RT Journal Article
SR Electronic
T1 Ultrasound shear wave elastography for non-invasive assessment of diaphragm activity in mechanically ventilated patients.
JF ERJ Open Research
JO erjor
FD European Respiratory Society
SP 19
DO 10.1183/23120541.RFMVC-2020.19
VO 6
IS suppl 4
A1 Quentin Fossé
A1 Thomas Poulard
A1 Jean Yves Hogrel
A1 Jean Luc Gennisson
A1 Thomas Similowski
A1 Alexandre Demoule
A1 Marie Cécile Niérat
A1 Damien Bachasson
A1 Martin Dres
YR 2020
UL http://openres.ersjournals.com/content/6/suppl_4/19.abstract
AB Introduction: Mechanical ventilation is a life-saving treatment that is however associated with diaphragm dysfunction. The optimal ventilator settings providing a lung protective ventilation while maintaining a safe diaphragm activity are difficult to determine. A noninvasive and bedside evaluation of the diaphragm activity could be helpful. We investigated whether changes in diaphragm stiffness (ΔSMdi) assessed using ultrasound shear wave elastography (SWE) may be used as a surrogate of changes in transdiaphragmatic pressure (ΔPdi) in mechanically ventilated (MV) patients.Methods: Pdi was continuously monitored using esophageal and gastric balloons and SMdi was measured at the zone of apposition of the right hemi-diaphragm. Measurements were performed twice under initial ventilator settings and every five minutes during a spontaneous breathing trial (SBT). Pearson correlation coefficient (r) were used to determine within-individual and overall relationships between Pdi and SMdi.Results: Among the 25 patients enrolled, 8 displayed a significant ΔSMdi-ΔPdi correlation (r=0.62-0.88, p<0.05). Compared to others, patients with significant correlations had a lower respiratory rate (16±5 vs 24±6 breath/min, respectively; p<0.01) and a significant increase in ΔSMdi between initial ventilator settings and the SBT. Patients without ΔSMdi-ΔPdi correlation only had an increase in ΔPdi during the SBT with no concomitant increase in ΔSMdi.Conclusion: SMdi obtained by SWE appears as a promising technique to assess diaphragm activity in MV patients. Technological improvements are necessary to increase SWE sampling rate before enabling its generalization in the ICU.FootnotesCite this article as: ERJ Open Research 2020; 6: Suppl. 4, 19.This is an ERS Respiratory Failure and Mechanical Ventilation Conference abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).