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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Bibliographic Details
Published in:Intensive care medicine Vol. 38; no. 5; pp. 796 - 803
Main Authors: Vivier, Emmanuel, Mekontso Dessap, Armand, Dimassi, Saoussen, Vargas, Frederic, Lyazidi, Aissam, Thille, Arnaud W., Brochard, Laurent
Format: Journal Article
Language:English
Published: Berlin/Heidelberg Springer-Verlag 01.05.2012
Springer
Springer Nature B.V
Subjects:
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
France
Ventilation
Ultrasound
Diaphragm
Intensive care
Resuscitation
Echography
ISSN:0342-4642, 1432-1238, 1432-1238
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Summary: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.
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ISSN:0342-4642
1432-1238
1432-1238
DOI:10.1007/s00134-012-2547-7