Poor Correlation between Diaphragm Thickening Fraction and Transdiaphragmatic Pressure in Mechanically Ventilated Patients and Healthy Subjects

2021 ◽  
Author(s):  
Thomas Poulard ◽  
Damien Bachasson ◽  
Quentin Fossé ◽  
Marie-Cécile Niérat ◽  
Jean-Yves Hogrel ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Healthy Subjects ◽  
Healthy Individuals ◽  
Transdiaphragmatic Pressure ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Diaphragm Function ◽  
Pressure Time ◽  
Pressure Time Product ◽  
Ventilated Patients

Background The relationship between the diaphragm thickening fraction and the transdiaphragmatic pressure, the reference method to evaluate the diaphragm function, has not been clearly established. This study investigated the global and intraindividual relationship between the thickening fraction of the diaphragm and the transdiaphragmatic pressure. The authors hypothesized that the diaphragm thickening fraction would be positively and significantly correlated to the transdiaphragmatic pressure, in both healthy participants and ventilated patients. Methods Fourteen healthy individuals and 25 mechanically ventilated patients (enrolled in two previous physiologic investigations) participated in the current study. The zone of apposition of the right hemidiaphragm was imaged simultaneously to transdiaphragmatic pressure recording within different breathing conditions, i.e., external inspiratory threshold loading in healthy individuals and various pressure support settings in patients. A blinded offline breath-by-breath analysis synchronously computed the changes in transdiaphragmatic pressure, the diaphragm pressure-time product, and diaphragm thickening fraction. Global and intraindividual relationships between variables were assessed. Results In healthy subjects, both changes in transdiaphragmatic pressure and diaphragm pressure-time product were moderately correlated to diaphragm thickening fraction (repeated measures correlation = 0.40, P < 0.0001; and repeated measures correlation = 0.38, P < 0.0001, respectively). In mechanically ventilated patients, changes in transdiaphragmatic pressure and thickening fraction were weakly correlated (repeated measures correlation = 0.11, P = 0.008), while diaphragm pressure-time product and thickening fraction were not (repeated measures correlation = 0.04, P = 0.396). Individually, changes in transdiaphragmatic pressure and thickening fraction were significantly correlated in 8 of 14 healthy subjects (ρ = 0.30 to 0.85, all P < 0.05) and in 2 of 25 mechanically ventilated patients (ρ = 0.47 to 0.64, all P < 0.05). Diaphragm pressure-time product and thickening fraction correlated in 8 of 14 healthy subjects (ρ = 0.41 to 0.82, all P < 0.02) and in 2 of 25 mechanically ventilated patients (ρ = 0.63 to 0.66, all P < 0.01). Conclusions Overall, diaphragm function as assessed with transdiaphragmatic pressure was weakly related to diaphragm thickening fraction. The diaphragm thickening fraction should not be used in healthy subjects or ventilated patients when changes in diaphragm function are evaluated. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Psychophysiologic responses of mechanically ventilated patients to music: a pilot study

1995 ◽  
Vol 4 (3) ◽  
pp. 233-238 ◽  
Author(s):  
LL Chlan
Keyword(s):  
Heart Rate ◽  
Respiratory Rate ◽  
Repeated Measures ◽  
Mood States ◽  
Profile Of Mood States ◽  
Music Listening ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Over Time ◽  
Ventilated Patients

BACKGROUND: Although mechanically ventilated patients experience numerous stressors, they have not been included in music therapy stress reduction and relaxation studies. OBJECTIVE: To examine selected psychophysiologic responses of mechanically ventilated patients to music. METHODS: A two-group experimental design with pretest, posttest, and repeated measures was used. Twenty mechanically ventilated patients were randomized to a music-listening group or a nonmusic (headphones only) group. Physiologic dependent measures--heart rate and rhythm, respiratory rate, systolic and diastolic blood pressure, oxygen saturation, and airway pressure--were collected at timed intervals. Psychologic data were collected before and after intervention using the Profile of Mood States. RESULTS: Using repeated measures analysis of variance, results for heart rate and respiratory rate over time and over time between groups were significant. Between-group differences were significant for respiratory rate. Significant differences were found via t test for the music group's Profile of Mood States scores. No adverse cardiovascular responses were noted for either group. CONCLUSIONS: Data indicated that music listening decreased heart rate, respiratory rate, and Profile of Mood States scores, indicating relaxation and mood improvement.

scholarly journals Role of Bedside Ultrasonography in Assessment of Diaphragm Function as a Predictor of Success of Weaning in Mechanically Ventilated Patients

2020 ◽  
Vol 83 (4) ◽  
pp. 295-302
Author(s):  
Mostafa Ibrahim Elshazly ◽  
Khaled Mahmoud kamel ◽  
Reem Ibrahim Elkorashy ◽  
Mohamed Said Ismail ◽  
Jumana Hesham Ismail ◽  
...  
Keyword(s):  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Diaphragm Function ◽  
Predictor Of Success ◽  
Bedside Ultrasonography ◽  
Ventilated Patients

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

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Benjamin Coiffard ◽  
Stephen Riegler ◽  
Michael C. Sklar ◽  
Martin Dres ◽  
Stefannie Vorona ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Healthy Subjects ◽  
Prolonged Mechanical Ventilation ◽  
Skewed Distribution ◽  
Initial Increase ◽  
Diaphragm Thickness ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Over Time ◽  
Ventilated Patients

Abstract 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; 85th 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 R2 = 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.

scholarly journals Influence of Dexmedetomidine on Diaphragm Function and Postoperative Outcomes in ICU Patients with Mechanical Ventilation

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Chengda Zhao ◽  
Meihua Huang ◽  
Baiyun Wang ◽  
Huanhui Zhong ◽  
Wen Meng
Keyword(s):  
Mechanical Ventilation ◽  
Success Rate ◽  
Ventilator Weaning ◽  
Postoperative Outcomes ◽  
Control Group ◽  
Diaphragm Thickness ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Diaphragm Function ◽  
Ventilated Patients

Objective. To probe into the influence of dexmedetomidine (DEX) on diaphragm function and postoperative outcomes of mechanically ventilated patients in the intensive care unit (ICU). Methods. 84 patients with mechanical ventilation (MV) in the ICU of our hospital were selected as the research participants, including 38 patients in the control group (CG) sedated with midazolam (MZ) and 46 patients in the research group (RG) with DEX sedation. Ramsay sedation score, visual analogue scale (VAS), and restlessness score (RS) were used to evaluate their state before sedation (T0), as well as 2 h (T1), 6 h (T2), and 24 h (T3) after sedation, and the alterations of mean arterial pressure (MAP) and heart rate (HR) were recorded. Serum cortisol (Cor), adrenocorticotropic hormone (ACTH), superoxide dismutase (SOD), malondialdehyde (MDA), interleukin- (IL-) 1β, IL-6, and tumor necrosis factor-α (TNF-α) were measured before and 24 h after sedation. The end-inspiratory diaphragm thickness (DTei) and end-expiratory diaphragm thickness (DTee) were measured within 2 h after the initiation of MV and 5 min after the spontaneous breathing test (SBT), and the diaphragm thickening fraction (DTF) was calculated. Finally, the ventilator weaning, MV time, and the incidence of adverse reactions (ADs) of the two groups were counted. Results. T0 and T3 witnessed no distinct difference in Ramsay, VAS, and RS scores between the two arms ( P > 0.05 ), but at T1 and T2, RG had better sedation state and lower VAS and RS scores than CG ( P < 0.05 ), with more stable vital signs ( P < 0.05 ). After sedation, the contents of oxidative stress and inflammatory factors in RG were lower, while DTee, DTei, and DTF were higher, versus CG ( P < 0.05 ). Moreover, RG presented higher success rate of first ventilator weaning, less MV time, and lower incidence of ADs than CG ( P < 0.05 ). Conclusions. DEX is effective in mechanically ventilated patients in the ICU, which can protect patients against diaphragm function damage, improve the success rate of ventilator weaning, and benefit the postoperative outcome, with excellent and rapid sedation effect and less stress damage to patients.

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