diaphragmatic dysfunction
Recently Published Documents


TOTAL DOCUMENTS

242
(FIVE YEARS 93)

H-INDEX

28
(FIVE YEARS 3)

2022 ◽  
pp. rapm-2021-102962
Author(s):  
Constantin Robles ◽  
Nick Berardone ◽  
Steven Orebaugh

BackgroundThe interscalene brachial plexus block has been used effectively for intraoperative and postoperative analgesia in patients undergoing shoulder surgery, but it is associated with high rates of diaphragmatic dysfunction. Performing the block more distally, at the level of the superior trunk, may reduce the incidence of phrenic nerve palsy. We hypothesized that superior trunk block would result in diaphragmatic paralysis rate of less than 20%.Methods30 patients undergoing arthroscopic shoulder surgery received superior trunk block under ultrasound guidance. Measurements of diaphragm excursion were determined with ultrasound prior to the block, 15 min after the block, and postoperatively in phase II of postanesthesia care unit, in conjunction with clinical parameters of respiratory function.Results10 patients (33.3%, 95% CI 17.3% to 52.8%) developed complete hemidiaphragmatic paralysis at the postoperative assessment. An additional eight patients (26.7%) developed paresis without paralysis. Of the 18 patients with diaphragm effects, seven (38.9%) reported dyspnea. 83.3% of patients with abnormal diaphragm motion (56.7% of the total sample) had audibly reduced breath sounds on auscultation. Oxygen saturation measurements did not correlate with diaphragm effect and were not significantly reduced by the postoperative assessment.ConclusionAlthough injection of local anesthetic at the superior trunk level is associated with less diaphragmatic paralysis compared with traditional interscalene block, a significant portion of patients will continue to have ultrasonographic and clinical evidence of diaphragmatic weakness or paralysis.


2021 ◽  
Vol 15 (1) ◽  
pp. 82-87
Author(s):  
Sebastián Lux ◽  
Daniel Ramos ◽  
Andrés Pinto ◽  
Sara Schilling ◽  
Mauricio Salinas

The diaphragm is the most important respiratory muscle, and its function may be limited by acute and chronic diseases. A diaphragmatic ultrasound, which quantifies dysfunction through different approaches, is useful in evaluating work of breathing and diaphragm atrophy, predicting successful weaning, and diagnosing critically ill patients. This technique has been used to determine reduced diaphragmatic function in patients with chronic obstructive pulmonary disease and interstitial diseases, while in those with COVID-19, diaphragmatic ultrasound has been used to predict weaning failure from mechanical ventilation.


2021 ◽  
pp. 107815522110674
Author(s):  
Cinzia Baldessari ◽  
Giuseppe Pugliese ◽  
Marta Venturelli ◽  
Stefano Greco ◽  
Leonardo Ferrara ◽  
...  

Introduction Immunotherapy dramatically changed history of melanoma patients with a clinical benefit never seen before. Nevertheless, severe and unexpected adverse effects can occur, fortunately rarely. Case presentation We reported the case of a 75-year-old male patient affected by metastatic melanoma who developed myocarditis and acute rhabdomyolysis with secondary diaphragmatic dysfunction and consequent pulmonary restrictive syndrome after Nivolumab monotherapy. Blood tests and ultrasonography of the diaphragm revealing left hypokinesis suggested a Nivolumab-related rhabdomyolysis, as an immune-mediated adverse event. The rhabdomylolysis involved the diaphragm with consequent diaphragmatic weakness and respiratory distress. Mangement & outcome The patient had a slow but slight and progressive improvement of symptoms and vital signs post-treatment with high-dose corticosteroids. Discussion With this case report, we want to highlight the importance of rapid recognition and treatment of rare and unexpected, but potential serious immune-related adverse events. These events might happen despite the remarkable clinical benefits of immune checkpoint inhibitors. We do not know which patients will benefit from these therapies and why, when and in which cases adverse event will occur: we must not lower our attention.


2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Hebert Olímpio Júnior ◽  
Gustavo Bittencourt Camilo ◽  
Aline Priori Fioritto ◽  
Agnaldo José Lopes

Background. Critically ill patients admitted to intensive care units (ICUs) may develop diaphragmatic dysfunction, especially when artificial airways are used. Positive effects have been observed when using the transcutaneous electrical diaphragmatic stimulation (TEDS) technique in different clinical conditions. However, no study has evaluated the safety of TEDS in patients admitted to ICUs. This study is aimed at evaluating the influence of TEDS on the hemodynamic and vital parameters of critically ill elderly patients under invasive mechanical ventilation (IMV). Methods. Forty-seven patients aged >60 years under IMV were evaluated for hemodynamic variables before and after TEDS. The procedure lasted 30 minutes and was performed once. Results. The sample consisted of 33 men and 14 women with a mean age of 69.9 ± 7.64 years. The mean systolic blood pressures pre-TEDS and post-TEDS were 126.6 ± 23.7 and 122.9 ± 25.9 , respectively ( p = 0.467 ). The mean diastolic blood pressures pre-TEDS and post-TEDS were 71.1 ± 12.2 and 67.7 ± 14.2 , respectively ( p = 0.223 ). No significant differences in the mean arterial pressure or heart rate were found between the pre-TEDS and post-TEDS time points ( p = 0.335 and p = 0.846 , respectively). Conclusion. Our findings suggest that TEDS does not have clinically relevant impacts on hemodynamic or vital parameters in critically ill elderly patients. These findings point to the possible safety of TEDS application in this population.


2021 ◽  
Author(s):  
Michael Poette ◽  
Laure Crognier ◽  
Fanny Vardon-Bounes ◽  
Stéphanie Ruiz ◽  
Bernard Georges ◽  
...  

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.


Author(s):  
Laurike Harlaar ◽  
Pierluigi Ciet ◽  
Gijs van Tulder ◽  
Esther Brusse ◽  
Remco G.M. Timmermans ◽  
...  

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Michal Soták ◽  
Karel Roubík ◽  
Tomáš Henlín ◽  
Tomáš Tyll

Abstract Background Diaphragm atrophy and dysfunction is a major problem among critically ill patients on mechanical ventilation. Ventilator-induced diaphragmatic dysfunction is thought to play a major role, resulting in a failure of weaning. Stimulation of the phrenic nerves and resulting diaphragm contraction could potentially prevent or treat this atrophy. The subject of this study is to determine the effectiveness of diaphragm stimulation in preventing atrophy by measuring changes in its thickness. Methods A total of 12 patients in the intervention group and 10 patients in the control group were enrolled. Diaphragm thickness was measured by ultrasound in both groups at the beginning of study enrollment (hour 0), after 24 hours, and at study completion (hour 48). The obtained data were then statistically analyzed and both groups were compared. Results The results showed that the baseline diaphragm thickness in the interventional group was (1.98 ± 0.52) mm and after 48 hours of phrenic nerve stimulation increased to (2.20 ± 0.45) mm (p=0.001). The baseline diaphragm thickness of (2.00 ± 0.33) mm decreased in the control group after 48 hours of mechanical ventilation to (1.72 ± 0.20) mm (p<0.001). Conclusions Our study demonstrates that induced contraction of the diaphragm by pacing the phrenic nerve not only reduces the rate of its atrophy during mechanical ventilation but also leads to an increase in its thickness – the main determinant of the muscle strength required for spontaneous ventilation and successful ventilator weaning. Trial registration: The study was registered with ClinicalTrials.gov (18/06/2018, NCT03559933, https://clinicaltrials.gov/ct2/show/NCT03559933).


CHEST Journal ◽  
2021 ◽  
Vol 160 (4) ◽  
pp. A2513
Author(s):  
Jan Fouad ◽  
Lauren Killingsworth ◽  
Margaret Pisani

Sign in / Sign up

Export Citation Format

Share Document