nach oben

Erschienen in:

01.05.2012 | Original

Diaphragm ultrasonography to estimate the work of breathing during non-invasive ventilation

verfasst von: Emmanuel Vivier, Armand Mekontso Dessap, Saoussen Dimassi, Frederic Vargas, Aissam Lyazidi, Arnaud W. Thille, Laurent Brochard

Erschienen in: Intensive Care Medicine | Ausgabe 5/2012

Einloggen, um Zugang zu erhalten

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 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 (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.

Nur mit Berechtigung zugänglich

Roussos C, Macklem PT (1982) The respiratory muscles. N Engl J Med 307:786–797PubMedCrossRef

Tobin MJ, Laghi F, Brochard L (2009) Role of the respiratory muscles in acute respiratory failure of COPD: lessons from weaning failure. J Appl Physiol 107:962–970PubMedCrossRef

Anzueto A, Peters JI, Tobin MJ, de los Santos R, Seidenfeld JJ, Moore G, Cox WJ, Coalson JJ (1997) Effects of prolonged controlled mechanical ventilation on diaphragmatic function in healthy adult baboons. Crit Care Med 25:1187–1190PubMedCrossRef

Le Bourdelles G, Viires N, Boczkowski J, Seta N, Pavlovic D, Aubier M (1994) Effects of mechanical ventilation on diaphragmatic contractile properties in rats. Am J Respir Crit Care Med 149:1539–1544PubMed

Sassoon CS, Caiozzo VJ, Manka A, Sieck GC (2002) Altered diaphragm contractile properties with controlled mechanical ventilation. J Appl Physiol 92:2585–2595PubMed

Hussain SN, Mofarrahi M, Sigala I, Kim HC, Vassilakopoulos T, Maltais F, Bellenis I, Chaturvedi R, Gottfried SB, Metrakos P, Danialou G, Matecki S, Jaber S, Petrof BJ, Goldberg P (2010) Mechanical ventilation-induced diaphragm disuse in humans triggers autophagy. Am J Respir Crit Care Med 182:1377–1386PubMedCrossRef

Jaber S, Petrof BJ, Jung B, Chanques G, Berthet JP, Rabuel C, Bouyabrine H, Courouble P, Koechlin-Ramonatxo C, Sebbane M, Similowski T, Scheuermann V, Mebazaa A, Capdevila X, Mornet D, Mercier J, Lacampagne A, Philips A, Matecki S (2011) Rapidly progressive diaphragmatic weakness and injury during mechanical ventilation in humans. Am J Respir Crit Care Med 183:364–371PubMedCrossRef

Levine S, Nguyen T, Taylor N, Friscia ME, Budak MT, Rothenberg P, Zhu J, Sachdeva R, Sonnad S, Kaiser LR, Rubinstein NA, Powers SK, Shrager JB (2008) Rapid disuse atrophy of diaphragm fibers in mechanically ventilated humans. N Engl J Med 358:1327–1335PubMedCrossRef

Boles JM, Bion J, Connors A, Herridge M, Marsh B, Melot C, Pearl R, Silverman H, Stanchina M, Vieillard-Baron A, Welte T (2007) Weaning from mechanical ventilation. Eur Respir J 29:1033–1056PubMedCrossRef

10.

Brochard L, Mancebo J, Elliott MW (2002) Noninvasive ventilation for acute respiratory failure. Eur Respir J 19:712–721PubMedCrossRef

11.

American Thoracic Society/European Respiratory Society (2002) ATS/ERS statement on respiratory muscle testing. Am J Respir Crit Care Med 166:518–624

12.

Kim SH, Na S, Choi JS, Na SH, Shin S, Koh SO (2010) An evaluation of diaphragmatic movement by M-mode sonography as a predictor of pulmonary dysfunction after upper abdominal surgery. Anesth Analg 110:1349–1354PubMedCrossRef

13.

Kim WY, Suh HJ, Hong SB, Koh Y, Lim CM (2011) Diaphragm dysfunction assessed by ultrasonography: influence on weaning from mechanical ventilation. Crit Care Med 39:2627–2630PubMedCrossRef

14.

Lerolle N, Guerot E, Dimassi S, Zegdi R, Faisy C, Fagon JY, Diehl JL (2009) Ultrasonographic diagnostic criterion for severe diaphragmatic dysfunction after cardiac surgery. Chest 135:401–407PubMedCrossRef

15.

Wait JL, Nahormek PA, Yost WT, Rochester DP (1989) Diaphragmatic thickness–lung volume relationship in vivo. J Appl Physiol 67:1560–1568PubMed

16.

Gottesman E, McCool FD (1997) Ultrasound evaluation of the paralyzed diaphragm. Am J Respir Crit Care Med 155:1570–1574PubMed

17.

Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829PubMedCrossRef

18.

Ferrer M, Valencia M, Nicolas JM, Bernadich O, Badia JR, Torres A (2006) Early noninvasive ventilation averts extubation failure in patients at risk: a randomized trial. Am J Respir Crit Care Med 173:164–170PubMedCrossRef

19.

Nava S, Gregoretti C, Fanfulla F, Squadrone E, Grassi M, Carlucci A, Beltrame F, Navalesi P (2005) Noninvasive ventilation to prevent respiratory failure after extubation in high-risk patients. Crit Care Med 33:2465–2470PubMedCrossRef

20.

Baydur A, Behrakis PK, Zin WA, Jaeger M, Milic-Emili J (1982) A simple method for assessing the validity of the esophageal balloon technique. Am Rev Respir Dis 126:788–791PubMed

21.

Diehl JL, Lofaso F, Deleuze P, Similowski T, Lemaire F, Brochard L (1994) Clinically relevant diaphragmatic dysfunction after cardiac operations. J Thorac Cardiovasc Surg 107:487–498PubMed

22.

Pepe PE, Marini JJ (1982) Occult positive end-expiratory pressure in mechanically ventilated patients with airflow obstruction: the auto-PEEP effect. Am Rev Respir Dis 126:166–170PubMed

23.

Lessard MR, Lofaso F, Brochard L (1995) Expiratory muscle activity increases intrinsic positive end-expiratory pressure independently of dynamic hyperinflation in mechanically ventilated patients. Am J Respir Crit Care Med 151:562–569PubMed

24.

Thorstensen A, Dalen H, Amundsen BH, Aase SA, Stoylen A (2010) Reproducibility in echocardiographic assessment of the left ventricular global and regional function, the HUNT study. Eur J Echocardiogr 11:149–159PubMedCrossRef

25.

Bland JM, Altman DG (1996) Measurement error and correlation coefficients. BMJ 313:41–42PubMedCrossRef

26.

Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310PubMedCrossRef

27.

Field S, Kelly SM, Macklem PT (1982) The oxygen cost of breathing in patients with cardiorespiratory disease. Am Rev Respir Dis 126:9–13PubMed

28.

Grasso S, Puntillo F, Mascia L, Ancona G, Fiore T, Bruno F, Slutsky AS, Ranieri VM (2000) Compensation for increase in respiratory workload during mechanical ventilation. Pressure-support versus proportional-assist ventilation. Am J Respir Crit Care Med 161:819–826PubMed

29.

Jubran A, Grant BJ, Laghi F, Parthasarathy S, Tobin MJ (2005) Weaning prediction: esophageal pressure monitoring complements readiness testing. Am J Respir Crit Care Med 171:1252–1259PubMedCrossRef

30.

Sassoon CS, Light RW, Lodia R, Sieck GC, Mahutte CK (1991) Pressure-time product during continuous positive airway pressure, pressure support ventilation, and T-piece during weaning from mechanical ventilation. Am Rev Respir Dis 143:469–475PubMed

31.

Fried AM, Cosgrove DO, Nassiri DK, McCready VR (1985) The diaphragmatic echo complex: an in vitro study. Invest Radiol 20:62–67PubMedCrossRef

32.

Boussuges A, Gole Y, Blanc P (2009) Diaphragmatic motion studied by m-mode ultrasonography: methods, reproducibility, and normal values. Chest 135:391–400PubMedCrossRef

33.

Harris RS, Giovannetti M, Kim BK (1983) Normal ventilatory movement of the right hemidiaphragm studied by ultrasonography and pneumotachography. Radiology 146:141–144PubMed

34.

Houston JG, Fleet M, Cowan MD, McMillan NC (1995) Comparison of ultrasound with fluoroscopy in the assessment of suspected hemidiaphragmatic movement abnormality. Clin Radiol 50:95–98PubMedCrossRef

35.

Cohn D, Benditt JO, Eveloff S, McCool FD (1997) Diaphragm thickening during inspiration. J Appl Physiol 83:291–296PubMed

36.

Ueki J, De Bruin PF, Pride NB (1995) In vivo assessment of diaphragm contraction by ultrasound in normal subjects. Thorax 50:1157–1161PubMedCrossRef

37.

Wait JL, Johnson RL (1997) Patterns of shortening and thickening of the human diaphragm. J Appl Physiol 83:1123–1132PubMed

38.

Summerhill EM, El-Sameed YA, Glidden TJ, McCool FD (2008) Monitoring recovery from diaphragm paralysis with ultrasound. Chest 133:737–743PubMedCrossRef

39.

Khan KS, Chien PF (2001) Evaluation of a clinical test. I. Assessment of reliability. BJOG 108:562–567PubMed

40.

Kramer MS, Feinstein AR (1981) Clinical biostatistics. LIV. The biostatistics of concordance. Clin Pharmacol Ther 29:111–123PubMedCrossRef

41.

Wysocki M, Cracco C, Teixeira A, Mercat A, Diehl JL, Lefort Y, Derenne JP, Similowski T (2006) Reduced breathing variability as a predictor of unsuccessful patient separation from mechanical ventilation. Crit Care Med 34:2076–2083PubMedCrossRef

42.

Loring SH (1994) Three-dimensional reconstruction of the in vivo human diaphragm shape at different lung volumes. J Appl Physiol 76:493–494PubMed

43.

Iwasawa T, Takahashi H, Ogura T, Asakura A, Gotoh T, Shibata H, Inoue T (2011) Influence of the distribution of emphysema on diaphragmatic motion in patients with chronic obstructive pulmonary disease. Jpn J radiol 29:256–264PubMedCrossRef

Titel: Diaphragm ultrasonography to estimate the work of breathing during non-invasive ventilation
verfasst von: Emmanuel Vivier
Armand Mekontso Dessap
Saoussen Dimassi
Frederic Vargas
Aissam Lyazidi
Arnaud W. Thille
Laurent Brochard
Publikationsdatum: 01.05.2012
Verlag: Springer-Verlag
Erschienen in: Intensive Care Medicine / Ausgabe 5/2012
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-012-2547-7

Neu im Fachgebiet AINS

23.04.2024 | Appendizitis | Nachrichten

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

hier abonnieren

Springer Medizin

Diaphragm ultrasonography to estimate the work of breathing during non-invasive ventilation

Abstract

Purpose

Methods

Results

Conclusions

Neu im Fachgebiet AINS

Hinter dieser Appendizitis steckte ein Erreger

Ärztliche Empathie hilft gegen Rückenschmerzen

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

S3-Leitlinie zu Pankreaskrebs aktualisiert

Update AINS

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 5/2012

Relative effects of negative versus positive pressure ventilation depend on applied conditions

Increased unbound drug fraction in acute carbamazepine intoxication: suitability and effectiveness of high-flux haemodialysis

Thirty years of home mechanical ventilation in children: escalating need for pediatric intensive care beds

Asynchrony, neural drive, ventilatory variability and COMFORT: NAVA versus pressure support in pediatric patients. A non-randomized cross-over trial

Contrast-induced acute kidney injury: what is the prevalence of prevention protocols?

Classification of sepsis, severe sepsis and septic shock: the impact of minor variations in data capture and definition of SIRS criteria

Neu im Fachgebiet AINS

Hinter dieser Appendizitis steckte ein Erreger

Ärztliche Empathie hilft gegen Rückenschmerzen

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

S3-Leitlinie zu Pankreaskrebs aktualisiert

Update AINS