Abstract
BackgroundThe most characteristic clinical signs of stroke are motor and/or sensory involvement of one side of the body. Respiratory involvement has also been described, which could be related to diaphragmatic dysfunction contralateral to the brain injury. Our objective is to establish the incidence of diaphragmatic dysfunction in ischaemic stroke and analyse the relationship between this and the main prognostic markers.MethodsA prospective study of 60 patients with supratentorial ischaemic stroke in the first 48 h. Demographic and clinical factors were recorded. A diaphragmatic ultrasound was performed for the diagnosis of diaphragmatic dysfunction by means of the thickening fraction, during normal breathing and after forced inspiration. Diaphragmatic dysfunction was considered as a thickening fraction lower than 20%. The appearance of respiratory symptoms, clinical outcomes and mortality were recorded for 6 months. A bivariate and multivariate statistical analysis was designed to relate the incidence of respiratory involvement with the diagnosis of diaphragmatic dysfunction and with the main clinical determinants.ResultsAn incidence of diaphragmatic dysfunction of 51.7% was observed. 70% (23 cases) of these patients developed symptoms of severe respiratory compromise during follow-up. Independent predictors were diaphragmatic dysfunction in basal respiration (p = 0.026), hemiparesis (p = 0.002) and female sex (p = 0.002). The cut-off point of the thickening fraction with greater sensitivity (75.75%) and specificity (62.9%) was 24% (p = 0.003).ConclusionsThere is a high incidence of diaphragmatic dysfunction in patients with supratentorial ischaemic stroke which can be studied by calculating the thickening fraction on ultrasound. Among these patients we have detected a higher incidence of severe respiratory involvement.
Highlights
The most characteristic clinical signs of stroke are motor and/or sensory involvement of one side of the body
Patients diagnosed with supratentorial ischaemic stroke in the first 48 h of hospital admission to a stroke unit or critical care unit were selected from the period between 1 November 2017 and 1 May 2018
The exclusion criteria were: infratentorial ischaemic stroke, patients not collaborating with the diaphragmatic ultrasonography, non-evaluable study of the thickening fraction (TF), use of maintained assisted ventilation in the first 48 h of hospital stay, and patients with a medical history that could interfere with diaphragmatic mobility, such as known previous diaphragmatic dysfunction, history of chest and upper abdominal surgery, previous chest injury and previous hemiparesis leading to significant functional limitation, defined by the mRS scale (Modified Rankin Scale) as 3 or higher
Summary
The most characteristic clinical signs of stroke are motor and/or sensory involvement of one side of the body. The motor and/or sensory involvement of one side of the body is the predominant clinical sign, though there are respiratory disorders which for the moment are poorly characterised in the literature. These depend on the location and extent of the neurological injury [4]. They can be attributed to changes in respiratory mechanics due to involvement of the respiratory control centres or weakness of respiratory muscles [4] They usually manifest as respiratory failure, atelectasis, lung infections or sleep disturbances [5,6,7]. Diaphragmatic dysfunction is another potential mechanism of respiratory impairment in stroke [8]
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