Diaphragmatic Function Assessed by Bed Side Ultrasonography in Patients with Sepsis or Septic Shock Admitted to Intensive Care Unit
DOI:
https://doi.org/10.3889/oamjms.2021.7060Keywords:
Sepsis, Septic shock, Diaphragmatic function, UltrasoundAbstract
BACKGROUND: Sepsis and septic shock are major problems faced the healthcare systems all over the world every year. The ultrasound (US) is a simple, non-invasive, easily accessible technique, and showed great accuracy in diaphragm assessment.
AIM: We evaluated the diaphragmatic function assessed by US in patients with sepsis and septic shock and correlated these assessments with different parameters.
MATERIALS AND METHODS: A prospective observational study carried out on 30 patients admitted to the intensive care unit (ICU) diagnosed with sepsis and/or septic shock. Both diaphragmatic excursion (DE) and thickness fraction (diaphragm thickening fraction [TDI] %) were assessed by US on admission and every 48 h along the patients’ ICU stay.
RESULTS: In the current study, there was a statistically significant reverse relationship between mortality and the different diaphragmatic function parameters (DE on admission, average DE, on admission TDI%, average TDI%). On the other hand, the DE (on admission and average) showed a statistically significant reverse relation with the need and duration of mechanical ventilation (MV) while the TDI% showed a statistically significant reverse relation only with the duration of MV. Besides, there was a statistically significant direct relationship between successful weaning from MV and all the measured parameters.
CONCLUSION: We proposed that the diaphragmatic function parameters (DE on admission, average DE, on admission TDI% and average TDI%) assessed by US of septic ICU patients could be used as a predictor of the need, duration, and successful weaning from MV and also as a predictor of mortality.Downloads
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Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):801-10. https://doi.org/10.1001/jama.2016.0288 PMid:26903338 DOI: https://doi.org/10.1001/jama.2016.0287
Mariani LF, Bedel J, Gros A, Lerolle N, Milojevic K, Laurent V, et al. Ultrasonography for screening and follow-up of diaphragmatic dysfunction in the ICU: A pilot study. J Intensive Care Med. 2015;31(5):338-43. https://doi.org/10.1177/0885066615583639 PMid:25979406 DOI: https://doi.org/10.1177/0885066615583639
Demoule A, Jung B, Prodanovic H, Molinari N, Chanques G, Coirault C, et al. Diaphragm dysfunction on admission to the intensive care unit. Prevalence, risk factors, and prognostic impact-a prospective study. Am J Respir Crit Care Med. 2013;188(2):213-9. https://doi.org/10.1164/rccm.201209-1668oc PMid:23641946 DOI: https://doi.org/10.1164/rccm.201209-1668OC
Hermans G, Agten A, Testelmans D, Decramer M, Gayan-Ramirez G. Increased duration of mechanical ventilation is associated with decreased diaphragmatic force: A prospective observational study. Critical Care. 2010;14(4):R127. https://doi.org/10.1186/cc9094 PMid:20594319 DOI: https://doi.org/10.1186/cc9094
Mayo P, Arntfield R, Balik M, Kory P, Mathis G, Schmidt G, et al. The ICM research agenda on critical care ultrasonography. Intensive Care Med. 2017;43(9):1257-69. https://doi.org/10.1007/s00134-017-4734-z PMid:28271320 DOI: https://doi.org/10.1007/s00134-017-4734-z
Lichtenstein DA. BLUE-protocol and FALLS-protocol: Two applications of lung ultrasound in the critically ill. Chest. 2015;147(6):1659-70. https://doi.org/10.1378/chest.14-1313 PMid:26033127 DOI: https://doi.org/10.1378/chest.14-1313
Llamas-Alvarez AM, Tenza-Lozano EM, Latour-Perez J. Accuracy of lung ultrasonography in the diagnosis of pneumonia in adults: Systematic review and meta-analysis. Chest. 2017;151(2):374-82. https://doi.org/10.1016/j.chest.2016.10.039 PMid:27818332 DOI: https://doi.org/10.1016/j.chest.2016.10.039
Gerscovich EO, Cronan M, McGahan JP, Jain K, Jones CD, McDonald C. Ultrasonographic evaluation of diaphragmatic motion. J Ultrasound Med. 2001;20(6):597-604. https://doi.org/10.7863/jum.2001.20.6.597 PMid:11400933 DOI: https://doi.org/10.7863/jum.2001.20.6.597
de Toledo JS, Munoz R, Landsittel D, Shiderly D, Yoshida M, Komarlu R, et al. Diagnosis of abnormal diaphragm motion after cardiothoracic surgery: Ultrasound performed by a cardiac intensivist vs. fluoroscopy. Congenit Heart Dis. 2010;5(6):565-72. https://doi.org/10.1111/j.1747-0803.2010.00431.x PMid:21106016 DOI: https://doi.org/10.1111/j.1747-0803.2010.00431.x
Ayoub J, Cohendy R, Prioux J, Ahmaidi S, Bourgeois JM, Dauzat M, et al. Diaphragm movement before and after cholecystectomy: A sonographic study. Anesth Analg. 2001;92(3):755-61. https://doi.org/10.1213/00000539-200103000-00038 PMid:11226114 DOI: https://doi.org/10.1213/00000539-200103000-00038
Miller SG, Brook MM, Tacy TA. Reliability of two-dimensional echocardiography in the assessment of clinically significant abnormal hemidiaphragm motion in pediatric cardiothoracic patients: Comparison with fluoroscopy. Pediatr Crit Care Med. 2006;7(5):441-4. https://doi.org/10.1097/01.pcc.0000227593.63141.36 PMid:16738495 DOI: https://doi.org/10.1097/01.PCC.0000227593.63141.36
Lerolle N, Diehl JL. Ultrasonographic evaluation of diaphragmatic function. Crit Care Med. 2011;39(12):2760-1. https://doi.org/10.1097/ccm.0b013e31822a55e9 PMid:22094504 DOI: https://doi.org/10.1097/CCM.0b013e31822a55e9
Summerhill EM, El-Sameed YA, Glidden TJ, McCool FD. Monitoring recovery from diaphragm paralysis with ultrasound. Chest. 2008;133(3):737-43. https://doi.org/10.1378/chest.07-2200 PMid:18198248 DOI: https://doi.org/10.1378/chest.07-2200
Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving sepsis campaign: International guidelines for management of sepsis and septic shock: 2016. Crit Care Med. 2016;45(3):486-552. https://doi.org/10.1097/ccm.0000000000000192 PMid:28098591 DOI: https://doi.org/10.1097/CCM.0000000000000192
Levy MM, Evans LE, Rhodes A. The surviving sepsis campaign bundle: 2018 update. Intensive Care Med. 2018;44(6):925-8. https://doi.org/10.1007/s00134-018-5085-0 PMid:29675566 DOI: https://doi.org/10.1007/s00134-018-5085-0
Abdelhafeez RM, Abumossalam AM, Arram EO, Elshafey MM, Abushehata ME. Diaphragm and weaning from mechanical ventilation: Anticipation and outcome. Egypt J Broncol. 2019;13(4):9. https://doi.org/10.4103/ejb.ejb_13_19 DOI: https://doi.org/10.4103/ejb.ejb_13_19
Supinski GS, Callahan LA. Diaphragm weakness in mechanically ventilated critically ill patients. Crit Care. 2013;17(3):R120. https://doi.org/10.1186/cc12792 PMid:23786764 DOI: https://doi.org/10.1186/cc12792
Goligher EC, Laghi F, Detsky ME, Farias P, Murray A, Brace D, et al. Measuring diaphragm thickness with ultrasound in mechanically ventilated patients: Feasibility, reproducibility and validity. Intensive Care Med. 2015;41(4):642-9. https://doi.org/10.1007/s00134-015-3687-3 PMid:25693448 DOI: https://doi.org/10.1007/s00134-015-3687-3
Lu Z, Ge H, Xu L, Guo F, Zhang G, Wu Y. Alterations in diaphragmatic function assessed by ultrasonography in mechanically ventilated patients with sepsis. J Clin Ultrasound. 2018;47(4):206-11. https://doi.org/10.1002/jcu.22690 PMid:30671990 DOI: https://doi.org/10.1002/jcu.22690
Ali ER, Mohamad AM. Diaphragm ultrasound as a new functional and morphological index of outcome, prognosis and discontinuation from mechanical ventilation in critically ill patients and evaluating the possible protective indices against VIDD. Egypt J Chest Dis Tuberc. 2017;66(2):187. https://doi.org/10.1016/j.ejcdt.2016.10.006 DOI: https://doi.org/10.1016/j.ejcdt.2016.10.006
Soliman SB, Ragab F, Soliman RA, Gaber A, Kamal A. Chest ultrasound in predication of weaning failure. Open Access Maced J Med Sci. 2019;7(7):1143-7. https://doi.org/10.3889/oamjms.2019.277 PMid:31049097 DOI: https://doi.org/10.3889/oamjms.2019.277
Zambon M, Greco M, Bocchino S, Cabrini L, Beccaria PF, Zangrillo A. Assessment of diaphragmatic dysfunction in the critically ill patient with ultrasound: A systematic review. Intensive Care Med. 2017;43(1):29-38. https://doi.org/10.1007/s00134-016-4524-z PMid:27620292 DOI: https://doi.org/10.1007/s00134-016-4524-z
Ferrari G, De Filippi G, Elia F, Panero F, Volpicelli G, Apra F. Diaphragm ultrasound as a new index of discontinuation from mechanical ventilation. Crit Ultrasound J. 2014;6(1):8. https://doi.org/10.1186/2036-7902-6-8 PMid:24949192 DOI: https://doi.org/10.1186/2036-7902-6-8
Eltrabili HH, Hasanin AM, Soliman MS, Lotfy AM, Hamimy WI, Mukhtar AM. Evaluation of diaphragmatic ultrasound indices as predictors of successful liberation from mechanical ventilation in subjects with abdominal sepsis. Respir Care. 2019;64(5):564-9. https://doi.org/10.4187/respcare.06391 PMid:30670667 DOI: https://doi.org/10.4187/respcare.06391
American Thoracic Society/European Respiratory Society. ATS/ERS Statement on respiratory muscle testing. Am J Respir Crit Care Med. 2002;166(4):518-624. https://doi.org/10.1164/rccm.166.4.518 PMid:12186831 DOI: https://doi.org/10.1164/rccm.166.4.518
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Copyright (c) 2020 Amal Zaki, Helmy Hassan El Ghawaby, Mostafa Mahmoud Mohammed Gad, Amira Mohamed Ismail, Amr Shafiq Nawar (Author)
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