USEFULNESS OF DIAPHRAGM ECOINTENSITY FOR THE MANAGEMENT OF PATIENTS WITH AMYOTROPHIC LATERAL SCLEROSIS

Abstract

<b>Introduction:</b> Ecointensity (EI) helps to characterize muscle attributes using a gray-scale that can be quantified. Therefore, it may be important to describe the functional status of the diaphragm in amyotrophic lateral sclerosis (ALS) in order to determine the need for non-invasive ventilation (NIV). <b>Methods:</b> We conducted a prospective observational study including patients with ALS. Demographic, clinical, respiratory and ultrasound variables were collected. M-mode images were obtained using a linear probe at 13MHz with the GE HealthCare Logic F7 ultrasound system with the patient in the supine position at 45º. The image was obtained at the end of expiration and was quantified with ImageJ software by means of image analysis with a histogram on a gray-scale. <b>Results:</b> 24 patients with ALS were enrolled (60,9% men, 65,45 +/− 13,07 years). 75% of them with spinal onset, 65,2% under ventilation, 70,1% with cough assist devices and 45,8% with percutaneous endoscopic gastrostomy.&nbsp;They were divided in two groups depending on whether they are ventilated or not.&nbsp;In the multivariate analysis, EI&nbsp;was the only variable capable of predicting the use of ventilation (OR 1.117, 95% CI 1.007-1.239, p=0.036). The ROC curves identified the cut-off point of 54,41 (S 81,3% E 100%) with and AUC of 0,867 to predict the start of NIV. Conclusions:&nbsp;Diaphragmatic echointensity may be useful in determining the need for NIV in patients with ALS.