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Assessment of diaphragmatic dysfunction in the critically ill patient with ultrasound: a systematic review

Intensive care medicine, 2017, Vol.43 (1), p.29-38 [Peer Reviewed Journal]

Springer-Verlag Berlin Heidelberg and ESICM 2016 ;COPYRIGHT 2017 Springer ;Intensive Care Medicine is a copyright of Springer, 2017. ;ISSN: 0342-4642 ;EISSN: 1432-1238 ;DOI: 10.1007/s00134-016-4524-z ;PMID: 27620292

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Title:
Assessment of diaphragmatic dysfunction in the critically ill patient with ultrasound: a systematic review
Author: Zambon, Massimo ; Greco, Massimiliano ; Bocchino, Speranza ; Cabrini, Luca ; Beccaria, Paolo Federico ; Zangrillo, Alberto
Subjects: Adult ; Aged ; Aged, 80 and over ; Analysis ; Anesthesiology ; Critical Care - methods ; Critical Care Medicine ; Critical Illness ; Diaphragm - diagnostic imaging ; Diaphragm - physiopathology ; Emergency Medicine ; Female ; Hospital patients ; Humans ; Intensive ; Male ; Medical research ; Medicine ; Medicine & Public Health ; Medicine, Experimental ; Middle Aged ; Pain Medicine ; Pediatrics ; Pneumology/Respiratory System ; Prospective Studies ; Respiratory Insufficiency - diagnosis ; Respiratory Insufficiency - therapy ; Systematic Review ; Ultrasound imaging
Is Part Of: Intensive care medicine, 2017, Vol.43 (1), p.29-38
Description: Purpose Diaphragmatic dysfunction (DD) has a high incidence in critically ill patients and is an under-recognized cause of respiratory failure and prolonged weaning from mechanical ventilation. Among different methods to assess diaphragmatic function, diaphragm ultrasonography (DU) is noninvasive, rapid, and easy to perform at the bedside. We systematically reviewed the current literature assessing the usefulness and accuracy of DU in intensive care unit (ICU) patients. Methods Pubmed, Cochrane Database of Systematic Reviews, Embase, Scopus, and Google Scholar Databases were searched for pertinent studies. We included all original, peer-reviewed studies about the use of DU in ICU patients. Results Twenty studies including 875 patients were included in the final analysis. DU was performed with different techniques to measure diaphragmatic inspiratory excursion, thickness of diaphragm (Tdi), and thickening fraction (TF). DU is feasible, highly reproducible, and allows one to detect diaphragmatic dysfunction in critically ill patients. During weaning from mechanical ventilation and spontaneous breathing trials, both diaphragmatic excursion and diaphragmatic thickening measurements have been used to predict extubation success or failure. Optimal cutoffs ranged from 10 to 14 mm for excursion and 30–36 % for thickening fraction. During assisted mechanical ventilation, diaphragmatic thickening has been found to be an accurate index of respiratory muscles workload. Observational studies suggest DU as a reliable method to assess diaphragm atrophy in patients undergoing mechanical ventilation. Conclusions Current literature suggests that DU could be a useful and accurate tool to detect diaphragmatic dysfunction in critically ill patients, to predict extubation success or failure, to monitor respiratory workload, and to assess atrophy in patients who are mechanically ventilated.
Publisher: Berlin/Heidelberg: Springer Berlin Heidelberg
Language: English
Identifier: ISSN: 0342-4642
EISSN: 1432-1238
DOI: 10.1007/s00134-016-4524-z
PMID: 27620292
Source: MEDLINE
ProQuest Central

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Assessment of diaphragmatic dysfunction in the critically ill patient with ultrasound: a systematic review

Springer-Verlag Berlin Heidelberg and ESICM 2016 ;COPYRIGHT 2017 Springer ;Intensive Care Medicine is a copyright of Springer, 2017. ;ISSN: 0342-4642 ;EISSN: 1432-1238 ;DOI: 10.1007/s00134-016-4524-z ;PMID: 27620292

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