Lucie Fenet Mariani1, Jêrome Bedel2, Antoine Gros2, Nicolas Lerolle3, Kolia Milojevic4, Virgine Laurent2, Julia Hilly2, Gilles Troché2, Jean Pierre Bedos2, Benjamin Planquette5. 1. Service de réanimation polyvalente, Versailles-Le Chesnay, France luciefenet84@gmail.com. 2. Service de réanimation polyvalente, Versailles-Le Chesnay, France. 3. Réanimation Médicale et Médicine Hyperbare, Centre Hospitalier Universitaire Angers, Faculté de Médecine, Université d'Angers, Angers, France. 4. SAMU 78 SMUR de Versailles, Le Chesnay, France. 5. Service de réanimation polyvalente, Versailles-Le Chesnay, France Service de pneumologie et de soins intensifs, Hôpital Européen Georges Pompidou-20 rue Leblanc, 75015 Paris, France.
Abstract
PURPOSE: Reversibility and impact of diaphragmatic dysfunction (DD) are unknown. The principal aim was to describe diaphragmatic function as assessed by ultrasonography during weaning trials. MATERIALS AND METHODS: The present study is a 6-month single-center prospective study. All patients under mechanical ventilation for more than 7 days and eligible for a spontaneous breathing trial (SBT) were enrolled prospectively. INTERVENTION: Two blinded ultrasonographers evaluated each hemidiaphragm during SBT. Prevalence of DD among weaning failure and death and interobserver reproducibility have been evaluated. RESULTS: The 34 included patients had a mean Simplified Acute Physiology Score version II of 55.7 ± 14 and a median intensive care unit (ICU) stay length of 17 days (13-30). Diaphragmatic dysfunction was found in 13 (38%) patients, on both sides in 8. Bilateral DD resolved before ICU discharge in 5 of the 7 reevaluated patients. No weaning failures were recorded. The ICU mortality was higher in patients with DD (37% vs 5%, P = .048). Mean interobserver agreement rate was 91%. Reproducibility was better with M-mode. CONCLUSION: The ICU-acquired DD usually improves before ICU discharge but might constitute a marker for greater disease severity. The present preliminary results require confirmation in a larger prospective multicenter study.
PURPOSE: Reversibility and impact of diaphragmatic dysfunction (DD) are unknown. The principal aim was to describe diaphragmatic function as assessed by ultrasonography during weaning trials. MATERIALS AND METHODS: The present study is a 6-month single-center prospective study. All patients under mechanical ventilation for more than 7 days and eligible for a spontaneous breathing trial (SBT) were enrolled prospectively. INTERVENTION: Two blinded ultrasonographers evaluated each hemidiaphragm during SBT. Prevalence of DD among weaning failure and death and interobserver reproducibility have been evaluated. RESULTS: The 34 included patients had a mean Simplified Acute Physiology Score version II of 55.7 ± 14 and a median intensive care unit (ICU) stay length of 17 days (13-30). Diaphragmatic dysfunction was found in 13 (38%) patients, on both sides in 8. Bilateral DD resolved before ICU discharge in 5 of the 7 reevaluated patients. No weaning failures were recorded. The ICU mortality was higher in patients with DD (37% vs 5%, P = .048). Mean interobserver agreement rate was 91%. Reproducibility was better with M-mode. CONCLUSION: The ICU-acquired DD usually improves before ICU discharge but might constitute a marker for greater disease severity. The present preliminary results require confirmation in a larger prospective multicenter study.
Authors: Christie L Glau; Thomas W Conlon; Adam S Himebauch; Nadir Yehya; Scott L Weiss; Robert A Berg; Akira Nishisaki Journal: Pediatr Crit Care Med Date: 2018-05 Impact factor: 3.624
Authors: Pieter R Tuinman; Annemijn H Jonkman; Martin Dres; Zhong-Hua Shi; Ewan C Goligher; Alberto Goffi; Chris de Korte; Alexandre Demoule; Leo Heunks Journal: Intensive Care Med Date: 2020-01-14 Impact factor: 17.440