A preliminary study on the evaluation of diaphragm function by ultrasound in patients with invasive mechanical ventilation / 中华内科杂志

ABSTRACT

Objectives:To study the feasibility of using ultrasound to evaluate diaphragm function in patients with invasive mechanical ventilation.Methods:From March to December 2017, 40 adult patients with acute respiratory distress syndrome who were admitted to the Department of Critical Care Medicine, Xiangya Hospital, Central South University for more than 48 hours were included. Diaphragmatic excursion and thickness of bilateral anterior, middle and posterior parts were measured by ultrasound for 5 consecutive days.Results:(1) Compared with the diaphragmatic excursion of the right [anterior (11.05±3.04) mm; middle (12.08±2.71) mm; posterior (11.51±3.33) mm] and left [anterior (13.63±7.52) mm; middle (15.44±7.52) mm; posterior (14.76±6.93) mm] sides on day 1, the diaphragmatic excursion of the right [anterior (8.90±3.65) mm; middle (10.02±4.24) mm; posterior (10.25±4.38) mm] and left [anterior (9.82±1.96) mm; middle (11.60±1.13) mm; posterior (11.52±1.98) mm] sides decreased significantly on day 3 ( P<0.05). Bilateral anterior, middle and posterior diaphragmatic excursion recovered on day 5, and was higher than the baseline levels on day 1, with the left middle and posterior diaphragmatic excursion changing most significantly. (2) Compared with day 1, 2, 3, the thickening fraction of bilateral anterior, middle and posterior diaphragm were significantly decreased on day 4, with the left middle part [day 1 (33.87±14.34)%; day 2 (37.26±13.91)%; day 3 (30.56±14.27)%; day 4 (15.53±5.68)%] and the left posterior part [day 1 (35.50±15.69)%; day 2 (39.84±15.32)%; day 3 (29.06±14.96)%; day 4 (13.30±5.79)%] changing most significantly ( P<0.05). The thickening fractions of left anterior, middle and posterior diaphragm recovered on day 5 compared with that on day 4, but still lower than those on day 1 ( P<0.05). Conclusions:It is feasible to evaluate the diaphragm function in patients with invasive mechanical ventilation by ultrasound, which can provide guidance for preventing diaphragmatic atrophy and withdrawing from mechanical ventilation.