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01.04.2015 | Original

Measuring diaphragm thickness with ultrasound in mechanically ventilated patients: feasibility, reproducibility and validity

verfasst von: Ewan C. Goligher, Franco Laghi, Michael E. Detsky, Paulina Farias, Alistair Murray, Deborah Brace, Laurent J. Brochard, Steffen Sebastien-Bolz, Gordon D. Rubenfeld, Brian P. Kavanagh, Niall D. Ferguson

Erschienen in: Intensive Care Medicine | Ausgabe 4/2015

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Abstract

Purpose

Ultrasound measurements of diaphragm thickness (T _di) and thickening (TF_di) may be useful to monitor diaphragm activity and detect diaphragm atrophy in mechanically ventilated patients. We aimed to establish the reproducibility of measurements in ventilated patients and determine whether passive inflation by the ventilator might cause thickening apart from inspiratory effort.

Methods

Five observers measured T _di and TF_di in 96 mechanically ventilated patients. The probe site was marked in 66 of the 96 patients. TF_di was measured at peak and end-inspiration (airway occluded and diaphragm relaxed) in nine healthy volunteers inhaling to varying lung volumes. The association with diaphragm electrical activity was quantified.

Results

Right hemidiaphragm thickness was obtained on 95 % of attempts; left hemidiaphragm measurements could not be obtained consistently. Right hemidiaphragm thickness measurements were highly reproducible (mean ± SD 2.4 ± 0.8 mm, repeatability coefficient 0.2 mm, reproducibility coefficient 0.4 mm), particularly after marking the location of the probe. TF_di measurements were only moderately reproducible (median 11 %, IQR 3–17 %, repeatability coefficient 17 %, reproducibility coefficient 16 %). TF_di and diaphragm electrical activity were positively correlated, r ² = 0.32, p < 0.01). At inspiratory volumes below 50 % of inspiratory capacity, passive inflation did not cause diaphragm thickening. TF_di was considerably lower in patients on either partially assisted or controlled ventilation compared to healthy subjects (median 11 vs. 35 %, p < 0.001).

Conclusions

Ultrasound measurements of right hemidiaphragm thickness are feasible and highly reproducible in ventilated patients. At clinically relevant inspiratory volumes, diaphragm thickening reflects muscular contraction and not passive inflation. This technique can be reliably employed to monitor diaphragm thickness, activity, and function during mechanical ventilation.

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Titel: Measuring diaphragm thickness with ultrasound in mechanically ventilated patients: feasibility, reproducibility and validity
verfasst von: Ewan C. Goligher
Franco Laghi
Michael E. Detsky
Paulina Farias
Alistair Murray
Deborah Brace
Laurent J. Brochard
Steffen Sebastien-Bolz
Gordon D. Rubenfeld
Brian P. Kavanagh
Niall D. Ferguson
Publikationsdatum: 01.04.2015
Verlag: Springer Berlin Heidelberg
Erschienen in: Intensive Care Medicine / Ausgabe 4/2015
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-015-3687-3

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Measuring diaphragm thickness with ultrasound in mechanically ventilated patients: feasibility, reproducibility and validity