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Diaphragm thickening in cardiac surgery: a perioperative prospective ultrasound study
BACKGROUND: Diaphragm paresis is common after cardiac surgery and may delay the weaning from the ventilator. Our objective was to evaluate diaphragm thickening during weaning and secondly the muscle thickness as a marker of myotrauma. METHODS: Patients undergoing elective cardiac surgery were prospe...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6478777/ https://www.ncbi.nlm.nih.gov/pubmed/31016412 http://dx.doi.org/10.1186/s13613-019-0521-z |
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author | Moury, Pierre-Henri Cuisinier, Adrien Durand, Michel Bosson, Jean-Luc Chavanon, Olivier Payen, Jean-François Jaber, Samir Albaladejo, Pierre |
author_facet | Moury, Pierre-Henri Cuisinier, Adrien Durand, Michel Bosson, Jean-Luc Chavanon, Olivier Payen, Jean-François Jaber, Samir Albaladejo, Pierre |
author_sort | Moury, Pierre-Henri |
collection | PubMed |
description | BACKGROUND: Diaphragm paresis is common after cardiac surgery and may delay the weaning from the ventilator. Our objective was to evaluate diaphragm thickening during weaning and secondly the muscle thickness as a marker of myotrauma. METHODS: Patients undergoing elective cardiac surgery were prospectively included. Ultrasonic index of right hemidiaphragm thickening fraction (TF) was measured as a surrogate criterion of work of breathing. A TF < 20% was defined as a low diaphragm thickening. Measurements of TF were performed during three periods to study diaphragm thickening evolution defined by the difference between two consecutive time line point: preoperative (D − 1), during a spontaneous breathing trial (SBT) in the intensive care unit and postoperative (D + 1). We studied three patterns of diaphragm thickness at end expiration evolution from D − 1 to D + 1: > 10% decrease, stability and > 10% increase. Demographical data, length of surgery, type of surgery, ICU length of stay (LOS) and extubation failure were collected. RESULTS: Of the 100 consecutively included patients, 75 patients had a low diaphragm thickening during SBT. Compared to TF values at D − 1 (36% ± 18), TF was reduced during SBT (17% ± 14) and D + 1 (12% ± 11) (P < 0.0001). Thickness and TF did not change according to the type of surgery or cooling method. TF at SBT was correlated to the length of surgery (both r = − 0.4; P < 0.0001). Diaphragm thickness as continuous variable did not change over time. Twenty-eight patients (42%) had a > 10% decrease thickness, 19 patients (29%) stability and 19 patients (28%) in > 10% increase, and this thickness evolution pattern was associated with: a longer LOS 3 days [2–5] versus 2 days [2–4] and 2 days [2], respectively (ANOVA P = 0.046), and diaphragm thickening evolution (ANOVA P = 0.02). Two patients experience extubation failure. CONCLUSION: These findings indicate that diaphragm thickening is frequently decreased after elective cardiac surgery without impact on respiratory outcome, whereas an altered thickness pattern was associated with a longer length of stay in the ICU. Contractile activity influenced thickness evolution. Trial registry number ClinicalTrial.gov ID NCT02208479 ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13613-019-0521-z) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-6478777 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-64787772019-05-15 Diaphragm thickening in cardiac surgery: a perioperative prospective ultrasound study Moury, Pierre-Henri Cuisinier, Adrien Durand, Michel Bosson, Jean-Luc Chavanon, Olivier Payen, Jean-François Jaber, Samir Albaladejo, Pierre Ann Intensive Care Research BACKGROUND: Diaphragm paresis is common after cardiac surgery and may delay the weaning from the ventilator. Our objective was to evaluate diaphragm thickening during weaning and secondly the muscle thickness as a marker of myotrauma. METHODS: Patients undergoing elective cardiac surgery were prospectively included. Ultrasonic index of right hemidiaphragm thickening fraction (TF) was measured as a surrogate criterion of work of breathing. A TF < 20% was defined as a low diaphragm thickening. Measurements of TF were performed during three periods to study diaphragm thickening evolution defined by the difference between two consecutive time line point: preoperative (D − 1), during a spontaneous breathing trial (SBT) in the intensive care unit and postoperative (D + 1). We studied three patterns of diaphragm thickness at end expiration evolution from D − 1 to D + 1: > 10% decrease, stability and > 10% increase. Demographical data, length of surgery, type of surgery, ICU length of stay (LOS) and extubation failure were collected. RESULTS: Of the 100 consecutively included patients, 75 patients had a low diaphragm thickening during SBT. Compared to TF values at D − 1 (36% ± 18), TF was reduced during SBT (17% ± 14) and D + 1 (12% ± 11) (P < 0.0001). Thickness and TF did not change according to the type of surgery or cooling method. TF at SBT was correlated to the length of surgery (both r = − 0.4; P < 0.0001). Diaphragm thickness as continuous variable did not change over time. Twenty-eight patients (42%) had a > 10% decrease thickness, 19 patients (29%) stability and 19 patients (28%) in > 10% increase, and this thickness evolution pattern was associated with: a longer LOS 3 days [2–5] versus 2 days [2–4] and 2 days [2], respectively (ANOVA P = 0.046), and diaphragm thickening evolution (ANOVA P = 0.02). Two patients experience extubation failure. CONCLUSION: These findings indicate that diaphragm thickening is frequently decreased after elective cardiac surgery without impact on respiratory outcome, whereas an altered thickness pattern was associated with a longer length of stay in the ICU. Contractile activity influenced thickness evolution. Trial registry number ClinicalTrial.gov ID NCT02208479 ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13613-019-0521-z) contains supplementary material, which is available to authorized users. Springer International Publishing 2019-04-24 /pmc/articles/PMC6478777/ /pubmed/31016412 http://dx.doi.org/10.1186/s13613-019-0521-z Text en © The Author(s) 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. |
spellingShingle | Research Moury, Pierre-Henri Cuisinier, Adrien Durand, Michel Bosson, Jean-Luc Chavanon, Olivier Payen, Jean-François Jaber, Samir Albaladejo, Pierre Diaphragm thickening in cardiac surgery: a perioperative prospective ultrasound study |
title | Diaphragm thickening in cardiac surgery: a perioperative prospective ultrasound study |
title_full | Diaphragm thickening in cardiac surgery: a perioperative prospective ultrasound study |
title_fullStr | Diaphragm thickening in cardiac surgery: a perioperative prospective ultrasound study |
title_full_unstemmed | Diaphragm thickening in cardiac surgery: a perioperative prospective ultrasound study |
title_short | Diaphragm thickening in cardiac surgery: a perioperative prospective ultrasound study |
title_sort | diaphragm thickening in cardiac surgery: a perioperative prospective ultrasound study |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6478777/ https://www.ncbi.nlm.nih.gov/pubmed/31016412 http://dx.doi.org/10.1186/s13613-019-0521-z |
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