6. Dubé BP, Dres M, Mayaux J, Demiri S, Similowski T, Demoule A. Ultrasound evaluation of diaphragm function in mechanically ventilated patients: comparison to phrenic stimulation and prognostic implications. Thorax. 2017;72:811-8. 7. Jaber S, Petrof BJ, Jung B, Chanques G, Berthet JP, Rabuel C, et al. Rapidly progressive diaphragmatic weakness and injury during mechanical ventilation in humans. Am J Respir Crit Care Med. 2011;183:364-71. 8. Peñuelas O, Keough E, López-RodrÃguez L, Carriedo D, Gonçalves G, Barreiro E, al. Ventilator-induced diaphragm dysfunction: translational mechanisms lead to therapeutical alternatives in the critically ill. Intensive Care Med Exp. 2019;25(7):48. 9. Whidden MA, Smuder AJ, Wu M, Hudson MB, Nelson WB, Powers SK. Oxidative stress is required for mechanical ventilation-induced protease activation in the diaphragm. J Appl Physiol. 2010;108:1376-82. 10. Falk DJ, Kavazis AN, Whidden MA, Smuder AJ, McClung JM, Hudson MB, et al. Mechanical ventilation-induced oxidative stress in the diaphragm: role of heme oxygenase-1. Chest. 2011;139:816-24. 11. Picard M, Jung B, Liang F, Azuelos I, Hussain S, Goldberg P, et al. Mitochondrial dysfunction and lipid accumulation in the human diaphragm during mechanical ventilation. Am J Respir Crit Care Med. 2010;186:1140-9. 12. Tang H, Shrager JB. The signalling network resulting in ventilator-induced diaphragm dysfunction. Am J Respir Cell Mol Biol. 2018;59(4):417-427. 13. Boussuges A, Gole Y, Blanc P. Diaphragmatic Motion Studied by M-Mode Ultrasonography methods, reproducibility, and normal values. Chest. 2009;135(2) :391-400. 14. Houston JG, Fleet M, Cowan MD, McMillan NC. Comparison of ultrasound with fluoroscopy in the assessment of suspected hemidiaphragmatic movement abnormality. Clin Radiol. 1995; 50(2):95-8. 15. Ueki J, De Bruin PF, Pride NB. In vivo assessment of diaphragm contraction by ultrasound in normal subjects. Thorax. 1995; 50(11):1157-61. 16. Patel A, Lall CG, Jennings SG, Sandrasegaran K. Abdominal compartment syndrome. AJR Am J Roentgenol. 2007;189(5):1037-43. 17. Trifi A, Abdellatif S, Abdennebi C, Daly F, Touil Y, Ben Lakhal S. Ultrasound variations of diaphragm activity between prone position versus supine position in ventilated patients: a cross‑sectional comparative study. J. Ultrasound. 2020;1:1-9. 18. Sarwal A, Walker FO, Cartwright MS. Neuromuscular ultrasound for evaluation of the diaphragm. Muscle Nerve. 2013;47(3):319-29. 19. Zambon M, Greco M, Bocchino S, Cabrini L, Beccaria PF, Zangrillo A. Assessment of diaphragmatic dysfunction in the critically ill patient with ultrasound: a systematic review. Intensive Care Med. 2017;43(1):29-38. 20. Matamis D, Soilemezi E, Tsagourias M, Akoumianaki E, Dimassi D, Boroli F, et al. Sonographic evaluation of the diaphragm in critically ill patients. Technique and clinical applications. Intensive Care Med. 2013;39:801-10. 21. Goligher EC, Laghi F, Detsky ME, Farias P, Murray A, Brace D, et al. Measuring diaphragm thickness with ultrasound in mechanically ventilated patients: feasibility, reproducibility and validity. Intensive Care Med. 2015;41:642-9. 22. Vivier E, Mekontso Dessap A, Dimassi S, Vargas F, Lyazidi A, Thille AW, Brochard L. Diaphragm ultrasonography to estimate the work of breathing during non-invasive ventilation. Intensive Care Med. 2012;38:796-803. 23. Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA. 1993;270(24):2957-63. 24. Bahtouee M, Eghbali SS, Maleki N, Rastgou V, Motamed N. Acute Physiology and Chronic Health Evaluation II score for the assessment of mortality prediction in the intensive care unit: a single-centre study from Iran. Nurs Crit Care. 2019;24(6):375-80. 25. Vincent JL, de Mendonça A, Cantraine F, Moreno R, Takala J, Suter PM, et al. Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on "sepsis-related problems" of the European Society of Intensive Care Medicine. Crit Care Med. 1998;26(11):1793-800. 26. Jung B, Nougaret S, Conseil M, Coisel Y, Futier E, Chanques G, et al. Sepsis is associated with a preferential diaphragmatic atrophy: a critically ill patient study using tridimensional computed tomography. Anesthesiology. 2014;120(5):1182 91. 27. Michelet P, Carreira S, Demoule A, Amour J, Langeron O, Riou B, et al. Effects of acute respiratory and metabolic acidosis on diaphragm muscle obtained from rats. Anesthesiology. 2015;122(4):876 83. 28. Callahan LA, Supinski GS. Hyperglycemia-induced diaphragm weakness is mediated by oxidative stress. Crit Care. 2014;18(3):R88. 29. Lerolle N, Guérot E, Dimassi S, Zegdi R, Faisy C, Fagon JY, et al. Ultrasonographic diagnostic criterion for severe diaphragmatic dysfunction after cardiac surgery. Chest. 2009;135(2):401-7. 30. Demoule A, Jung B, Prodanovic H, Molinari N, Chanques G, Coirault C et al. Diaphragm dysfunction on admission to the intensive care unit. Prevalence, risk factors, and prognostic impact-a prospective study. Am J Respir Crit Care Med. 2013;188(2):213-9. 31. Kim WY, Suh HJ, Hong SB, Koh Y, Lim CM. Diaphragm dysfunction assessed by ultrasonography: Influence on weaning from mechanical ventilation. Crit Care Med. 2011;39(12):2627 30. 32. Jiang JR, Tsai TH, Jerng JS, Yu CJ, Wu HD, Yang P-C. Ultrasonographic evaluation of liver/spleen movements and extubation outcome. Chest. 2004;126(1):179 85. 33. DiNino E, Gartman EJ, Sethi JM, McCool FD. Diaphragm ultrasound as a predictor of successful extubation from mechanical ventilation. Thorax. 2014;69(5):431 5. 34. Watson AC, Hughes PD, Louise Harris M, Hart N, Ware RJ, Wendon J, et al. Measurement of twitch transdiaphragmatic, esophageal, and endotracheal tube pressure with bilateral anterolateral magnetic phrenic nerve stimulation in patients in the intensive care unit. Crit Care Med. 2001;29(7):1325 31. 35. Laghi F, Cattapan SE, Jubran A, Parthasarathy S, Warshawsky P, Choi Y-SA, et al. Is weaning failure caused by low-frequency fatigue of the diaphragm? Am J Respir Crit Care Med. 2003;167(2):120 7. 36. Supinski GS, Ann Callahan L. Diaphragm weakness in mechanically ventilated critically ill patients. Crit Care. 2013;17(3):R120. 37. Shanely RA, Van Gammeren D, Deruisseau KC, Zergeroglu AM, McKenzie MJ, Yarasheski KE, et al. Mechanical ventilation depresses protein synthesis in the rat diaphragm. Am J Respir Crit Care Med. 2004;170(9): 994-9. 38. Sassoon CSH, Caiozzo VJ, Manka A, Sieck GC. Altered diaphragm contractile properties with controlled mechanical ventilation. J Appl Physiol. 2002;92(6):258525 95. 39. Jung B, Constantin J-M, Rossel N, Le Goff C, Sebbane M, Coisel Y, et al. Adaptive support ventilation prevents ventilator-induced diaphragmatic dysfunction in piglet: an in vivo and in vitro study. Anesthesiology. 2010;112(6):1435 43. 40. Grosu HB, Lee YI, Lee J, Eden E, Eikermann M, Rose KM. Diaphragm muscle thinning in patients who are mechanically ventilated. Chest. 2012;142(6):1455 60. 41. Tobin MJ. Narrative Review: Ventilator-induced respiratory muscle weakness. Ann Intern Med. 2010;153(4):240. 42. Goligher EC, Dres M, Fan E, Rubenfeld GD, Scales DC, Herridge MS, et al. Mechanical ventilation-induced diaphragm atrophy strongly impacts clinical outcomes. Am J Respir Crit Care Med. 2018;197(2):204 13. 43. Boon AJ, Harper CJ, Ghahfarokhi LS, Strommen JA, Watson JC, Sorenson EJ. Two-dimensional ultrasound imaging of the diaphragm: quantitative values in normal subjects. Muscle Nerve. 2013;47(6):884 9. 44. Summerhill EM, El-Sameed YA, Glidden TJ, McCool FD. Monitoring recovery from diaphragm paralysis with ultrasound. Chest. 2008;133(3):737 43. 45. Zambon M, Beccaria P, Matsuno J, Gemma M, Frati E, Colombo S, et al. Mechanical ventilation and diaphragmatic atrophy in critically ill patients. Crit Care Med. 2016;44(7):1347-52. 46. Brown C, Tseng SC, Mitchell K, Roddey T. Body position affects ultrasonographic measurement of diaphragm contractility. Cardiopulm Phys Ther J. 2018;29(4):166-72. 47. Goligher EC, Fan E, Herridge MS, Murray A, Vorona S, Brace D, et al. Evolution of diaphragm thickness during mechanical ventilation. Impact of inspiratory effort. Am J Respir Crit Care Med. 2015;192(9):1080-8. 48. Farghaly S, Hasan AA. Diaphragm ultrasound as a new method to predict extubation outcome in mechanically ventilated patients. Aust Crit Care. 2017;30(1):37 43. 49. Blumhof S, Wheeler D, Thomas K, McCool FD, Mora J. Change in diaphragmatic thickness during the respiratory cycle predicts extubation success at various levels of pressure support Ventilation. Lung. 2016;194(4):519 25. 50. Ferrari G, De Filippi G, Elia F, Panero F, Volpicelli G, Aprà F. Diaphragm ultrasound as a new index of discontinuation from mechanical ventilation. Crit Ultrasound J. 2014;6(1):8. 51. Thurlbeck WM. Diaphragm and body weight in emphysema. Thorax. 1978;33(4):483-7. 52. Harper CJ, Shahgholi L, Cieslak K, Hellyer NJ, Strommen JA, Boon AJ. Variability in diaphragm motion during normal breathing, assessed with B-mode ultrasound. J Orthop Sports Phys Ther. 2013;43(12):927-31.