Diaphragm ultrasonography to estimate the work of breathing during non-invasive ventilation
Purpose Ultrasonography allows the direct observation of the diaphragm. Its thickness variation measured in the zone of apposition has been previously used to diagnose diaphragm paralysis. We assessed the feasibility and accuracy of this method to assess diaphragmatic function and its contribution t...
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| Published in: | Intensive care medicine Vol. 38; no. 5; pp. 796 - 803 |
|---|---|
| Main Authors: | , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
Berlin/Heidelberg
Springer-Verlag
01.05.2012
Springer Springer Nature B.V |
| Subjects: | |
| ISSN: | 0342-4642, 1432-1238, 1432-1238 |
| Online Access: | Get full text |
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| Abstract | Purpose
Ultrasonography allows the direct observation of the diaphragm. Its thickness variation measured in the zone of apposition has been previously used to diagnose diaphragm paralysis. We assessed the feasibility and accuracy of this method to assess diaphragmatic function and its contribution to respiratory workload in critically ill patients under non-invasive ventilation.
Methods
This was a preliminary physiological study in the intensive care unit of a university hospital. Twelve patients requiring planned non-invasive ventilation after extubation were studied while spontaneously breathing and during non-invasive ventilation at three levels of pressure support (5, 10 and 15 cmH
2
O). Diaphragm thickness was measured in the zone of apposition during tidal ventilation and the thickening fraction (TF) was calculated as (thickness at inspiration − thickness at expiration)/thickness at expiration. Diaphragmatic pressure–time product per breath (PTP
di
) was measured from oesophageal and gastric pressure recordings.
Results
PTP
di
and TF both decreased as the level of pressure support increased. A significant correlation was found between PTP
di
and TF (ρ = 0.74,
p
< 0.001). The overall reproducibility of TF assessment was good but the coefficient of repeatability reached 18 % for inter-observer reproducibility.
Conclusions
Ultrasonographic assessment of the diaphragm TF is a non-invasive method that may prove useful in evaluating diaphragmatic function and its contribution to respiratory workload in intensive care unit patients. |
|---|---|
| AbstractList | Purpose
Ultrasonography allows the direct observation of the diaphragm. Its thickness variation measured in the zone of apposition has been previously used to diagnose diaphragm paralysis. We assessed the feasibility and accuracy of this method to assess diaphragmatic function and its contribution to respiratory workload in critically ill patients under non-invasive ventilation.
Methods
This was a preliminary physiological study in the intensive care unit of a university hospital. Twelve patients requiring planned non-invasive ventilation after extubation were studied while spontaneously breathing and during non-invasive ventilation at three levels of pressure support (5, 10 and 15 cmH
2
O). Diaphragm thickness was measured in the zone of apposition during tidal ventilation and the thickening fraction (TF) was calculated as (thickness at inspiration − thickness at expiration)/thickness at expiration. Diaphragmatic pressure–time product per breath (PTP
di
) was measured from oesophageal and gastric pressure recordings.
Results
PTP
di
and TF both decreased as the level of pressure support increased. A significant correlation was found between PTP
di
and TF (ρ = 0.74,
p
< 0.001). The overall reproducibility of TF assessment was good but the coefficient of repeatability reached 18 % for inter-observer reproducibility.
Conclusions
Ultrasonographic assessment of the diaphragm TF is a non-invasive method that may prove useful in evaluating diaphragmatic function and its contribution to respiratory workload in intensive care unit patients. Ultrasonography allows the direct observation of the diaphragm. Its thickness variation measured in the zone of apposition has been previously used to diagnose diaphragm paralysis. We assessed the feasibility and accuracy of this method to assess diaphragmatic function and its contribution to respiratory workload in critically ill patients under non-invasive ventilation. This was a preliminary physiological study in the intensive care unit of a university hospital. Twelve patients requiring planned non-invasive ventilation after extubation were studied while spontaneously breathing and during non-invasive ventilation at three levels of pressure support (5, 10 and 15 cmH.sub.2O). Diaphragm thickness was measured in the zone of apposition during tidal ventilation and the thickening fraction (TF) was calculated as (thickness at inspiration - thickness at expiration)/thickness at expiration. Diaphragmatic pressure-time product per breath (PTP.sub.di) was measured from oesophageal and gastric pressure recordings. PTP.sub.di and TF both decreased as the level of pressure support increased. A significant correlation was found between PTP.sub.di and TF ([rho] = 0.74, p < 0.001). The overall reproducibility of TF assessment was good but the coefficient of repeatability reached 18 % for inter-observer reproducibility. Ultrasonographic assessment of the diaphragm TF is a non-invasive method that may prove useful in evaluating diaphragmatic function and its contribution to respiratory workload in intensive care unit patients. Ultrasonography allows the direct observation of the diaphragm. Its thickness variation measured in the zone of apposition has been previously used to diagnose diaphragm paralysis. We assessed the feasibility and accuracy of this method to assess diaphragmatic function and its contribution to respiratory workload in critically ill patients under non-invasive ventilation. This was a preliminary physiological study in the intensive care unit of a university hospital. Twelve patients requiring planned non-invasive ventilation after extubation were studied while spontaneously breathing and during non-invasive ventilation at three levels of pressure support (5, 10 and 15 cmH(2)O). Diaphragm thickness was measured in the zone of apposition during tidal ventilation and the thickening fraction (TF) was calculated as (thickness at inspiration - thickness at expiration)/thickness at expiration. Diaphragmatic pressure-time product per breath (PTP(di)) was measured from oesophageal and gastric pressure recordings. PTP(di) and TF both decreased as the level of pressure support increased. A significant correlation was found between PTP(di) and TF (ρ = 0.74, p < 0.001). The overall reproducibility of TF assessment was good but the coefficient of repeatability reached 18% for inter-observer reproducibility. Ultrasonographic assessment of the diaphragm TF is a non-invasive method that may prove useful in evaluating diaphragmatic function and its contribution to respiratory workload in intensive care unit patients. Ultrasonography allows the direct observation of the diaphragm. Its thickness variation measured in the zone of apposition has been previously used to diagnose diaphragm paralysis. We assessed the feasibility and accuracy of this method to assess diaphragmatic function and its contribution to respiratory workload in critically ill patients under non-invasive ventilation.PURPOSEUltrasonography allows the direct observation of the diaphragm. Its thickness variation measured in the zone of apposition has been previously used to diagnose diaphragm paralysis. We assessed the feasibility and accuracy of this method to assess diaphragmatic function and its contribution to respiratory workload in critically ill patients under non-invasive ventilation.This was a preliminary physiological study in the intensive care unit of a university hospital. Twelve patients requiring planned non-invasive ventilation after extubation were studied while spontaneously breathing and during non-invasive ventilation at three levels of pressure support (5, 10 and 15 cmH(2)O). Diaphragm thickness was measured in the zone of apposition during tidal ventilation and the thickening fraction (TF) was calculated as (thickness at inspiration - thickness at expiration)/thickness at expiration. Diaphragmatic pressure-time product per breath (PTP(di)) was measured from oesophageal and gastric pressure recordings.METHODSThis was a preliminary physiological study in the intensive care unit of a university hospital. Twelve patients requiring planned non-invasive ventilation after extubation were studied while spontaneously breathing and during non-invasive ventilation at three levels of pressure support (5, 10 and 15 cmH(2)O). Diaphragm thickness was measured in the zone of apposition during tidal ventilation and the thickening fraction (TF) was calculated as (thickness at inspiration - thickness at expiration)/thickness at expiration. Diaphragmatic pressure-time product per breath (PTP(di)) was measured from oesophageal and gastric pressure recordings.PTP(di) and TF both decreased as the level of pressure support increased. A significant correlation was found between PTP(di) and TF (ρ = 0.74, p < 0.001). The overall reproducibility of TF assessment was good but the coefficient of repeatability reached 18% for inter-observer reproducibility.RESULTSPTP(di) and TF both decreased as the level of pressure support increased. A significant correlation was found between PTP(di) and TF (ρ = 0.74, p < 0.001). The overall reproducibility of TF assessment was good but the coefficient of repeatability reached 18% for inter-observer reproducibility.Ultrasonographic assessment of the diaphragm TF is a non-invasive method that may prove useful in evaluating diaphragmatic function and its contribution to respiratory workload in intensive care unit patients.CONCLUSIONSUltrasonographic assessment of the diaphragm TF is a non-invasive method that may prove useful in evaluating diaphragmatic function and its contribution to respiratory workload in intensive care unit patients. Purpose Ultrasonography allows the direct observation of the diaphragm. Its thickness variation measured in the zone of apposition has been previously used to diagnose diaphragm paralysis. We assessed the feasibility and accuracy of this method to assess diaphragmatic function and its contribution to respiratory workload in critically ill patients under non-invasive ventilation. Methods This was a preliminary physiological study in the intensive care unit of a university hospital. Twelve patients requiring planned non-invasive ventilation after extubation were studied while spontaneously breathing and during non-invasive ventilation at three levels of pressure support (5, 10 and 15 cmH.sub.2O). Diaphragm thickness was measured in the zone of apposition during tidal ventilation and the thickening fraction (TF) was calculated as (thickness at inspiration - thickness at expiration)/thickness at expiration. Diaphragmatic pressure-time product per breath (PTP.sub.di) was measured from oesophageal and gastric pressure recordings. Results PTP.sub.di and TF both decreased as the level of pressure support increased. A significant correlation was found between PTP.sub.di and TF ([rho] = 0.74, p < 0.001). The overall reproducibility of TF assessment was good but the coefficient of repeatability reached 18 % for inter-observer reproducibility. Conclusions Ultrasonographic assessment of the diaphragm TF is a non-invasive method that may prove useful in evaluating diaphragmatic function and its contribution to respiratory workload in intensive care unit patients. PurposeUltrasonography allows the direct observation of the diaphragm. Its thickness variation measured in the zone of apposition has been previously used to diagnose diaphragm paralysis. We assessed the feasibility and accuracy of this method to assess diaphragmatic function and its contribution to respiratory workload in critically ill patients under non-invasive ventilation.MethodsThis was a preliminary physiological study in the intensive care unit of a university hospital. Twelve patients requiring planned non-invasive ventilation after extubation were studied while spontaneously breathing and during non-invasive ventilation at three levels of pressure support (5, 10 and 15 cmH2O). Diaphragm thickness was measured in the zone of apposition during tidal ventilation and the thickening fraction (TF) was calculated as (thickness at inspiration − thickness at expiration)/thickness at expiration. Diaphragmatic pressure–time product per breath (PTPdi) was measured from oesophageal and gastric pressure recordings.ResultsPTPdi and TF both decreased as the level of pressure support increased. A significant correlation was found between PTPdi and TF (ρ = 0.74, p < 0.001). The overall reproducibility of TF assessment was good but the coefficient of repeatability reached 18 % for inter-observer reproducibility.ConclusionsUltrasonographic assessment of the diaphragm TF is a non-invasive method that may prove useful in evaluating diaphragmatic function and its contribution to respiratory workload in intensive care unit patients. |
| Audience | Academic |
| Author | Thille, Arnaud W. Vargas, Frederic Vivier, Emmanuel Lyazidi, Aissam Dimassi, Saoussen Mekontso Dessap, Armand Brochard, Laurent |
| Author_xml | – sequence: 1 givenname: Emmanuel surname: Vivier fullname: Vivier, Emmanuel organization: AP-HP, Service de Réanimation Médicale, Centre Hospitalo-Universitaire Henri Mondor, Faculté de Médecine, Université Paris Est Créteil, Réanimation Polyvalente, Centre Hospitalier Saint Joseph Saint – sequence: 2 givenname: Armand surname: Mekontso Dessap fullname: Mekontso Dessap, Armand email: armand.dessap@hmn.aphp.fr organization: AP-HP, Service de Réanimation Médicale, Centre Hospitalo-Universitaire Henri Mondor, Faculté de Médecine, Université Paris Est Créteil, Unité U955 (IMRB), INSERM – sequence: 3 givenname: Saoussen surname: Dimassi fullname: Dimassi, Saoussen organization: AP-HP, Service de Réanimation Médicale, Centre Hospitalo-Universitaire Henri Mondor, Unité U955 (IMRB), INSERM – sequence: 4 givenname: Frederic surname: Vargas fullname: Vargas, Frederic organization: AP-HP, Service de Réanimation Médicale, Centre Hospitalo-Universitaire Henri Mondor, Unité U955 (IMRB), INSERM – sequence: 5 givenname: Aissam surname: Lyazidi fullname: Lyazidi, Aissam organization: AP-HP, Service de Réanimation Médicale, Centre Hospitalo-Universitaire Henri Mondor, Unité U955 (IMRB), INSERM – sequence: 6 givenname: Arnaud W. surname: Thille fullname: Thille, Arnaud W. organization: AP-HP, Service de Réanimation Médicale, Centre Hospitalo-Universitaire Henri Mondor, Unité U955 (IMRB), INSERM – sequence: 7 givenname: Laurent surname: Brochard fullname: Brochard, Laurent organization: AP-HP, Service de Réanimation Médicale, Centre Hospitalo-Universitaire Henri Mondor, Faculté de Médecine, Université Paris Est Créteil, Unité U955 (IMRB), INSERM, Soins Intensifs, Hôpitaux Universitaires de Genève et Université de Genève |
| BackLink | http://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25845297$$DView record in Pascal Francis https://www.ncbi.nlm.nih.gov/pubmed/22476448$$D View this record in MEDLINE/PubMed |
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Ultrasonography allows the direct observation of the diaphragm. Its thickness variation measured in the zone of apposition has been previously used to... Ultrasonography allows the direct observation of the diaphragm. Its thickness variation measured in the zone of apposition has been previously used to diagnose... Purpose Ultrasonography allows the direct observation of the diaphragm. Its thickness variation measured in the zone of apposition has been previously used to... PurposeUltrasonography allows the direct observation of the diaphragm. Its thickness variation measured in the zone of apposition has been previously used to... |
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| SubjectTerms | Aged Aged, 80 and over Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Anesthesiology Biological and medical sciences Chronic obstructive pulmonary disease Critical Care Medicine Diaphragm - diagnostic imaging Diaphragm - physiology Emergency and intensive respiratory care Emergency Medicine Extubation Feasibility Studies Female France Hospital patients Hospitals, University Humans Intensive Intensive care Intensive care medicine Intensive Care Units Male Medical sciences Medicine Medicine & Public Health Monitoring, Physiologic Original Ostomy Pain Medicine Pediatrics Physiological aspects Pneumology/Respiratory System Positive-Pressure Respiration Reproducibility Respiratory failure Ultrasonic imaging Ultrasonography Ultrasound imaging Ventilators Weaning Work of Breathing - physiology Workloads |
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| Title | Diaphragm ultrasonography to estimate the work of breathing during non-invasive ventilation |
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