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Usefulness of Parasternal Intercostal Muscle Ultrasound during Weaning from Mechanical Ventilation
- Source :
- Anesthesiology, Anesthesiology, 2020, 132 (5), pp.1114-1125. ⟨10.1097/ALN.0000000000003191⟩, Anesthesiology, Lippincott, Williams & Wilkins, 2020, 132 (5), pp.1114-1125. ⟨10.1097/ALN.0000000000003191⟩
- Publication Year :
- 2020
-
Abstract
- Background The assessment of diaphragm function with diaphragm ultrasound seems to bring important clinical information to describe diaphragm work and weakness. When the diaphragm is weak, extradiaphragmatic muscles may play an important role, but whether ultrasound can also assess their activity and function is unknown. This study aimed to (1) evaluate the feasibility of measuring the thickening of the parasternal intercostal and investigate the responsiveness of this muscle to assisted ventilation; and (2) evaluate whether a combined evaluation of the parasternal and the diaphragm could predict failure of a spontaneous breathing trial. Methods First, an exploratory evaluation of the parasternal in 23 healthy subjects. Second, the responsiveness of parasternal to several pressure support levels were studied in 16 patients. Last, parasternal activity was compared in presence or absence of diaphragm dysfunction (assessed by magnetic stimulation of the phrenic nerves and ultrasound) and in case of success/failure of a spontaneous breathing trial in 54 patients. Results The parasternal was easily accessible in all patients. The interobserver reproducibility was good (intraclass correlation coefficient, 0.77 (95% CI, 0.53 to 0.89). There was a progressive decrease in parasternal muscle thickening fraction with increasing levels of pressure support (Spearman ρ = −0.61 [95% CI, −0.74 to −0.44]; P < 0.0001) and an inverse correlation between parasternal muscle thickening fraction and the pressure generating capacity of the diaphragm (Spearman ρ = −0.79 [95% CI, −0.87 to −0.66]; P < 0.0001). The parasternal muscle thickening fraction was higher in patients with diaphragm dysfunction: 17% (10 to 25) versus 5% (3 to 8), P < 0.0001. The pressure generating capacity of the diaphragm, the diaphragm thickening fraction and the parasternal thickening fraction similarly predicted failure or the spontaneous breathing trial. Conclusions Ultrasound assessment of the parasternal intercostal muscle is feasible in the intensive care unit and provides novel information regarding the respiratory capacity load balance. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New
- Subjects :
- Adult
Male
medicine.medical_specialty
Weakness
Intraclass correlation
medicine.medical_treatment
[SDV]Life Sciences [q-bio]
Diaphragm
Intercostal Muscles
Spontaneous breathing trial
03 medical and health sciences
Young Adult
0302 clinical medicine
Internal medicine
medicine
Humans
Ultrasonography, Interventional
Mechanical ventilation
business.industry
Ultrasound
030208 emergency & critical care medicine
Respiration, Artificial
Diaphragm (structural system)
[SDV] Life Sciences [q-bio]
Anesthesiology and Pain Medicine
medicine.anatomical_structure
030228 respiratory system
Parasternal line
Cardiology
Female
medicine.symptom
business
Ventilator Weaning
Intercostal muscle
Subjects
Details
- ISSN :
- 15281175 and 00033022
- Volume :
- 132
- Issue :
- 5
- Database :
- OpenAIRE
- Journal :
- Anesthesiology
- Accession number :
- edsair.doi.dedup.....9a6660442bb8f9c2822f3edc6165c6f0