Zhihua Lu1, Qiuping Xu1, Yuehua Yuan2, Ge Zhang1, Feng Guo1, Huiqing Ge3. 1. Department of Critical Care Medicine. 2. Department of Respiratory Care, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China. 3. Department of Respiratory Care, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China. gehq@zju.edu.cn.
Abstract
BACKGROUND: Diaphragmatic dysfunction is often underdiagnosed and is among the risk factors for failed weaning. The purpose of this study was to determine the prevalence of diaphragmatic dysfunction diagnosed by B-mode ultrasonography and to determine whether prolonged weaning subjects with diaphragmatic dysfunction have increased duration of mechanical ventilation compared with those without diaphragmatic dysfunction. METHODS: This was a prospective observational study in mechanically ventilated subjects who failed ≥3 spontaneous breathing trials or required >7 d of weaning after the first spontaneous breathing trial. Diaphragm thickness was measured in the zone of apposition using a 6-13-MHz ultrasound transducer during a spontaneous breathing trial. The diaphragmatic thickening fraction was calculated as a percentage from the formula: (Thickness at peak inspiration - thickness at end expiration)/thickness at end expiration. Intra-observer and inter-observer reliability were also evaluated. RESULTS: Forty-one subjects (24 males; 62.2 ± 15.9 y old) were included in the study. Of these, the prevalence of ultrasonographic diaphragmatic dysfunction (defined as diaphragmatic thickening fraction of <20% with inspiration) was 34.1% (n = 14). Subjects with diaphragmatic dysfunction had longer ventilation time after inclusion (293.4 ± 194.8 vs 145.1 ± 101.3 h, P = .02) and ICU stay (29.2 ± 11.4 vs 22.4 ± 7.7 d, P = .03) than subjects without diaphragmatic dysfunction. CONCLUSIONS: Diaphragmatic dysfunction as assessed by B-mode ultrasonography is common in subjects with prolonged weaning. Subjects with such diaphragmatic dysfunction show longer mechanical ventilation durations and ICU stays.
BACKGROUND:Diaphragmatic dysfunction is often underdiagnosed and is among the risk factors for failed weaning. The purpose of this study was to determine the prevalence of diaphragmatic dysfunction diagnosed by B-mode ultrasonography and to determine whether prolonged weaning subjects with diaphragmatic dysfunction have increased duration of mechanical ventilation compared with those without diaphragmatic dysfunction. METHODS: This was a prospective observational study in mechanically ventilated subjects who failed ≥3 spontaneous breathing trials or required >7 d of weaning after the first spontaneous breathing trial. Diaphragm thickness was measured in the zone of apposition using a 6-13-MHz ultrasound transducer during a spontaneous breathing trial. The diaphragmatic thickening fraction was calculated as a percentage from the formula: (Thickness at peak inspiration - thickness at end expiration)/thickness at end expiration. Intra-observer and inter-observer reliability were also evaluated. RESULTS: Forty-one subjects (24 males; 62.2 ± 15.9 y old) were included in the study. Of these, the prevalence of ultrasonographic diaphragmatic dysfunction (defined as diaphragmatic thickening fraction of <20% with inspiration) was 34.1% (n = 14). Subjects with diaphragmatic dysfunction had longer ventilation time after inclusion (293.4 ± 194.8 vs 145.1 ± 101.3 h, P = .02) and ICU stay (29.2 ± 11.4 vs 22.4 ± 7.7 d, P = .03) than subjects without diaphragmatic dysfunction. CONCLUSIONS:Diaphragmatic dysfunction as assessed by B-mode ultrasonography is common in subjects with prolonged weaning. Subjects with such diaphragmatic dysfunction show longer mechanical ventilation durations and ICU stays.
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: Ryan W Johnson; Kay W P Ng; Alexander R Dietz; Mary E Hartman; Jack D Baty; Nausheen Hasan; Craig M Zaidman; Michael Shoykhet Journal: PLoS One Date: 2018-12-19 Impact factor: 3.240
Authors: Pauliane Vieira Santana; Leticia Zumpano Cardenas; André Luis Pereira de Albuquerque; Carlos Roberto Ribeiro de Carvalho; Pedro Caruso Journal: J Bras Pneumol Date: 2020-11-20 Impact factor: 2.624
Authors: Katherine C Locke; Margo L Randelman; Daniel J Hoh; Lyandysha V Zholudeva; Michael A Lane Journal: Neural Regen Res Date: 2022-10 Impact factor: 6.058
Authors: Friederike Sophie Magnet; Hannah Bleichroth; Sophie Emilia Huttmann; Jens Callegari; Sarah Bettina Schwarz; Claudia Schmoor; Wolfram Windisch; Jan Hendrik Storre Journal: J Intensive Care Date: 2018-10-16