Year : 2018  |  Volume : 12  |  Issue : 2  |  Page : 218-225

Assessment of ventilator-induced diaphragmatic dysfunction in patients with chronic obstructive pulmonary disease using transthoracic ultrasonography

Chest Department, Faculty of Medicine, Assiut University Hospital, Assuit, Egypt

Correspondence Address:
Shereen Farghaly
Chest Department, Faculty of Medicine, Assiut University Hospital, Assiut University Hospital, Assuit 7111
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ejb.ejb_99_17

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Background Mechanical ventilation (MV) can cause progressive thinning of diaphragm muscle and hence progressive decrease in diaphragmatic function. We aimed to assess the rate at which diaphragm thickness (tdi) changed during MV and its effect on weaning outcome using transthoracic ultrasound (TUS) evaluation in patients with chronic obstructive pulmonary disease (COPD). Patients and methods Thirty mechanically ventilated patients with COPD were enrolled in this cohort study. Baseline tdi was recorded within 24 h of MV after stoppage of sedation using TUS. The subsequent measurements were recorded on the third, fifth, and seventh day of MV and at the time of initiation of weaning. Results There was a significant decrease in tdi at end expiration and at end inspiration by approximately 27.2 and 17% at third day of MV, respectively, and 35.5 and 18.5% at fifth day of MV, respectively, compared with baseline parameters. In the 10 patients who were still on ventilator till the seventh day, tdi were significantly lower compared with baseline recordings. Percentage of decrease of tdi at end inspiration from baseline recordings was significantly higher in patients with difficult weaning than in those with simple weaning. The optimum cutoff value of % of decline of tdi at end inspiration associated with difficult weaning was at least 10.6% giving 88.9% sensitivity and 83.3% specificity. Conclusion MV is associated with gradual diaphragmatic atrophy which can be detected by TUS and could predict weaning outcome in mechanically ventilated patients with COPD.

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