Table 3. Relevant studies about the use of diaphragmatic ultrasound in critical care.
| Authors | n | Setting | Measurement | Cutoff/Correlate |
|---|---|---|---|---|
| Predicting weaning outcome - TF | ||||
| DiNino et al. 46 | 63 | Medical ICU | TF during SBT (PSV [5] or T tube) | Cutoff for TF: > 30% |
| Jung et al. 43 | 33 | Medical and Surgical ICU | TF during SBT (PSV [5] or T tube) Only patients with ICUAW |
Cutoff for TF: > 20% |
| Dres et al. 40 | 76 | Medical ICU | TF during SBT on PSV | Cutoff for TF: > 29% |
| Blumhof et al. 61 | 56 | Medical ICU | TF during SBT on PSV (5,10, and 15) | Cutoff for TF: > 20% |
| Farghaly et al. 62 | 54 | Respiratory ICU | TF during SBT on PSV (8) | Cutoff for TF: > 34% |
| Dres et al. 63 | 76 | Medical ICU | TF and PtrStim a few minutes before SBT SBT on PSV (7), ZEEP |
Cutoff for TF: > 25.8% PtrStim > 7.2 cm |
| Predicting weaning outcome - DE | ||||
| Jiang et al. 53 | 55 | Medical ICU | DE during SBT on PSV or T tube | Cutoff for DE: 1.1 cm |
| Kim et al. 13 | 82 | Medical ICU | DE during SBT on PSV or T tube | Cutoff for DE: 1.0 cm |
| Spadaro et al. 54 | 51 | Medical ICU | DE during SBT (not clear) | Cutoff for DE: 1.4 cm |
| Dres et al. 40 | 76 | Medical ICU | DE during SBT on PSV | Cutoff for DE: 0.95 cm |
| Farghaly et al. 62 | 54 | Respiratory ICU | DE during SBT on PSV | Cutoff for DE: 1.05 cm |
| Assessing atrophy during MV | ||||
| Grosu et al. 52 | 7 | Medical ICU | Tdi-exp measured daily since intubation | Tdi-exp ⇓ 6%/day of MV |
| Goligher et al. 12 | 107 | Medical ICU | Tdi-exp and TF measured daily since intubation until 72 h of MV -Tdi-exp ⇓ = Tdi-exp reduction > 10% - Tdi-exp ⇑ = Tdi-exp increase > 10% |
Tdi-exp in 44%; Tdi-exp ⇑ in 12% Low TF correlated with ⇓ in Tdi-exp High TF correlated with ⇑ in Tdi-exp. TF ⇓ with ⇑ driving pressure and CMV |
| Schepens et al. 15 | 54 | Medical ICU | Tdi-exp measured during first 24 h of MV, and daily after | Tdi-exp ⇓ ≈32% at the nadir MV duration associated with atrophy |
| Zambon et al. 18 | 40 | Medical ICU | Tdi-exp measured daily since intubation during SB or CPAP High PSV (5-12) Low PSV (> 12): CMV |
Tdi-exp ⇓ ≈7.5%/day on CMV Tdi-exp ⇓ ≈5,3%/day on high PSV Tdi-exp ⇓ ≈1.5%/day at low PSV Tdi-exp ⇑ ≈2.3%/day in SB/CPAP |
| Goligher et al. 64 | 211 | Medical ICU | Tdi-exp and TF measured daily since intubation until 72h of MV Inspiratory effort → TF Tdi-exp ⇓ = Tdi-exp reduction > 10% Tdi-exp ⇑ = Tdi-exp increase > 10% |
Tdi-exp ⇓ in 41%; Tdi-exp in 24% Tdi-exp ⇓ associated with ⇑ MV, ICU admission and ⇑ risk of complications Tdi-exp ⇑ predicted ⇑ MV ⇓ Tdi-exp correlated with low inspiratory effort ⇑ Tdi-exp was related to excessive effort TF (15-30%) → shortest duration of MV |
| Assessing DD | ||||
| Lerolle et al. 14 | 28 | Adult cardiac ICU | DE, Pdi, and Gilbert index Severe DD = best DE < 25 cm MV > 7 days |
Best DE < 25 correlated with Gilbert index < 0 |
| Kim et al. 13 | 82 | Medical ICU | During SBT on PSV or T tube MV > 48 h |
DD in 24 (29%) DE < 1.0 cm predicted weaning outcome |
| Valette et al. 48 | 10 | Medical ICU | DE during unassisted breathing DD = paradoxical or absent excursion, or DE < 1.0 cm |
DD in 10 patients High mortality rate (60%) of patients with DD and ARF |
| Mariani et al. 49 | 34 | Medical ICU | DE during SBT on T tube DD = DE <1.0 cm MV > 7 days and SBT eligible |
DD in 13 (38%) Bilateral DD in 8 Unilateral (left/right side) DD = 3/2 |
| Lu et al. 50 | 41 | Medical ICU | TF during SBT on PSV only patients with prolonged MV DD = TF < 20% |
DD prevalence in 14 (34.1%). DE < 1.0 cm predicted weaning outcome |
| Dubé et al. 45 | 112 | Medical ICU | PtrStim, TF and DE measured during first < 24 h of MV or during ACV or at switch to PSV DD = PtrStim <11 cmH2O |
TF and DE correlated with PtrStim at switch to PSV, but not at initiation of MV TF < 29% identified DD TF < 29% was associated with ⇑ ICU-LOS, ⇑ MV duration, and ⇑ mortality |
TF: thickening fraction; PSV: pressure-support ventilation (numbers in parentheses/brackets are cmH2O); SBT: spontaneous breathing trial; ICUAW: ICU-acquired weakness; PtrStim: tracheal pressure in response to phrenic nerve stimulation; ZEEP: zero end-expiratory pressure; DE: diaphragmatic excursion; Tdi-exp: diaphragm thickness at end-expiration; MV: mechanical ventilation; CMV: controlled mechanical ventilation; SB: spontaneous breathing; CPAP: continuous positive airway pressure; DD: diaphragmatic dysfunction; Pdi: transdiaphragmatic pressure; ARF: acute respiratory failure; ACV: assist-control ventilation; and LOS: length of stay.