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Am J Crit Care. 2016 Jan;25(1):e1-8. doi: 10.4037/ajcc2016563.

Ultrasonographic Evaluation of Diaphragm Thickness During Mechanical Ventilation in Intensive Care Patients.

Author information

1
Colin Anthony Francis is a doctoral student in the Department of Experimental Medicine, University of British Columbia, Vancouver, Canada. Joaquín Andrés Hoffer is a professor in the Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada. Steven Reynolds is a critical care physician in the Department of Critical Care, Royal Columbian Hospital, Fraser Health Authority, New Westminster, BC, Canada.
2
Colin Anthony Francis is a doctoral student in the Department of Experimental Medicine, University of British Columbia, Vancouver, Canada. Joaquín Andrés Hoffer is a professor in the Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada. Steven Reynolds is a critical care physician in the Department of Critical Care, Royal Columbian Hospital, Fraser Health Authority, New Westminster, BC, Canada. sreynolds.md@gmail.com.

Abstract

BACKGROUND:

Mechanical ventilation is associated with atrophy and weakness of the diaphragm. Ultrasound is an easy noninvasive way to track changes in thickness of the diaphragm.

OBJECTIVE:

To validate ultrasound as a means of tracking thickness of the diaphragm in patients undergoing mechanical ventilation by evaluating interobserver and interoperator reliability and to collect initial data on the relationship of mode of ventilation to changes in the diaphragm.

METHODS:

Daily ultrasound images of the quadriceps and the right side of the diaphragm were acquired in 8 critically ill patients receiving various modes of mechanical ventilation. Thickness of the diaphragm and the quadriceps was measured, and changes with time were noted. Interoperator and interobserver reliability were measured.

RESULTS:

Intraclass correlation coefficients between operators and between observers for thickness of the diaphragm and quadriceps were greater than 0.95, indicating excellent interoperator and interobserver reliability. Patients receiving assist-control ventilation (n = 4) showed a mean decline in diaphragm thickness of 4.7% per day. Patients receiving pressure support ventilation (n = 8) showed a mean increase in diaphragm thickness of 1.5% per day. Quadriceps thickness declined in all participants (n = 8) at a mean rate of 2.0% per day.

CONCLUSIONS:

Use of ultrasound to measure thickness of the diaphragm in 8 intensive care patients undergoing various modes of mechanical ventilation was feasible and yielded reproducible results. Ultrasound tracking of changes in thickness of the diaphragm in this small sample indicated that the thickness decreased during assist-control mode and increased during pressure support mode.

PMID:
26724302
DOI:
10.4037/ajcc2016563
[Indexed for MEDLINE]
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