Incidence Of Diaphragmatic Dysfunction Research Articles

The Incidence of Diaphragmatic Dysfunction in Patients Presenting With Dyspnea in the Emergency Department.

Diaphragmatic dysfunction has been reported as a cause of dyspnea, and its diagnosis can be made using ultrasound. Diaphragmatic ultrasound is mainly used to predict respiratory failure in chronic conditions. The use of diaphragmatic ultrasound has also risen in acute settings, such as emergency departments (EDs). However, the number of studies on its use still needs to be increased. The present study aimed to find the incidence of diaphragmatic dysfunction in the ED. This prospective cohort study was conducted in an ED. We enrolled patients aged greater than 18 years who presented with dyspnea. Diaphragmatic excursion and diaphragmatic thickness techniques were performed. The primary outcome was the incidence of diaphragmatic dysfunction. The secondary outcomes were the associations between diaphragmatic dysfunction and the composition of respiratory therapies within 24hours, intubation within 24hours, and 7-day mortality. A total of 237 patients were analyzed. The incidences of diaphragmatic dysfunction assessed by diaphragmatic excursion and diaphragm thickness were 22.4 and 32.1%, respectively. Patients with sepsis and cancer had the highest incidences. Diaphragmatic dysfunction assessed by both techniques was not associated with the composition of respiratory support therapies within 24hours, intubation within 24hours, or 7-day mortality. The incidence of diaphragmatic dysfunction in dyspneic patients in the ED ranged from 22.4 to 32.1%, depending on the ultrasound technique. Diaphragmatic dysfunction was not associated with the composition of respiratory support therapies, intubation, or mortality.

Effects of Unilateral Intermediate Cervical Plexus Block on the Diaphragmatic Function in Patients Undergoing Unilateral Thyroidectomy: A Randomized Controlled Study.

Background and PurposeAlthough unilateral intermediate cervical plexus block (ICPB) can be used for perioperative analgesia in neck surgery, its effect on diaphragm function remains controversial. This prospective study aimed to examine whether unilateral ICPB with different concentrations of ropivacaine resulted in the diaphragmatic dysfunction in unilateral thyroidectomy.MethodsA total of 54 patients scheduled to undergo unilateral thyroidectomy under general anesthesia were randomly allocated to receive either 10 mL of 0.3% (Group L) or 0.5% (Group H) ropivacaine for ICPB. General anesthesia was then administered for surgery. The diaphragm thickness and diaphragmatic excursion were measured at three different times: before the ICPB, at 40 min and 4 h after the block. The primary outcome was the incidence of diaphragmatic dysfunction of the block side at 40 min and 4 h after ICPB. Secondary outcomes included the maximum pain score within 24 h after the surgery, rescue analgesics within 24 h after the surgery, and time to first ambulation.ResultsThe incidence of diaphragmatic dysfunction on the block side of Group H was higher than that of Group L at 40 min after block (58% vs 29%, P = 0.01). However, the incidence of diaphragmatic dysfunction was comparable between Group H and Group L (65% vs 46%) at 4 h after block placement. Within 24 h after the operation, the maximum VAS pain score of Group H was significantly lower than Group L (P = 0.04), and fewer patients in Group H required rescue analgesics (P < 0.01).ConclusionThe ICPB with different concentrations of ropivacaine can induce the ipsilateral diaphragmatic dysfunction. The high concentration of ropivacaine results in higher incidence of diaphragmatic dysfunction at 40 min, but comparable incidence at 4 h after block compared with lower concentration of ropivacaine.Chinese Clinical Trial RegistryChiCTR2000029348.

Assessment of Diaphragm in Hemiplegic Patients after Stroke with Ultrasound and Its Correlation of Extremity Motor and Balance Function.

Background: A variety of functional disorders can be caused after stroke, among which impairment of respiratory function is a frequent and serious complication of stroke patients. The aim of this study was to examine diaphragmatic function after stroke by diaphragm ultrasonography and then to apply to explore its correlation with extremity motor function and balance function of the hemiplegia patients. Methods: This cross-sectional observational study recruited 48 hemiplegic patients after stroke and 20 matched healthy participants. The data of demographic and ultrasonographic assessment of all healthy subjects were recorded, and 45 patients successfully underwent baseline data assessment in the first 48 h following admission, including post-stroke duration, stroke type, hemiplegia side, pipeline feeding, pulmonary infection, ultrasonographic assessment for diaphragm, Fugl–Meyer Motor Function Assessment Scale (FMA Scale), and Berg Balance Scale assessment. Ultrasonographic assessment parameters included diaphragm mobility under quiet and deep breathing, diaphragm thickness at end-inspiratory and end-expiratory, and calculated thickening fraction of the diaphragm. The aim was to analyze the diaphragm function of hemiplegic patients after stroke and to explore its correlation with extremity motor function and balance function. Results: The incidence of diaphragmatic dysfunction under deep breath was 46.67% in 45 hemiplegia patients after stroke at the convalescent phase. The paralyzed hemidiaphragm had major impairments, and the mobility of the hemiplegic diaphragm was significantly reduced during deep breathing (p < 0.05). Moreover, the thickness fraction of hemiplegic side was extremely diminished when contrasted with the healthy control and non-hemiplegic side (p < 0.05). We respectively compared the diaphragm mobility under deep breath on the hemiplegic and non-hemiplegic side of patients with left and right hemiplegia and found there was no significant difference between the hemiplegic side of right and left hemiplegia (p > 0.05), but the non-hemiplegic side of right hemiplegia was significantly weaker than that of left hemiplegia patients (p < 0.05). The diaphragm mobility of stroke patients under quiet breath was positively correlated with age and FMA Scale score (R2 = 0.296, p < 0.05), and significant positive correlations were found between the diaphragm mobility under deep breath and Berg Balance Scale score (R2 = 0.11, p < 0.05), diaphragm thickness at end-inspiratory and FMA Scale score (R2 = 0.152, p < 0.05), and end-expiratory thickness and FMA Scale score (R2 = 0.204, p < 0.05). Conclusions: The mobility and thickness fraction of the hemiplegic diaphragm after stroke by diaphragm ultrasonography were significantly reduced during deep breathing. Diaphragm mobility on bilateral sides of the right hemiplegia patients were reduced during deep breathing. Moreover, the hemiplegic diaphragmatic function was positively correlated with extremity motor and balance function of the hemiplegia patients.

Diaphragm Dysfunction after Cardiac Surgery: Insights from Ultrasound Imaging during Cardiac Rehabilitation.

Diaphragm dysfunction is common after cardiac surgery and can be evaluated with ultrasonography (US). We aimed at assessing with US the incidence of diaphragmatic dysfunction and the impact of cardiovascular rehabilitation (CR) on its recovery. A single-center cohort study was performed. Patients were enrolled after cardiac surgery. The 6-min walking test (6MWT) and diaphragm US were performed at CR admission and after 10 rehabilitative sessions. One hundred eighty-five patients were eligible for final analysis. One hundred thirty-one patients (70.8%) were found to have diaphragm dysfunction (excursion <2 cm). After CR, 68 patients regained normal diaphragmatic function; those with persistent dysfunction had a lower level of functional performance on the 6MWT (metabolic equivalents of tasks: 3.3 vs. 3.6, p =0.013). The patients who underwent combined surgery (adjusted odds ratio [aOR]=4.09, p=0.001) and those with post-operative pneumothorax (aOR=3.02, p=0.042) were at increased risk of failure to improve diaphragmatic excursion. US parameters were more powerful tools in predicting diaphragmatic evolution compared with the 6MWT indexes: baseline diaphragm excursion and thickening fraction were associated with complete diaphragmatic functional recovery after CR (aOR=9.101, p < 0.001, and aOR=1.058, p=0.020 respectively). US is a valuable tool for the assessment of post-operative diaphragmatic dysfunction and can identify patients at risk of diaphragmatic recovery failure.

Диафрагмальная дисфункция среди детей на искусственной вентиляции легких: проспективное обсервационное когортное исследование

Актуальность. Искусственная вентиляция легких (ИВЛ) может приводить к повреждению диафрагмы, которое называют вентилятор-индуцированной диафрагмальной дисфункцией и связывают с неблагоприятными результатами лечения, длительным отлучением от респираторной терапии и длительным пребыванием в отделении интенсивной терапии. Целью нашего исследования было установить распространенность диафрагмальной дисфункции среди детей в зависимости от стратегии ИВЛ. Рабочей была гипотеза, что возникновение диафрагмальной дисфункции не зависит от стратегии проведения ИВЛ. Материалы и методы. Нами проведено проспективное когортное одноцентровое исследование в отделении анестезиологии с койками интенсивной терапии КНП «Львовская областная детская клиническая больница «ОХМАТДЕТ». В исследование включали пациентов с острой дыхательной недостаточностью, требующих ИВЛ более 3 суток. Критериями исключения из исследования были: отказ законных представителей пациента от участия в исследовании на любом из его этапов, агональное состояние пациента при поступлении на лечение. В исследование были включены 89 пациентов в возрасте от 1 мес. до 18 лет. Все пациенты были разделены случайным образом на 2 группы (с помощью сервиса random.org). В I группу вошли пациенты, у которых применяли легочно-протективную стратегию ИВЛ, во II группу — пациенты, у которых применяли легочно-протективную и диафрагм-протективную стратегии ИВЛ. В анализ данных включены 82 пациента. Для оценки показателей, зависящих от возраста, пациенты были разделены на возрастные подгруппы: 1-я подгруппа — дети в возрасте 1 мес. — 1 год; 2-я подгруппа — дети 1–3 лет; 3-я подгруппа — дети 3–6 лет; 4-я подгруппа — дети 6–13 лет; 5-я подгруппа — дети 13–18 лет. Этапы исследования: 1-е сутки (d1), 3-и сутки (d3), 5-е сутки (d5), 7-е сутки (d7), 9-е сутки (d9), 14-е сутки (d14), 28-е сутки (d28). В обеих группах пациентов изучали: изменения амплитуды движений диафрагмы в ходе исследования; контрактильные свойства диафрагмы с помощью определения фракции ее истончения и динамику в ходе исследования; рассматривали снижение данного показателя менее 15 % как маркер диафрагмальной слабости; повышение его более 35 % как маркер высокой работы дыхания и потенциально повреждающий фактор для диафрагмы; время вдоха по ультразвуковым данным; мониторировали показатели кислотно-щелочного равновесия крови и параметры искусственной вентиляции легких. Результаты. Нами выявлены специфические возрастные особенности: среди пациентов 1-й возрастной подгруппы в І группе мы регистрировали слабость правого купола диафрагмы с компенсаторным чрезмерным сокращением левого купола в начале отлучения и на этапе d9, тогда как во II группе эпизод чрезмерной работы диафрагмы был зарегистрирован только на этапе d5. Среди пациентов 2-й возрастной подгруппы I группы изменения были диаметрально противоположными по сравнению с 1-й возрастной подгруппой — преобладала чрезмерная работа правого купола с низкими показателями сокращения левого купола на всех этапах исследования, тогда как во II группе был зарегистрирован эпизод диафрагмальной слабости на этапе d3. В 3-й возрастной подгруппе достоверно позже восстанавливалась надлежащая диафрагмальная активность в І группе пациентов по сравнению со II группой. В 4-й возрастной подгруппе среди пациентов I группы отмечен эпизод высокой работы диафрагмы на этапе d5, тогда как во II группе все показатели были в пределах, рекомендованных диафрагм-протективной стратегией. В 5-й возрастной подгруппе в І группе достоверно чаще регистрировали чрезмерную работу как правого, так и левого куполов диафрагмы, во II группе были эпизоды как диафрагмальной слабости, так и чрезмерной ее работы. Использование в комплексе интенсивной терапии диафрагм-протективной стратегии при проведении отлучения от ИВЛ позволило снизить продолжительность ИВЛ: у пациентов 1-й возрастной подгруппы — в 1,5 раза (p = 0,08); у пациентов 2-й возрастной подгруппы — в 2,4 раза (p = 0,18); в 4-й возрастной подгруппе — в 1,75 раза (p = 0,1); в 5-й возрастной подгруппе — в 4,25 раза (p = 0,009). У пациентов 3-й возрастной подгруппы продолжительность ИВЛ возросла в 1,1 раза (p = 0,68). Выводы. Распространенность и разнообразие проявлений диафрагмальной дисфункции зависят от стратегии проведения механической вентиляции легких. Комплексный подход на этапе отлучения от респираторной терапии, включающей проведение диафрагм-протективной стратегии ИВЛ, позволяет уменьшить инцидентность возникновения дисфункции диафрагмы и снизить продолжительность отлучения от ИВЛ.

Diaphragm Dysfunction After Cardiac Surgery: Reappraisal

The aim of this study was to re-investigate the incidence, risk factors, and outcomes of postoperative diaphragmatic dysfunction (DD) with actual cardiac surgery procedures. Single-center, retrospective, observational study based on a prospectively collected database. Tertiary care cardiac surgery center. Patients who underwent cardiac surgery between January 2016 and September 2019. None. The DD group included patients with clinically perceptible diaphragmatic paralysis, which was confirmed by chest ultrasound (amplitude of the diaphragm movement in time-motion mode at rest, after a sniff test). The primary endpoint was the incidence of DD. Among 3,577 patients included, the authors found 272 cases of DD (7.6%). Individuals with DD had more arterial hypertension (64.3% v 52.6%; p < 0.0001), higher body mass index (BMI) (28 [25-30] kg/m2v 26 [24-29] kg/m2; p < 0.0002), and higher incidence of coronary bypass grafting (CABG) (58.8% v 46.6%; p = 0.0001). DD was associated with more postoperative pneumonia (23.9% v 8.7%; p < 0.0001), reintubation (8.8% v 2.9%; p < 0.0001), tracheotomy (3.3% v 0.3%; p < 0.0001), noninvasive ventilation (45.6% v 5.4%; p < 0.0001), duration of mechanical ventilation (five [four-11] hours v four [three-six] hours; p < 0.0001), and intensive care unit and hospital stays (14 [11-17] days v 13 [11-16] days; p < 0.0001). In multivariate analysis, DD was associated with CABG (odds ratio [OR] 1.9 [1.5-2.6]; p = 0.0001), arterial hypertension (OR 1.4 [1.1-1.9]; p = 0.008), and BMI (OR per point 1.04 [1.01-1.07] kg/m2; p = 0.003). The incidence of symptomatic DD after cardiac surgery was 7.6%, leading to respiratory complications and increased ICU stay. CABG was the principal factor associated with DD.

DIAPHRAGMATIC MYOTRAUMA IN CHILDREN WITH ACUTE RESPIRATORY FAILURE

The aim of the study was to establish the prevalence of diaphragmatic dysfunction (DD), depending on the strategy of mechanical ventilation (MV). Materials and methods. We completed the prospective single-center cohort study. Data analysis included 82 patients (1 month – 18 years old), divided into I group (lung-protective MV) and II group (diaphragm-protective in addition to lung-protective MV). Patients were divided into age subgroups. Stages of the study: 1st day (d1), 3rd (d3), 5th (d5), 7th (d7), 9th (d9), 14th (d14), 28th (d28). We studied amplitude of diaphragm movement; thickening fraction, parameters of acid-base balance and MV. Results are described as median [IQR - interquartile range] with level of significance p. Results. In patients of the 1st age subgroup in I group there were episodes with under-assist during MV, while in II group diaphragm overload was registered only on d5. In patients of 2nd subgroup in I group we found over-assist of MV with excessive work of the right hemidiaphragm and low contractions of left dome at all stages of study, while in II group – the only episode of diaphragmatic weakness on d3 due to under-assist of MV. In the 3rd subgroup the proper diaphragmatic activity in I group was restored significantly later than in II group. In 4th subgroup of I group there was episode of high work of diaphragm on d5, whereas in II group – all data were within the recommended parameters for diaphragm-protective strategy of MV. In 5th subgroup of I group excessive work of both right and left domes of diaphragm was significantly more often registered than in II group, however, in II group there were found episodes of both type changes – diaphragmatic weakness and excessive work. Conclusion: The prevalence and variety of manifestations of DD depend on the strategy of MV. Low incidence of DD was associated with lower duration of MV: in 1st age subgroup in 1.5 times; in 2nd age subgroup – in 2.4 times; in 4th age subgroup – in 1.75 times; in 5th age subgroup – in 4.25 times.