Cargando…
Diaphragm ultrasound as indicator of respiratory effort in critically ill patients undergoing assisted mechanical ventilation: a pilot clinical study
INTRODUCTION: Pressure-support ventilation, is widely used in critically ill patients; however, the relative contribution of patient’s effort during assisted breathing is difficult to measure in clinical conditions. Aim of the present study was to evaluate the performance of ultrasonographic indices...
Autores principales: | , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2015
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4403842/ https://www.ncbi.nlm.nih.gov/pubmed/25886857 http://dx.doi.org/10.1186/s13054-015-0894-9 |
_version_ | 1782367392776585216 |
---|---|
author | Umbrello, Michele Formenti, Paolo Longhi, Daniela Galimberti, Andrea Piva, Ilaria Pezzi, Angelo Mistraletti, Giovanni Marini, John J Iapichino, Gaetano |
author_facet | Umbrello, Michele Formenti, Paolo Longhi, Daniela Galimberti, Andrea Piva, Ilaria Pezzi, Angelo Mistraletti, Giovanni Marini, John J Iapichino, Gaetano |
author_sort | Umbrello, Michele |
collection | PubMed |
description | INTRODUCTION: Pressure-support ventilation, is widely used in critically ill patients; however, the relative contribution of patient’s effort during assisted breathing is difficult to measure in clinical conditions. Aim of the present study was to evaluate the performance of ultrasonographic indices of diaphragm contractile activity (respiratory excursion and thickening) in comparison to traditional indices of inspiratory muscle effort during assisted mechanical ventilation. METHOD: Consecutive patients admitted to the ICU after major elective surgery who met criteria for a spontaneous breathing trial with pressure support ventilation were enrolled. Patients with airflow obstruction or after thoracic/gastric/esophageal surgery were excluded. Variable levels of inspiratory muscle effort were achieved by delivery of different levels of ventilatory assistance by random application of pressure support (0, 5 and 15 cmH(2)O). The right hemidiaphragm was evaluated by B- and M-mode ultrasonography to record respiratory excursion and thickening. Airway, gastric and oesophageal pressures, and airflow were recorded to calculate indices of respiratory effort (diaphragm and esophageal pressure–time product). RESULTS: 25 patients were enrolled. With increasing levels of pressure support, parallel reductions were found between diaphragm thickening and both diaphragm and esophageal pressure–time product (respectively, R = 0.701, p < 0.001 and R = 0.801, p < 0.001) during tidal breathing. No correlation was found between either diaphragm or esophageal pressure–time product and diaphragm excursion (respectively, R = −0.081, p = 0.506 and R = 0.003, p = 0.981), nor was diaphragm excursion correlated to diaphragm thickening (R = 0.093, p = 0.450) during tidal breathing. CONCLUSIONS: In patients undergoing in assisted mechanical ventilation, diaphragm thickening is a reliable indicator of respiratory effort, whereas diaphragm excursion should not be used to quantitatively assess diaphragm contractile activity. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13054-015-0894-9) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-4403842 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-44038422015-04-21 Diaphragm ultrasound as indicator of respiratory effort in critically ill patients undergoing assisted mechanical ventilation: a pilot clinical study Umbrello, Michele Formenti, Paolo Longhi, Daniela Galimberti, Andrea Piva, Ilaria Pezzi, Angelo Mistraletti, Giovanni Marini, John J Iapichino, Gaetano Crit Care Research INTRODUCTION: Pressure-support ventilation, is widely used in critically ill patients; however, the relative contribution of patient’s effort during assisted breathing is difficult to measure in clinical conditions. Aim of the present study was to evaluate the performance of ultrasonographic indices of diaphragm contractile activity (respiratory excursion and thickening) in comparison to traditional indices of inspiratory muscle effort during assisted mechanical ventilation. METHOD: Consecutive patients admitted to the ICU after major elective surgery who met criteria for a spontaneous breathing trial with pressure support ventilation were enrolled. Patients with airflow obstruction or after thoracic/gastric/esophageal surgery were excluded. Variable levels of inspiratory muscle effort were achieved by delivery of different levels of ventilatory assistance by random application of pressure support (0, 5 and 15 cmH(2)O). The right hemidiaphragm was evaluated by B- and M-mode ultrasonography to record respiratory excursion and thickening. Airway, gastric and oesophageal pressures, and airflow were recorded to calculate indices of respiratory effort (diaphragm and esophageal pressure–time product). RESULTS: 25 patients were enrolled. With increasing levels of pressure support, parallel reductions were found between diaphragm thickening and both diaphragm and esophageal pressure–time product (respectively, R = 0.701, p < 0.001 and R = 0.801, p < 0.001) during tidal breathing. No correlation was found between either diaphragm or esophageal pressure–time product and diaphragm excursion (respectively, R = −0.081, p = 0.506 and R = 0.003, p = 0.981), nor was diaphragm excursion correlated to diaphragm thickening (R = 0.093, p = 0.450) during tidal breathing. CONCLUSIONS: In patients undergoing in assisted mechanical ventilation, diaphragm thickening is a reliable indicator of respiratory effort, whereas diaphragm excursion should not be used to quantitatively assess diaphragm contractile activity. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13054-015-0894-9) contains supplementary material, which is available to authorized users. BioMed Central 2015-04-13 2015 /pmc/articles/PMC4403842/ /pubmed/25886857 http://dx.doi.org/10.1186/s13054-015-0894-9 Text en © Umbrello et al.; licensee BioMed Central. 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Umbrello, Michele Formenti, Paolo Longhi, Daniela Galimberti, Andrea Piva, Ilaria Pezzi, Angelo Mistraletti, Giovanni Marini, John J Iapichino, Gaetano Diaphragm ultrasound as indicator of respiratory effort in critically ill patients undergoing assisted mechanical ventilation: a pilot clinical study |
title | Diaphragm ultrasound as indicator of respiratory effort in critically ill patients undergoing assisted mechanical ventilation: a pilot clinical study |
title_full | Diaphragm ultrasound as indicator of respiratory effort in critically ill patients undergoing assisted mechanical ventilation: a pilot clinical study |
title_fullStr | Diaphragm ultrasound as indicator of respiratory effort in critically ill patients undergoing assisted mechanical ventilation: a pilot clinical study |
title_full_unstemmed | Diaphragm ultrasound as indicator of respiratory effort in critically ill patients undergoing assisted mechanical ventilation: a pilot clinical study |
title_short | Diaphragm ultrasound as indicator of respiratory effort in critically ill patients undergoing assisted mechanical ventilation: a pilot clinical study |
title_sort | diaphragm ultrasound as indicator of respiratory effort in critically ill patients undergoing assisted mechanical ventilation: a pilot clinical study |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4403842/ https://www.ncbi.nlm.nih.gov/pubmed/25886857 http://dx.doi.org/10.1186/s13054-015-0894-9 |
work_keys_str_mv | AT umbrellomichele diaphragmultrasoundasindicatorofrespiratoryeffortincriticallyillpatientsundergoingassistedmechanicalventilationapilotclinicalstudy AT formentipaolo diaphragmultrasoundasindicatorofrespiratoryeffortincriticallyillpatientsundergoingassistedmechanicalventilationapilotclinicalstudy AT longhidaniela diaphragmultrasoundasindicatorofrespiratoryeffortincriticallyillpatientsundergoingassistedmechanicalventilationapilotclinicalstudy AT galimbertiandrea diaphragmultrasoundasindicatorofrespiratoryeffortincriticallyillpatientsundergoingassistedmechanicalventilationapilotclinicalstudy AT pivailaria diaphragmultrasoundasindicatorofrespiratoryeffortincriticallyillpatientsundergoingassistedmechanicalventilationapilotclinicalstudy AT pezziangelo diaphragmultrasoundasindicatorofrespiratoryeffortincriticallyillpatientsundergoingassistedmechanicalventilationapilotclinicalstudy AT mistralettigiovanni diaphragmultrasoundasindicatorofrespiratoryeffortincriticallyillpatientsundergoingassistedmechanicalventilationapilotclinicalstudy AT marinijohnj diaphragmultrasoundasindicatorofrespiratoryeffortincriticallyillpatientsundergoingassistedmechanicalventilationapilotclinicalstudy AT iapichinogaetano diaphragmultrasoundasindicatorofrespiratoryeffortincriticallyillpatientsundergoingassistedmechanicalventilationapilotclinicalstudy |