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01-05-2012 | Original

Diaphragm ultrasonography to estimate the work of breathing during non-invasive ventilation

Authors: Emmanuel Vivier, Armand Mekontso Dessap, Saoussen Dimassi, Frederic Vargas, Aissam Lyazidi, Arnaud W. Thille, Laurent Brochard

Published in: Intensive Care Medicine | Issue 5/2012

Abstract

Purpose

Ultrasonography allows the direct observation of the diaphragm. Its thickness variation measured in the zone of apposition has been previously used to diagnose diaphragm paralysis. We assessed the feasibility and accuracy of this method to assess diaphragmatic function and its contribution to respiratory workload in critically ill patients under non-invasive ventilation.

Methods

This was a preliminary physiological study in the intensive care unit of a university hospital. Twelve patients requiring planned non-invasive ventilation after extubation were studied while spontaneously breathing and during non-invasive ventilation at three levels of pressure support (5, 10 and 15 cmH₂O). Diaphragm thickness was measured in the zone of apposition during tidal ventilation and the thickening fraction (TF) was calculated as (thickness at inspiration − thickness at expiration)/thickness at expiration. Diaphragmatic pressure–time product per breath (PTP_di) was measured from oesophageal and gastric pressure recordings.

Results

PTP_di and TF both decreased as the level of pressure support increased. A significant correlation was found between PTP_di and TF (ρ = 0.74, p < 0.001). The overall reproducibility of TF assessment was good but the coefficient of repeatability reached 18 % for inter-observer reproducibility.

Conclusions

Ultrasonographic assessment of the diaphragm TF is a non-invasive method that may prove useful in evaluating diaphragmatic function and its contribution to respiratory workload in intensive care unit patients.

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Title: Diaphragm ultrasonography to estimate the work of breathing during non-invasive ventilation
Authors: Emmanuel Vivier
Armand Mekontso Dessap
Saoussen Dimassi
Frederic Vargas
Aissam Lyazidi
Arnaud W. Thille
Laurent Brochard
Publication date: 01-05-2012
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 5/2012
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-012-2547-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Diaphragm ultrasonography to estimate the work of breathing during non-invasive ventilation

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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