Abstract:

Dysfunction of the respiratory muscles is now considered to be a serious complication of critical health issues. Diaphragm dysfunction has been associated to higher mortality and complications weaning with mechanical ventilation in patients getting invasive mechanical ventilation treating acute respiratory failure. Diaphragm dysfunction can occur in mechanically ventilated patients for a variety of factors, involving disuse atrophy with mechanical ventilation. Therefore, it is becoming increasingly essential for clinical and research priorities to measure and track diaphragm contractile activity, structural dimensions, as well as strength during mechanical ventilation. It is generally accepted that ultrasound may be used to visualize the diaphragm. The key indicators of diaphragm function have been developed over the past 15 years for mechanically ventilated patients to monitor changes in diaphragm size as well as function over time, to evaluate and diagnose diaphragmatic dysfunction, and to determine whether these indices can predict successfully exiting mechanical ventilation. These indices include diaphragm thickness, thickening fraction, as well as excursion.

References:

[1] Newth, C.J.L., Khemani, R.G., Jouvet, P.A. and Sward, K.A., 2017. Mechanical ventilation and decision support in pediatric intensive care. Pediatric Clinics, 64(5),1057-1070.

[2] Boles, J.M., Bion, J., Connors, A., Herridge, M., Marsh, B., Melot, C., Pearl, R., Silverman, H., Stanchina, M., Vieillard-Baron, A. and Welte, T., 2007. Weaning from mechanical ventilation. European Respiratory Journal, 29(5),1033-1056.

[3] Beduneau, G., Pham, T., Schortgen, F., Piquilloud, L., Zogheib, E., Jonas, M., Grelon, F., Runge, I., Terzi, N., Grange, S. and Barberet, G., 2017. Epidemiology of weaning outcome according to a new definition. The WIND study. American journal of respiratory and critical care medicine, 195(6),772-783.

[4] Epstein, S.K., Ciubotaru, R.L. and Wong, J.B., 1997. Effect of failed extubation on the outcome of mechanical ventilation. Chest, 112(1),186-192.

[5] Ambrosino, N. and Gabbrielli, L., 2010. The difficult-to-wean patient. Expert review of respiratory medicine, 4(5), 685-692.

[6] Hermans, G. and Van den Berghe, G., 2015. Clinical review: intensive care unit acquired weakness. Critical care, 19(1), 1-9.

[7] Magalhães, P.A., Camillo, C.A., Langer, D., Andrade, L.B., Maria do Carmo, M.B. and Gosselink, R., 2018. Weaning failure and respiratory muscle function: what has been done and what can be improved? Respiratory medicine, 134, 54-61.

[8] Huaringa, A.J., Wang, A., Haro, M.H. and Leyva, F.J., 2013. The weaning index as predictor of weaning success. Journal of intensive care medicine, 28(6), 369-374.

[9] Baptistella, A.R., Sarmento, F.J., da Silva, K.R., Baptistella, S.F., Taglietti, M., Zuquello, R.A. and Nunes Filho, J.R., 2018. Predictive factors of weaning from mechanical ventilation and extubation outcome: a systematic review. Journal of critical care, 48, 56-62.

[10] Kneyber, M.C., De Luca, D., Calderini, E., Jarreau, P.H., Javouhey, E., Lopez-Herce, J., Hammer, J., Macrae, D., Markhorst, D.G., Medina, A. and Pons-Odena, M., 2017. Recommendations for mechanical ventilation of critically ill children from the Paediatric Mechanical Ventilation Consensus Conference (PEMVECC). Intensive care medicine, 43, 1764-1780.

[11] Heunks, L.M. and Van Der Hoeven, J.G., 2010. Clinical review: The ABC of weaning failure-a structured approach. Critical care, 14(6), 1-9.

[12] Zapata, L., Vera, P., Roglan, A., Gich, I., Ordonez-Llanos, J. and Betbesé, A.J., 2011. B-type natriuretic peptides for prediction and diagnosis of weaning failure from cardiac origin. Intensive care medicine, 37, 477-485.

[13] Papanikolaou, J., Makris, D., Saranteas, T., Karakitsos, D., Zintzaras, E., Karabinis, A., Kostopanagiotou, G. and Zakynthinos, E., 2011. New insights into weaning from mechanical ventilation left ventricular diastolic dysfunction is a key player. Intensive care medicine, 37,1976-1985.

[14] Demoule, A., Jung, B., Prodanovic, H., Molinari, N., Chanques, G., Coirault, C., Matecki, S., Duguet, A., Similowski, T. and Jaber, S., 2013. Diaphragm dysfunction on admission to the intensive care unit. Prevalence, risk factors, and prognostic impact—a prospective study. American journal of respiratory and critical care medicine, 188(2), 213-219.

[15] Levine, S., Nguyen, T., Taylor, N., Friscia, M.E., Budak, M.T., Rothenberg, P., Zhu, J., Sachdeva, R., Sonnad, S., Kaiser, L.R. and Rubinstein, N.A., 2008. Rapid disuse atrophy of diaphragm fibers in mechanically ventilated humans. New England Journal of Medicine, 358(13), 1327-1335.

[16] Vassilakopoulos, T. and Petrof, B.J., 2004. Ventilator-induced diaphragmatic dysfunction. American journal of respiratory and critical care medicine, 169(3), 336-341.

[17] Kim, W.Y., Suh, H.J., Hong, S.B., Koh, Y. and Lim, C.M., 2011. Diaphragm dysfunction assessed by ultrasonography: influence on weaning from mechanical ventilation. Critical care medicine, 39(12), 2627-2630.

[18] Ali, E.R. and Mohamad, A.M., 2017. 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. Egyptian Journal of Chest Diseases and Tuberculosis, 66(2), 339-351.

[19] Dres, M., Dubé, B.P., Mayaux, J., Delemazure, J., Reuter, D., Brochard, L., Similowski, T. and Demoule, A., 2017. Coexistence and impact of limb muscle and diaphragm weakness at time of liberation from mechanical ventilation in medical intensive care unit patients. American journal of respiratory and critical care medicine, 195(1), 57-66.

[20] Zhou, P., Zhang, Z., Hong, Y., Cai, H., Zhao, H., Xu, P., Zhao, Y., Lin, S., Qin, X., Guo, J. and Pan, Y., 2017. The predictive value of serial changes in diaphragm function during the spontaneous breathing trial for weaning outcome: a study protocol. BMJ open, 7(6), e015043.

[21] Llamas-Alvarez, A.M., Tenza-Lozano, E.M. and Latour-Perez, J., 2017. Diaphragm and lung ultrasound to predict weaning outcome: systematic review and meta-analysis. Chest, 152(6), 1140-1150.

[22] Dres, M., Goligher, E.C., Dubé, B.P., Morawiec, E., Dangers, L., Reuter, D., Mayaux, J., Similowski, T. and Demoule, A., 2018. Diaphragm function and weaning from mechanical ventilation: an ultrasound and phrenic nerve stimulation clinical study. Annals of Intensive Care, 8, 1-7.

[23] Goligher, E.C., Dres, M., Fan, E., Rubenfeld, G.D., Scales, D.C., Herridge, M.S., Vorona, S., Sklar, M.C., Rittayamai, N., Lanys, A. and Murray, A., 2018. Mechanical ventilation–induced diaphragm atrophy strongly impacts clinical outcomes. American journal of respiratory and critical care medicine, 197(2), 204-213.

[24] Goligher, E.C., Fan, E., Herridge, M.S., Murray, A., Vorona, S., Brace, D., Rittayamai, N., Lanys, A., Tomlinson, G., Singh, J.M. and Bolz, S.S., 2015. Evolution of diaphragm thickness during mechanical ventilation. Impact of inspiratory effort. American journal of respiratory and critical care medicine, 192(9), 1080-1088.

[25] Glau, C.L., Conlon, T.W., Himebauch, A.S., Yehya, N., Weiss, S.L., Berg, R.A. and Nishisaki, A., 2018. Progressive diaphragm atrophy in pediatric acute respiratory failure. Pediatric critical care medicine: a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 19(5), 406.

[26] Cartwright, M.S., Kwayisi, G., Griffin, L.P., Sarwal, A., Walker, F.O., Harris, J.M., Berry, M.J., Chahal, P.S. and Morris, P.E., 2013. Quantitative neuromuscular ultrasound in the intensive care unit. Muscle & nerve, 47(2), 255-259.

[27] Baldwin, C.E. and Bersten, A.D., 2014. Alterations in respiratory and limb muscle strength and size in patients with sepsis who are mechanically ventilated. Physical therapy, 94(1), 68-82.

[28] Doust, B.D., Baum, J.K., Maklad, N.F. and Doust, V.L., 1975. Ultrasonic evaluation of pleural opacities. Radiology, 114(1), 135-140.

[29] Matamis, D., Soilemezi, E., Tsagourias, M., Akoumianaki, E., Dimassi, S., Boroli, F., Richard, J.C.M. and Brochard, L., 2013. Sonographic evaluation of the diaphragm in critically ill patients. Technique and clinical applications. Intensive care medicine, 39, 801-810.

[30] Testa, A., Soldati, G., Giannuzzi, R., Berardi, S., Portale, G. and Silveri, N.G., 2011. Ultrasound M-mode assessment of diaphragmatic kinetics by anterior transverse scanning in healthy subjects. Ultrasound in medicine & biology, 37(1), 44-52.

[31] Houston, J.G., Morris, A.D., Howie, C.A., Reid, J.L. and McMillan, N., 1992. Technical report: quantitative assessment of diaphragmatic movement—a reproducible method using ultrasound. Clinical radiology, 46(6), 405-407.

[32] Scarlata, S., Mancini, D., Laudisio, A., Benigni, A. and Incalzi, R.A., 2018. Reproducibility and clinical correlates of supine diaphragmatic motion measured by M-mode ultrasonography in healthy volunteers. Respiration, 96(3), 259-266.

[33] Boussuges, A., Gole, Y. and Blanc, P., 2009. Diaphragmatic motion studied by m-mode ultrasonography: methods, reproducibility, and normal values. Chest, 135(2), 391-400.

[34] Houston, J.G., Angus, R.M., Cowan, M.D., McMillan, N.C. and Thomson, N.C., 1994. Ultrasound assessment of normal hemidiaphragmatic movement: relation to inspiratory volume. Thorax, 49(5), pp.500-503.

[35] Haji, K., Royse, A., Green, C., Botha, J., Canty, D. and Royse, C., 2016. Interpreting diaphragmatic movement with bedside imaging, review article. Journal of critical care, 34, 56-65.

[36] Boon, A.J., Harper, C.J., Ghahfarokhi, L.S., Strommen, J.A., Watson, J.C. and Sorenson, E.J., 2013. Two‐dimensional ultrasound imaging of the diaphragm: quantitative values in normal subjects. Muscle & nerve, 47(6), 84-889.

[37] Cardenas, L.Z., Santana, P.V., Caruso, P., de Carvalho, C.R.R. and de Albuquerque, A.L.P., 2018. Diaphragmatic ultrasound correlates with inspiratory muscle strength and pulmonary function in healthy subjects. Ultrasound in medicine & biology, 44(4), 786-793.

[38] Holtzhausen, S., Unger, M., Lupton-Smith, A. and Hanekom, S., 2018. An investigation into the use of ultrasound as a surrogate measure of diaphragm function. Heart & Lung, 47(4), 418-424.

[39] Hellyer, N.J., Andreas, N.M., Bernstetter, A.S., Cieslak, K.R., Donahue, G.F., Steiner, E.A., Hollman, J.H. and Boon, A.J., 2017. Comparison of diaphragm thickness measurements among postures via ultrasound imaging. PM&R, 9(1), 21-25.

[40] Vivier, E., Roche-Campo, F., Brochard, L. and Dessap, A.M., 2017. Determinants of diaphragm thickening fraction during mechanical ventilation: an ancillary study of a randomised trial. European Respiratory Journal, 50(3).

[41] Vivier, E., Roche-Campo, F., Brochard, L. and Dessap, A.M., 2017. Determinants of diaphragm thickening fraction during mechanical ventilation: an ancillary study of a randomised trial. European Respiratory Journal, 50(3).

[42] Gursel, G., Inci, K. and Alasgarova, Z., 2018. Can diaphragm dysfunction be reliably evaluated with pocket-sized ultrasound devices in intensive care units? Critical Care Research and Practice, 2018.

[43] Dres, M., Goligher, E.C., Dubé, B.P., Morawiec, E., Dangers, L., Reuter, D., Mayaux, J., Similowski, T. and Demoule, A., 2018. Diaphragm function and weaning from mechanical ventilation: an ultrasound and phrenic nerve stimulation clinical study. Annals of Intensive Care, 8, 1-7.

[44] Houston, J.G., Fleet, M., Cowan, M.D. and McMillan, N.C., 1995. Comparison of ultrasound with fluoroscopy in the assessment of suspected hemidiaphragmatic movement abnormality. Clinical radiology, 50(2), 95-98.

[45] Zambon, M., Greco, M., Bocchino, S., Cabrini, L., Beccaria, P.F. and Zangrillo, A., 2017. Assessment of diaphragmatic dysfunction in the critically ill patient with ultrasound: a systematic review. Intensive care medicine, 43, 29-38.

[46] Llamas-Alvarez, A.M., Tenza-Lozano, E.M. and Latour-Perez, J., 2017. Diaphragm and lung ultrasound to predict weaning outcome: systematic review and meta-analysis. Chest, 152(6), 1140-1150.

[47] Li, C., Li, X., Han, H., Cui, H., Wang, G. and Wang, Z., 2018. Diaphragmatic ultrasonography for predicting ventilator weaning: a meta-analysis. Medicine, 97(22).

[48] Goligher, E.C., Laghi, F., Detsky, M.E., Farias, P., Murray, A., Brace, D., Brochard, L.J., Sebastien-Bolz, S., Rubenfeld, G.D., Kavanagh, B.P. and Ferguson, N.D., 2015. Measuring diaphragm thickness with ultrasound in mechanically ventilated patients: feasibility, reproducibility, and validity. Intensive care medicine, 41, 642-649.

[49] Kim, W.Y., Suh, H.J., Hong, S.B., Koh, Y., and Lim, C.M., 2011. Diaphragm dysfunction assessed by ultrasonography: influence on weaning from mechanical ventilation. Critical care medicine, 39(12), 2627-2630.

[50] Jiang, J.R., Tsai, T.H., Jerng, J.S., Yu, C.J., Wu, H.D. and Yang, P.C., 2004. Ultrasonographic evaluation of liver/spleen movements and extubation outcome. Chest, 126(1), 179-185.

[51] DiNino, E., Gartman, E.J., Sethi, J.M. and McCool, F.D., 2014. Diaphragm ultrasound as a predictor of successful extubation from mechanical ventilation. Thorax, 69(5), 431-435.

[52] Ferrari, G., De Filippi, G., Elia, F., Panero, F., Volpicelli, G. and Aprà, F., 2014. Diaphragm ultrasound as a new index of discontinuation from mechanical ventilation. Critical ultrasound journal, 6(1), 1-6.

[53] Zhou, P., Zhang, Z., Hong, Y., Cai, H., Zhao, H., Xu, P., Zhao, Y., Lin, S., Qin, X., Guo, J. and Pan, Y., 2017. The predictive value of serial changes in diaphragm function during the spontaneous breathing trial for weaning outcome: a study protocol. BMJ open, 7(6), e015043.

[54] Samanta, S., Singh, R.K., Baronia, A.K., Poddar, B., Azim, A. and Gurjar, M., 2017. Diaphragm thickening fraction to predict weaning—a prospective exploratory study. Journal of intensive care, 5, 1-9.

[55] Blumhof, S., Wheeler, D., Thomas, K., McCool, F.D. and Mora, J., 2016. Change in diaphragmatic thickness during the respiratory cycle predicts extubation success at various levels of pressure support ventilation. Lung, 194, 519-525.

[56] Hayat, A., Khan, A., Khalil, A. and Asghar, A., 2017. Diaphragmatic excursion: Does it predict successful weaning from mechanical ventilation. J Coll Physicians Surg Pak, 27(12), 743-6.

[57] Haji, K., Royse, A., Tharmaraj, D., Haji, D., Botha, J. and Royse, C., 2015. Diaphragmatic regional displacement assessed by ultrasound and correlated to subphrenic organ movement in the critically ill patients—an observational study. Journal of critical care, 30(2), 439-e7.

[58] Yoo, J.W., Lee, S.J., Lee, J.D. and Kim, H.C., 2018. Comparison of clinical utility between diaphragm excursion and thickening change using ultrasonography to predict extubation success. The Korean journal of internal medicine, 33(2), 331.

[59] Dhungana, A., Khilnani, G., Hadda, V. and Guleria, R., 2017. Reproducibility of diaphragm thickness measurements by ultrasonography in patients on mechanical ventilation. World Journal of Critical Care Medicine, 6(4), 185.

[60] Chien, J.Y., Lin, M.S., Huang, Y.C.T., Chien, Y.F., Yu, C.J. and Yang, P.C., 2008. Changes in B-type natriuretic peptide improve weaning outcome predicted by spontaneous breathing trial. Critical care medicine, 36(5), 1421-1426.

[61] Luo, L., Li, Y., Chen, X., Sun, B., Li, W., Gu, W., Wang, S., Zhao, S., Lv, Y., Chen, M. and Xia, J., 2017. Different effects of cardiac and diaphragm function assessed by ultrasound on extubation outcomes in difficult-to-wean patients: a cohort study. BMC Pulmonary Medicine, 17, 1-13.

[62] Silva, S., Ait Aissa, D., Cocquet, P., Hoarau, L., Ruiz, J., Ferre, F., Rousset, D., Mora, M., Mari, A., Fourcade, O. and Riu, B., 2017. Combined thoracic ultrasound assessment during a successful weaning trial predicts postextubation distress. Anesthesiology, 127(4), 666-674.

[63] Haji, K., Haji, D., Canty, D.J., Royse, A.G., Green, C. and Royse, C.F., 2018. The impact of heart, lung, and diaphragmatic ultrasound on prediction of failed extubation from mechanical ventilation in critically ill patients: a prospective observational pilot study. Critical ultrasound journal, 10, 1-12.

[64] Yang, K.L. and Tobin, M.J., 1991. A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation. New England Journal of Medicine, 324(21), 1445-1450.

[65] Karthika, M, Al Enezi, F.A., Pillai, L.V., Arabi, Y.M. Rapid shallow breathing index. Ann Thorac Med, 11(3),167-76 48.

[66] Banerjee, A. and Mehrotra, G., 2018. Comparison of lung ultrasound-based weaning indices with rapid shallow breathing index: are they helpful? Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine, 22(6), 435.

[67] Pirompanich, P. and Romsaiyut, S., 2018. Use of diaphragm thickening fraction combined with rapid shallow breathing index for predicting success of weaning from mechanical ventilator in medical patients. Journal of intensive care, 6, 1-7.

[68] Doorduin, J., Van Hees, H.W., Van Der Hoeven, J.G. and Heunks, L.M., 2013. Monitoring of the respiratory muscles in the critically ill. American journal of respiratory and critical care medicine, 187(1), 20-27.

[69] Zambon, M., Greco, M., Bocchino, S., Cabrini, L., Beccaria, P.F. and Zangrillo, A., 2017. Assessment of diaphragmatic dysfunction in the critically ill patient with ultrasound: a systematic review. Intensive care medicine, 43, 29-38.

[70] Jiang, J.R., Tsai, T.H., Jerng, J.S., Yu, C.J., Wu, H.D. and Yang, P.C., 2004. Ultrasonographic evaluation of liver/spleen movements and extubation outcome. Chest, 126(1), 179-185.

[71] Hu, S., Zhou, S., Wu, D. and Chen, Y., 2016. The predicting value of diaphragm ultrasound for weaning. Acta Universitatis Medicinalis Anhui, 51, 673-7.

[72] Spadaro, S., Grasso, S., Mauri, T., Dalla Corte, F., Alvisi, V., Ragazzi, R., Cricca, V., Biondi, G., Di Mussi, R., Marangoni, E. and Volta, C.A., 2016. Can diaphragmatic ultrasonography performed during the T-tube trial predict weaning failure? The role of diaphragmatic rapid shallow breathing index. Critical Care, 20(1), 1-11.

[73] Farghaly, S. and Hasan, A.A., 2017. Diaphragm ultrasound is a new method to predict extubation outcome in mechanically ventilated patients. Australian Critical Care, 30(1), 37-43.

[74] Xu, S, Bu, Z, Pan, C., 2017. Diaphragm excursion as a predictor of difficult weaning from mechanical ventilation in patients with severe chronic obstructive pulmonary disease. Chin J Crit Care Med, 37,49-53.

[75] Vassilakopoulos, T., Zakynthinos, S. and Roussos, C., 1998. The tension–time index and the frequency/tidal volume ratio are the major pathophysiologic determinants of weaning failure and success. American journal of respiratory and critical care medicine, 158(2), 378-385.

[76] Capdevila X, Perrigault PF, Ramonatxo M, Roustan JP, Peray P, d’Athis F, et al. Changes in breathing pattern and respiratory muscle performance parameters during difficult weaning. Crit Care Med. 1998;26(1):79-87.

[77] Mead, J., 1979. Functional significance of the area of apposition of diaphragm to rib cage. American Review of Respiratory Disease, 119(2P2), 31-32.

[78] Gong, J. and Zhang, B., 2016. A comparative study on predicting outcome of ventilator weaning by diaphragmatic excursion, spontaneous breathing trial and rapid shallow breathing index. Trauma & Critical Care Medicine, 4, 133-7.

[79] Carrie, C., Gisbert-Mora, C., Bonnardel, E., Gauche, B., Biais, M., Vargas, F. and Hilbert, G., 2017. Ultrasonographic diaphragmatic excursion is inaccurate and not better than the MRC score for predicting weaning-failure in mechanically ventilated patients. Anaesthesia Critical Care & Pain Medicine, 36(1), 9-14.

[80] Vivier, E., Mekontso Dessap, A., Dimassi, S., Vargas, F., Lyazidi, A., Thille, A.W. and Brochard, L., 2012. Diaphragm ultrasonography to estimate the work of breathing during non-invasive ventilation. Intensive care medicine, 38, 796-803.

[81] De Jonghe, B., Bastuji-Garin, S., Durand, M.C., Malissin, I., Rodrigues, P., Cerf, C., Outin, H. and Sharshar, T., 2007. Respiratory weakness is associated with limb weakness and delayed weaning in critical illness. Critical care medicine, 35(9).

[82] Supinski, G.S. and Ann Callahan, L., 2013. Diaphragm weakness in mechanically ventilated critically ill patients. Critical care, 17(3), 1-17.

[83] Dubé, B.P., Dres, M., Mayaux, J., Demiri, S., Similowski, T. and Demoule, A., 2017. Ultrasound evaluation of diaphragm function in mechanically ventilated patients: comparison to phrenic stimulation and prognostic implications. Thorax, 72(9), 811-818.