scholarly journals Feasability of Diaphragmatic Speckle Tracking In Intensive Care Units

2021 ◽  
Author(s):  
Michael Poette ◽  
Laure Crognier ◽  
Fanny Vardon-Bounes ◽  
Stéphanie Ruiz ◽  
Bernard Georges ◽  
...  
Keyword(s):  
Intensive Care ◽  
Strain Rate ◽  
Intensive Care Units ◽  
Strongly Correlated ◽  
Diaphragmatic Dysfunction ◽  
Good Reliability ◽  
Diaphragmatic Function ◽  
Strain And Strain Rate ◽  
Measured Strain ◽  
The Right

Abstract Background: Diaphragmatic dysfunction is a common condition in intensive care units (ICU). Its presence correlates with prolonged weaning from mechanical ventilation and mortality. Diaphragmatic excursion (EXdi) and thickening fraction (TFdi) are the 2 main measures currently described in diaphragmatic ultrasound, but each has its limitations. Strain and strain rate are already used cardiac sonography and could be of interest in the assessment of diaphragmatic function in ICU. The aim of this work was to evaluate the feasibility of diaphragmatic strain and strain rate in ICU and to describe their distribution, reproducibility and agreement with existing parameters. Methods: All patients who underwent a T-tube weaning test were prospectively included. Ultrasound loops were recorded on each side of the patient during the last 30 minutes of the weaning test. Two operators measured strain, strain rate, EXdi, and TFdi blind to each other in post-treatment analysis. Results: Thirty patients were analyzed. The median values for strain and strain rate were -6.74% and -0.23.s-1 on the left side and -8.17% and -0.22.s-1 on the right side. Concerning strain and strain rate, intra-class coefficients showed systematically a very good reliability between operators. Conclusion: Diaphragmatic strain and strain rate measurements appeared feasible in an ICU environment and seemed reproducible and not strongly correlated with EXdi and TFdi. An improvement of the analysis software is needed to improve the ease of interpretation. The interest of these parameters in clinical practice should be explored in forthcoming studies.

scholarly journals Bloodstream infections among patients using central venous catheters in intensive care units

2007 ◽  
Vol 15 (3) ◽  
pp. 453-459 ◽  
Author(s):  
Eni Rosa Aires Borba Mesiano ◽  
Edgar Merchán-Hamann
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Analytical Study ◽  
Hospital Costs ◽  
Bloodstream Infections ◽  
Federal District ◽  
Central Venous Catheters ◽  
Central Venous ◽  
Catheter Group ◽  
The Right

Central Venous Catheters (CVC), widely used in Intensive Care Units (ICU) are important sources of bloodstream infections (BSI). This prospective cohort epidemiological analytical study, aimed to infer the incidence of BSI, the risk factors associated and evaluate the care actions related to the use of these catheters in seven ICU in the Federal District - Brasília, Brazil. From the 630 patients using CVC, 6.4% developed BSI (1.5% directly related to the catheter and 4.9% clinic BSI). The hospitalization term was 3.5 times greater among these patients. Different modalities of catheter insertion and antiseptic substances use were observed. Time of CVC permanence was significantly associated to infection incidence (p<1x10-8) as well as the right subclavian access and double-lumen catheters. Patients with neurological disorders and those submitted to tracheotomy were the most affected. We suggest the organization of a "catheter group" aiming to standardize procedures related to the use of catheters in order to reduce the hospitalization term and hospital costs.

scholarly journals MRI Assessment of Global and Regional Diaphragmatic Motion in Critically Ill Patients Following Prolonged Ventilator Weaning

2019 ◽  
Vol 7 (5) ◽  
pp. 66
Author(s):  
Khurram Saleem Khan ◽  
James Meaney ◽  
Ignacio Martin-Loeches ◽  
Daniel V. Collins
Keyword(s):  
Intensive Care ◽  
Vertical Displacement ◽  
Interquartile Range ◽  
Control Group ◽  
P Value ◽  
Diaphragmatic Dysfunction ◽  
Intensive Care Patients ◽  
The Right ◽  
Ventilated Patients ◽  
Left Hemi

Introduction: diaphragmatic dysfunction is a common cause of slow weaning in mechanically ventilated patients. Diaphragmatic dysfunction in ventilated patients can be global or regional. The aim of our study was to evaluate the motion of the entire diaphragm in patients who were ventilated for a protracted period in comparison with healthy controls by using Magnetic Resonance Imaging (MRI). Methods: Intensive care patients who had a prolonged ventilator wean and required tracheostomies were enrolled based on extensive exclusion criteria. MRI dynamic sequence and subtraction images were used to measure vertical displacement at five different points on each hemi-diaphragm during normal tidal breathing. Tidal displacement of each point on the right and left hemi-diaphragms of the patients were compared to the precise respective points on the right and left hemi-diaphragms of enrolled controls. Results: Eight intensive care patients and eight controls were enrolled. There were observed significant differences in the displacements of the left hemi-diaphragm between the two groups (median 6.4 mm [Interquartile range (IQR), 4.6–12.5]) vs. 11.6 mm [IQR, 9.5–14.5], p = 0.02). There were also observed significant differences in the displacements at five evaluated study points on the left hemi-diaphragms of the patients when compared to the precise respective points in controls, especially at the dome (median 6.7 mm [IQR, 5.0–11.4] vs. 13.5 mm [IQR 11.5-18], p value = 0.005) and the anterior zone of apposition (median 5.0 mm [IQR, 3.3–7.1] vs. 7.8mm [IQR, 7.1–10.5], p value = 0.01). The intensive care patients showed lower minimal and maximal values of displacement of right hemi-diaphragms compared to the controls, suggesting that the differences in the displacement of right hemi-diaphragm are possible; however, the differences in the mean values of displacement of right hemi-diaphragm between the intensive care patient group and the control group (median 9.8 mm [IQR (Interquartile range), 5.0–12.3] vs. 10.1 mm [IQR 8.3–18.5], p = 0.12) did not reach the level of significance. Conclusion: Although frequently global, diaphragm dysfunction in ventilated patients after prolonged ventilation can also be regional or focal when assessed by MRI dynamic sequence. The vertical displacement of both right and left hemi-diaphragms at various anatomical locations had different values in both controls, and patients. There were significant focal variations in the movement of diaphragm in patients with ventilator-induced diaphragmatic dysfunction.

scholarly journals Evaluation of the right ventricular function in hypertrophic obstructive cardiomyopathy: a strain and tissue Doppler study

2010 ◽  
pp. 697-702
Author(s):  
D Zemánek ◽  
P Tomašov ◽  
P Přichystalová ◽  
K Linhartová ◽  
J Veselka
Keyword(s):  
Strain Rate ◽  
Hypertrophic Obstructive Cardiomyopathy ◽  
Tissue Doppler ◽  
Doppler Imaging ◽  
Ejection Time ◽  
Alcohol Septal Ablation ◽  
Strain And Strain Rate ◽  
Doppler Study ◽  
Diastolic Velocity ◽  
The Right

We investigated the utility of strain, strain rate, and tissue Doppler imaging (TDI) for the evaluation of the right ventricle (RV) impairment in patients with a hypertrophic obstructive cardiomyopathy (HOCM) who underwent a successful alcohol septal ablation (ASA) and were without RV hypertrophy. A group of 19 patients suffering from HOCM with 22 controls was compared. The parameters of TDI were evaluated in mitral and tricuspid annulus. Strain and strain rate derived from TDI were assessed in an apical free wall of RV, as well as in basal segments of the left ventricle. Between both groups, there were significant differences only in isovolumic pre-ejection time (79.2±17.3 ms vs. 58.5±8.1 ms, p<0.01), isovolumic relaxation time (104.7±26.2 ms vs. 77.3±24.5 ms, p<0.01), myocardial performance (Tei) index measured from TDI (0.61±0.14 vs. 0.49±0.09, p<0.01), and early peak diastolic velocity of TDI (10.6±1.67 cm/s vs. 12.6±2.21 cm/s; p<0.05). Our results suggest the impairment of both systolic and diastolic RV function in patients suffering from HOCM. TDI-related parameters appear to be more sensitive than strain and strain rate for evaluation.

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