Quantification of diaphragmatic dynamic dysfunction in septic patients by bedside ultrasound

Yunqiu Chen, Yujia Liu, Mingxin Han, Shuai Zhao, Ya Tan, Liying Hao, Wenjuan Liu, Wenyan Zhang, Wei Song, Mengmeng Pan, Guangyu Jiao, Yunqiu Chen, Yujia Liu, Mingxin Han, Shuai Zhao, Ya Tan, Liying Hao, Wenjuan Liu, Wenyan Zhang, Wei Song, Mengmeng Pan, Guangyu Jiao

Abstract

Although diaphragmatic dysfunction is an important indicator of severity of illness and poor prognosis in ICU patients, there is no convenient and practical method to monitor diaphragmatic function. This study was designed to analyze diaphragmatic dynamic dysfunction by bedside ultrasound in septic patients and provide quantitative evidence to assess diaphragm function systematically. This prospective observational study was conducted from October 2019 to January 2021 in the Department of Respiratory and Critical Care Medicine. 74 patients suffered from sepsis were recruited and divided into two groups, sepsis group 1 (2 ≤ SOFA ≤ 5, n = 41) and sepsis group 2 (SOFA > 5, n = 33). 107 healthy volunteers were randomly recruited as the control group. In all participants, the diaphragmatic thickness and excursion were measured directly and the dynamic parameters including thickening fraction (TF), EQB/EDB, Contractile velocity, and area under diaphragmatic movement curve (AUDMC) were calculated by bedside ultrasound during quiet breathing (QB) and deep breathing (DB). Each parameter among three groups was analyzed separately by covariance analysis, which was adjusted by age, sex, body mass index, MAP, hypertension, and diabetes. First, contractile dysfunction occurred before diaphragmatic atrophy both in sepsis group 1 and sepsis group 2. Second, compared with the control group, the dynamic parameters showed significant decrease in sepsis group 1 and more obvious change in sepsis group 2, including TF, EQB/EDB. Third, the maximum contractile velocity decreased in sepsis group 1, reflecting the damage of intrinsic contraction efficiency accurately. Finally, per breathing AUDMC in two septic groups were lower than those in control group. However, per minute AUDMC was compensated by increasing respiratory rate in sepsis group 1, whereas it failed to be compensated which indicated gradual failure of diaphragm in sepsis group 2. Diaphragmatic ultrasound can be used to quantitatively evaluate the severity of sepsis patients whose contractile dysfunction occurred before diaphragmatic atrophy. As dynamic parameters, TF and EQB/EDB are early indicator associated with diaphragmatic injury. Furthermore, maximum contractile velocity can reflect intrinsic contraction efficiency accurately. AUDMC can evaluate diaphragmatic breathing effort and endurance to overcome resistance loads effectively.

Conflict of interest statement

The authors declare no competing interests.

© 2022. The Author(s).

Figures

Figure 1
Figure 1
Diaphragmatic thickness measured by B mode ultrasound at end-expiration (A1) and end-maximum inspiration (A2). Diaphragmatic mobile curve in M mode of ultrasound was shown during quiet breathing (B1) and deep breathing (B2). Parameters were measured at three consecutive breathing cycles. EQB, excursion during quiet breathing; EDB, excursion during deep breathing; TI, inspiratory time; AUDMC, area under diaphragmatic movement curve in the inspiratory phase. Contractile velocity: diaphragmatic excursion/inspiratory time.
Figure 2
Figure 2
Diaphragmatic thickening fraction (A), EQB/EDB (B), excursion during quiet breathing and deep breathing (C). *P < 0.05 compared with control group; †P < 0.05 compared with sepsis group 1.
Figure 3
Figure 3
AUDMC during quiet breathing (A), AUDMC during deep breathing (B), AUDMC in per minute (C), Diaphragm contractile velocity (D). *P < 0.05 compared with control group; †P < 0.05 compared with sepsis group 1.

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