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Diaphragm echodensity in mechanically ventilated patients: a description of technique and outcomes

BACKGROUND: Acute increases in muscle sonographic echodensity reflect muscle injury. Diaphragm echodensity has not been measured in mechanically ventilated patients. We undertook to develop a technique to characterize changes in diaphragm echodensity during mechanical ventilation and to assess wheth...

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Autores principales: Coiffard, Benjamin, Riegler, Stephen, Sklar, Michael C., Dres, Martin, Vorona, Stefannie, Reid, W. Darlene, Brochard, Laurent J., Ferguson, Niall D., Goligher, Ewan C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7884870/
https://www.ncbi.nlm.nih.gov/pubmed/33593412
http://dx.doi.org/10.1186/s13054-021-03494-9
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author Coiffard, Benjamin
Riegler, Stephen
Sklar, Michael C.
Dres, Martin
Vorona, Stefannie
Reid, W. Darlene
Brochard, Laurent J.
Ferguson, Niall D.
Goligher, Ewan C.
author_facet Coiffard, Benjamin
Riegler, Stephen
Sklar, Michael C.
Dres, Martin
Vorona, Stefannie
Reid, W. Darlene
Brochard, Laurent J.
Ferguson, Niall D.
Goligher, Ewan C.
author_sort Coiffard, Benjamin
collection PubMed
description BACKGROUND: Acute increases in muscle sonographic echodensity reflect muscle injury. Diaphragm echodensity has not been measured in mechanically ventilated patients. We undertook to develop a technique to characterize changes in diaphragm echodensity during mechanical ventilation and to assess whether these changes are correlated with prolonged mechanical ventilation. METHODS: Diaphragm ultrasound images were prospectively collected in mechanically ventilated patients and in 10 young healthy subjects. Echodensity was quantified based on the right-skewed distribution of grayscale values (50th percentile, ED50; 85(th) percentile, ED85). Intra- and inter-analyzer measurement reproducibility was determined. Outcomes recorded included duration of ventilation and ICU complications (including reintubation, tracheostomy, prolonged ventilation, or death). RESULTS: Echodensity measurements were obtained serially in 34 patients comprising a total of 104 images. Baseline (admission) diaphragm ED85 was increased in mechanically ventilated patients compared to younger healthy subjects (median 56, interquartile range (IQR) 42–84, vs. 39, IQR 36–52, p = 0.04). Patients with an initial increase in median echodensity over time (≥ + 10 in ED50 from baseline) had fewer ventilator-free days to day 60 (n = 13, median 46, IQR 0–52) compared to patients without this increase (n = 21, median 53 days, IQR 49–56, unadjusted p = 0.03). Both decreases and increases in diaphragm thickness during mechanical ventilation were associated with increases in ED50 over time (adjusted p = 0.03, conditional R(2) = 0.80) and the association between increase in ED50 and outcomes persisted after adjusting for changes in diaphragm thickness. CONCLUSIONS: Many patients exhibit increased diaphragm echodensity at the outset of mechanical ventilation. Increases in diaphragm echodensity during the early course of mechanical ventilation are associated with prolonged mechanical ventilation. Both decreases and increases in diaphragm thickness during mechanical ventilation are associated with increased echodensity.
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spelling pubmed-78848702021-02-16 Diaphragm echodensity in mechanically ventilated patients: a description of technique and outcomes Coiffard, Benjamin Riegler, Stephen Sklar, Michael C. Dres, Martin Vorona, Stefannie Reid, W. Darlene Brochard, Laurent J. Ferguson, Niall D. Goligher, Ewan C. Crit Care Research BACKGROUND: Acute increases in muscle sonographic echodensity reflect muscle injury. Diaphragm echodensity has not been measured in mechanically ventilated patients. We undertook to develop a technique to characterize changes in diaphragm echodensity during mechanical ventilation and to assess whether these changes are correlated with prolonged mechanical ventilation. METHODS: Diaphragm ultrasound images were prospectively collected in mechanically ventilated patients and in 10 young healthy subjects. Echodensity was quantified based on the right-skewed distribution of grayscale values (50th percentile, ED50; 85(th) percentile, ED85). Intra- and inter-analyzer measurement reproducibility was determined. Outcomes recorded included duration of ventilation and ICU complications (including reintubation, tracheostomy, prolonged ventilation, or death). RESULTS: Echodensity measurements were obtained serially in 34 patients comprising a total of 104 images. Baseline (admission) diaphragm ED85 was increased in mechanically ventilated patients compared to younger healthy subjects (median 56, interquartile range (IQR) 42–84, vs. 39, IQR 36–52, p = 0.04). Patients with an initial increase in median echodensity over time (≥ + 10 in ED50 from baseline) had fewer ventilator-free days to day 60 (n = 13, median 46, IQR 0–52) compared to patients without this increase (n = 21, median 53 days, IQR 49–56, unadjusted p = 0.03). Both decreases and increases in diaphragm thickness during mechanical ventilation were associated with increases in ED50 over time (adjusted p = 0.03, conditional R(2) = 0.80) and the association between increase in ED50 and outcomes persisted after adjusting for changes in diaphragm thickness. CONCLUSIONS: Many patients exhibit increased diaphragm echodensity at the outset of mechanical ventilation. Increases in diaphragm echodensity during the early course of mechanical ventilation are associated with prolonged mechanical ventilation. Both decreases and increases in diaphragm thickness during mechanical ventilation are associated with increased echodensity. BioMed Central 2021-02-16 /pmc/articles/PMC7884870/ /pubmed/33593412 http://dx.doi.org/10.1186/s13054-021-03494-9 Text en © The Author(s) 2021 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. 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 in a credit line to the data.
spellingShingle Research
Coiffard, Benjamin
Riegler, Stephen
Sklar, Michael C.
Dres, Martin
Vorona, Stefannie
Reid, W. Darlene
Brochard, Laurent J.
Ferguson, Niall D.
Goligher, Ewan C.
Diaphragm echodensity in mechanically ventilated patients: a description of technique and outcomes
title Diaphragm echodensity in mechanically ventilated patients: a description of technique and outcomes
title_full Diaphragm echodensity in mechanically ventilated patients: a description of technique and outcomes
title_fullStr Diaphragm echodensity in mechanically ventilated patients: a description of technique and outcomes
title_full_unstemmed Diaphragm echodensity in mechanically ventilated patients: a description of technique and outcomes
title_short Diaphragm echodensity in mechanically ventilated patients: a description of technique and outcomes
title_sort diaphragm echodensity in mechanically ventilated patients: a description of technique and outcomes
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7884870/
https://www.ncbi.nlm.nih.gov/pubmed/33593412
http://dx.doi.org/10.1186/s13054-021-03494-9
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